Millions of people around the world have already survived COVID-19. Clinicians are now learning how cases can trigger lasting consequences for the body. Joseph R. Berger, MD, a professor of Neurology, Benjamin Abramoff, MD, an assistant professor of Clinical Physical Medicine and Rehabilitation, and Robert M. Kotloff, MD, a professor in Pulmonary, Allergy, and Critical Care Medicine and director of the Harron Lung Center, were quoted discussing the long-term impacts of the coronavirus.
1. Difficulty Swallowing
The doctors have broken up long haulers into three categories based on their initial illness. The first involves the most serious cases. "These are patients who have been in the ICU on mechanical ventilation, those patients who have had a prolonged course of critical illness," Robert Kotloff of Penn's Harron Lung Center. "We call this post-intensive care syndrome." The first prolonged symptom experienced by this group is that they have trouble swallowing, likely due to being hooked up to a ventilator.
2. Profound Weakness
Some patients in this group do not regain their strength, and instead suffer profound weakness for months on end.
3. Slow Recovery of Lung Function
This group also struggles when it comes to the recovery of their damaged lungs, making it difficult to breathe. Pulmonary difficulties are not uncommon when an individual is in recovery from a serious respiratory virus.
4. Psychological Issues
The last common symptom of the first group has to do with the brain. Berger describes the "strange phenomena" of patients he has seen who report neurological symptoms—including confusion and behavioral changes—post-COVID infection, sometimes accompanying headaches and dizziness. "It may be some sort of structural damage to the brain we're not able to see," he says. "We haven't seen anything major on imaging studies and even spinal fluid examinations have not been terribly revealing."
5. Shortness of Breath
The second group also experienced a serious form of COVID-19—including pneumonia—and were either treated at the hospital or at home, but were never considered critically ill. However, they appear to be sustaining long-term lung damage and inflammation as a result. The first way this manifests itself is via shortness of breath.
6. Persistent Shadows on Chest X-Rays
Once x-rays are conducted on these patients, persistent shadows are usually found, signifying the damage. "The question in my mind is, do we watch and wait or would some of these patients benefit from corticosteroids," says Kotloff.
7. Profound Fatigue Plus Shortness of Breath
The third category, accounting for the majority of patients treated for long-term COVID, consists of people who suffered mild infections. "These cases are more curious," Kotloff says. "These are patients who had relatively mild infections, not even pneumonia, but come to us later with shortness of breath, and often with profound fatigue, but we can't find anything physiological to account for these symptoms." Abramoff adds that specialists have seen patients who "had a residual cough or residual shortness of breath, or other symptoms like weakness, loss of endurance, or pain."
8. Autoimmune Response
Berger adds that there is another rare, long-term manifestation of the virus he has witnessed—similar to the autoimmune disease Guillain-Barré that attacks the nervous system. "Even though [the coronavirus infection] is an acute insult that doesn't continue, the response to it can leave patients with weakness and other neurological manifestation," he explains. "But fortunately these are small numbers, very small numbers, of patients."
9. Other Organ Damage
The doctors add that a small number of patients have sustained damage to other organs, likely due to complications from the acute phase of the virus—including strokes and other blood clots, kidney failure, and cardiac inflammation. "We had been seeing people in inpatient rehab—pretty much the sickest patients, those with long ICU stays, multi-organ system failure—who had a lot of multidisciplinary needs," says Abramoff.
