Long Covid - what's the prevalence and prognosis?

I broke out a discussion on long covid from the breaking news thread. I’m interested in seeing more info on this.

Continuing the discussion from Coronavirus COVID-19 (2019-nCoV) Thread - 2021 Breaking News:

I also just posted in another thread that a coronavirus vaccine may give some people relief from long covid.

I haven’t had COVID (baruch HaShem), but I get a lot of bacterial sinus infections, and if I don’t get into the doctor right away, I can get a lingering bronchitis. I may be absent all other symptoms, but cough for a month. The first time it happened I was in training with the military, and was trying to “suck it up,” and assumed I just had a cold anyway, until it didn’t go away for two weeks, and I was having trouble breathing on runs.

The medic ended up giving me an inhaler for the cough, but what really helped was an OTC cough suppressant, dextromethorphan. Later, I discovered that the Rx cough suppressant tessalon works even better, but insurance doesn’t like to pay for it.

Nothing about this aspect of COVID surprises me at all.

To your point, any potentially life-threatening illness can have long-term consequences. As an example, patients who survive a bout of sepsis (which can be a complication of severe flu) report symptoms months later and may have some form of long-term impairment.

What’s worrisome about COVID is that complications seem to present in a variety of ways, some of which are unexpected and result from cases that might have initially appeared to be only moderate.

My 58 year old cousin from Texas had Covid in November and was hospitalized for 4 days. He was sent home on oxygen and needed it for almost 10 weeks. Still not 100% back to his old self. He was a anti-masker before but he is now totally about people wearing mask.

The havoc a virus does to the host aka survivor varies - for young people, their pancreases are compromised with this SARs virus, and we’ll see more diabetes, later. It’s kinda like finding out you have a heart murmur from rheumatic fever, later. With time, the other effects will reveal themselves. I disagree with NPR about liver cirrhosis being a side effect from this virus because people choose to drink more, though - so perhaps defining effects would be necessary as a starting point.

I had probable Covid last April (semi-serious but no breathing difficulties and not close to needing hospitalisation) and I still feel compromised with the occasional fuzzy head feeling - I have it as I type this now. But I agree that it’s very difficult to know what is just a general symptom and what might be related to Covid. After my vaccine I had muscle aches for nearly three weeks. It’s been nearly a year since I got those first symptoms, I really hope these echoes of my symptoms go away eventually.

Still figuring out prevalence and prognosis here. My daily patient schedule has had 1 or 2 PACS patients a day. Not surprising, since 80% of my patients have tested + for covid. Not much to do other than treat symptoms thus far. Nor much solid data on how long it’ll last. I’ve got patients who had it 7 months ago, are still dragging, aching, short of breach with exertion, and mentally fuzzy

That could be an artifact of the medications used. Sepsis may be bacterial and would be treated with massive infusions of industrial-strength antibiotics. Fluoroquinolones like Ciprofloxacin are a common choice, and these can cross the blood-brain barrier and do severe and largely irreversible neurological (both peripheral and CNS) damage.

Some good news.

US health agency will invest $1 billion to investigate ‘long COVID’

The National Institutes of Health will fund researchers to track people’s recovery, and will host a biospecimen bank.

The UK is also investing into research on long covid.

Do you have patients who took months to feel better, but eventually shook it - or once you’ve spent MONTHS with long Covid it seems to be as far as you can tell right now, a chronic condition?

Rebecca Watson correctly noted a potential issue. Since the effects are nonspecific and vague, they are the prime candidate for quack medicine. She predicted it six months ago, and found Gwyneth Paltrow preying on victims recently.

Original video:

Paltrow callout:

Too soon to tell whether it’ll turn into a chronic problem. I’ve some folks who felt horrible for 6 months but are almost back to normal, per their subjective opinions. Others aren’t there yet. Saw one today who is 5 months out and dragging, but feels maybe 10% better than a month ago.

So - subjectively - there is some hope for these folks.

I have a good friend with it - he’s four or five months into it at this point. He’s been making steady progress getting over it but still has good and bad days. Early on, he couldn’t even sit up at his computer for long periods of time. Now he can walk about a mile before pooping out.

He recently had a battery of lung and heart tests and everything came back good. He’s hopeful that he’s on an upswing, and also that when he gets the vaccine it will help, as it appears to with some people.

There is no current treatment or even a real understanding of “long COVID”, or even a real understanding of whether this is all different facets of one syndrome or an umbrella for a bunch of different effects. It is going to be an area for research for years if not decades (especially if SARS-CoV-2 ends up being endemic in the population) and some types of damage, like scarring of pleura and loss of alveoli due to sarcoidosis are essentially irreparable, as his myocardial damage that has been observed in a small minority of patients. Hopefully someone figures out what is causing this damage and effective treatments for it, but it is concerning and a reason to continue to be cautious even after vaccination.


Yeah, this.

Some of my patients who are still feeling sick and tired over 4 months after have normal labwork, normal EKGs, Chest x-rays, etc. Others have mildly to moderately elevated muscle enzymes, others have eletrolytes just a bit off their previous normal readings, etc. Nothing to hang one’s hat on, just a wide ranging cluster of varied symptoms with a few physical and lab signs.

Frustrating all around

One thing I’ve need wondering and haven’t really found a definitive answer to is are their other pathogens that cause this diverse range of sequelae? Poliomyelitis can cause post-polio syndrome (PPS) which can have an array of symptoms including fatigue, cardiopulmonary issues, sleep apnea, palsy, and of course muscular atrophy and partial paralysis (in addition to the dramatic paralysis and neurological issues resulting from primary infection) but these are all associated with viral effects on the nervous system.

It took months for the CDC and medical authorities to acknowledge that SARS-CoV-2 is not ‘just’ a disease of the respiratory system and that it can and does infect the peripheral nervous system (which should have been evident from the symptom of anosmia) and it seems that a number of medical authorities are still asserting that “COVID brain fog” and various reported mental and emotional issues like depression, anxiety, confusion, and dementia are just a result of fatigue and/or the social restrictions resulting from pandemic lockdown measures, but the wide diversity of different, often independent symptoms of post-infection sequelae seem almost unique in medical annals. It makes me wonder how much of various mental illness and ‘chronic fatigue syndrome’ issues might actually be attributable to undetected or undiagnosed infections by what are often viewed as simple respiratory viruses which actually have longer term effects.

Anyway, I’m just curious if you have any insights or thoughts on this.


This is so important because the people who are advocating that everything open back up are sometimes doing so on the premise that the shutdowns are affecting people’s mental health. But what if opening up leads to more covid cases that leads to even bigger mental health issues over a longer and maybe indefinite amount of time.

Is there a method of testing for vascular damage? I’ve read that COVID can havoc on blood vessels. I’m guessing this has been looked into but just wondering if this is the sort of thing that would appear in a normal battery of lab testing

It’s being looked into but there’s no easy test to assess for vascular damage. Catheterizations might show some specific lesions, along with certain less invasive imaging angiography, but those aren’t tests you do blithely as they have a certain degree of risk. Nor are they meant to diagnose general vasculitis.

I can and do look for vasculitis signs, like skin purpura and limb ischemia, but those are general signs and honestly I’ve not been seeing them on my patients. Blood cell counts have been mostly normal, as have been the coagulation studies.