What are the long-term effects of COVID-19 on recovered patients?

Dr Vijayant Solanki, Pulmonologist, Aster Medical Centre Al Hilal (Qatar)

Most people who develop COVID-19 experience mild symptoms and recover without treatment. However, a significant number of cases sometimes even after mild illness go on to develop lasting symptoms after the initial recovery. As COVID-19 is a new entity, researchers are still puzzled about its long-term effects. Persistence of symptoms after 3 weeks since onset of symptoms is referred to as 'long COVID' or post-COVID-19 syndrome.

The symptoms, which have been recognized most commonly are fatigue, body aches, and difficulty in breathing, cough and fever may come and go. Other symptoms include confusion, loss of smell and taste, scratchy throat, stomach upset, clotting problems, skin rash and uncontrolled blood sugar in some. Severe COVID patient may in addition have ICU related complication like severe muscle weakness; tremendous psychological impact called post-traumatic stress disorder and decreased functional capacity of lungs and heart. 

Heart: Imaging tests taken months after recovery from COVID-19 have shown lasting damage to the heart muscle, even in people who experienced only mild COVID-19 symptoms. This may increase the risk of heart failure or other heart complications in the future.

Lungs: COVID-19 mainly affects the lungs, it can directly cause damage and also leads to clotting of small vessels supplying and facilitating transport of oxygen. It has been observed that COVID pneumonia on Chest X-ray and CT scan can persist for 5-6 weeks and even more in some cases. Sometimes, there is also a possibility of scarring of lungs called pulmonary fibrosis in cases that have had extensive lung involvement and can lead to serious exercise limitations and difficulty in supply of oxygen to our body.

Brain:  Some people develop non-specific headache dizziness and confusion called "brain fog" accompanied by fatigue and breathlessness. Though rare, COVID-19 cases can cause strokes, seizures and infection of neurons in brain.

Blood vessels: COVID-19 can make blood cells more likely to clump up and form clots. While large clots can cause heart attacks and strokes, much of the heart damage caused by COVID-19 is believed to stem from very small clots that block tiny blood vessels in the heart muscle. COVID-19 can also weaken blood vessels, which contribute to potentially long-lasting problems with the liver and kidneys.

Anxiety & depression: The COVID – 19 virus has already led to diverse mental health problems, including anxiety, depression, PTSD, and other trauma and stress-related disorders.

Muscles: Muscle weakness is also one of the consequence of COVID. It could be due to prolonged bed rest that many COVID patients have to undergo therapy as this virus decreases their power and strength called deconditioning. As we know that many COVID patients receive steroids as part of treatment, it again causes muscle weakness. Muscle weakness may be responsible for tiredness and overall weakness.

Anyone experiencing new or existing symptoms following recovery from COVID-19 should contact their doctor for a post COVID-19 assessment. The doctor can assess the symptoms and, if needed, perform diagnostic tests to check for complications after COVID recovery. They can also to help monitor and manage the symptoms over time. If a person experiences severe or rapidly worsening symptoms, they should seek emergency medical help.

Some of these concerning symptoms are:

Chest pain or high blood pressure

Difficulty in breathing

Continued fatigue

Change in the color of the lips —which may appear blue in people with lighter skin or grey or white in people with darker skin

Inability to stay awake

Inability to keep liquids down

Rapid weight loss or gain

Overall management of post-COVID Syndrome

In majority of people, there are no serious concerns regarding heart, lung, brain or other organ dysfunction, but it may need to be ruled out by a clinical examination, pulse oximetry and certain tests like chest X-ray, CT scan, ECG and some blood tests.

Symptoms can be managed with simple medicines like pain killers.

Fortunately, programmed rehabilitation is emerging, it involves pulmonary rehabilitation in particular, where some breathing exercises are taught in addition to aerobic exercise arm and thigh strengthening.

Sleep hygiene and proper diet and nutrition are ensured and positive attitude is encouraged.