Some people still have long-term sequelae even recovered from COVID-19

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Some people still have long-term sequelae even recovered from COVID-19

Some people still have long-term sequelae even recovered from COVID-19.

“When you are vaccinated, even if you do have a breakthrough infection, there will be enough immune response to prevent long-term symptoms.”

Will Grogan stared blankly at his ninth grade biology class. On this day, they need to review what they learned in the last class, but the contents are completely unfamiliar to him.

“I don’t know what you are talking about,” he blurted out. His teachers and classmates reminded him that in the last class, he was very proficient in answering the teacher’s questions. “I didn’t learn this at all,” he insisted. He acted very confused and frightened the teacher who was going to criticize him.

The 15-year-old Grogan lives in Dallas. He is a very healthy teenager. He plays tennis well and has outstanding academic records. He likes learning languages very much, and he is taking French and Arabic as an elective. But after contracting COVID-19 in October last year, for 35 days, he was too sick to get out of bed. In order to avoid fainting, he could only sit and take a bath.

After he finally recovered, he still showed some physical and neurological symptoms, including severe leg pain, fatigue, and a lump in his brain. This is the so-called long-term sequelae of COVID-19. He described that when he returned to the high school class, he felt that he saw “numbers floating on the paper” in math class, forgot to turn in the history essay that had been written, and inserted some French in an English homework. Fragment.

“The most terrifying thing is,” Grogan said. When he went to the doctor, the doctor’s “answer was, ‘Hey, kid, take it easy. Just rest and rest.’”

In the past few months, epidemiologists have tried to prepare the world for the future of COVID-19. They predict that humans may never return to what they looked like in 2019, but vaccines can allow people to coexist with viruses. After being vaccinated, infection may still occur, serious complications or even death may occur, but in the end, the new coronavirus will be similar to seasonal flu.

But this optimistic view leaves a big problem: In some cases, COVID-19 will cause long-term complications, including dyspnea, fatigue and brain fog, etc., and the symptoms may last for at least several months. It will have a serious impact on patients like Grogan and the whole society.

The sequelae caused by COVID-19 was once dismissed as a legend. Some people believed that it was imaginary, and some believed that patients used it to defraud benefits such as disability benefits. However, more and more first-line doctors and studies have begun to confirm that the sequelae of the COVID-19 true. On August 26, Chinese researchers published online in the well-known “Lancet” magazine the largest study to date to evaluate the sequelae of COVID-19. The conclusion is that nearly half of the patients still have at least one type a year after being discharged from the hospital. Lingering symptoms.

These long-term complications are not unique to the new coronavirus. Other viruses, including seasonal flu, may also cause long-term symptoms. But the problem with COVID-19 is that it is too large. More than 210 million people have been infected worldwide. The number has reached 39 million in the United States alone, and the number is still rising, even though only a small percentage of people have sequelae. There may also be millions of people affected.

Therefore, these problems are particularly urgent: From an individual perspective, if the problem of sequelae really exists, even if the vaccine is unavoidable, then do you need to be more cautious when treating your children when they return to school or work by themselves? ? If COVID-19 causes long-term health problems for a large number of people, causing people to lose the ability to study and work, can the world really treat it as a flu-level disease?

The sequelae of COVID-19 are real

There are still many unsolved mysteries about the sequelae of COVID-19, but through objective data, scientists can already confirm that it does exist.

Scientists at the Scripps Research Translational Institute in California conducted a trial to monitor early symptoms of COVID-19 through wearable devices. Participants agreed to share data from Fitbit wearable devices and submit COVID-19 test results. As a result, researchers report that data shows that the behavioral and physiological changes exhibited by patients with COVID-19 may last for weeks or months.

Of the 875 participants involved in this study, all had fever, cough, body aches, or other symptoms of respiratory diseases. Among them, 234 tested positive for COVID-19. The rest are presumed to have other types of infections.

The researchers found from their data that whether they were infected with COVID-19 or other viruses, participants slept more, walked less, and increased their resting heart rate after falling ill. But these changes are more pronounced in patients with COVID-19.

Scientists also found that about 9 days after participants infected with the new coronavirus first reported symptoms, their heart rate dropped. But after the initial drop, their heart rate rose again, and then continued for several months. This situation is not observed in people with other diseases. On average, it takes 79 days for the resting heart rate of patients with COVID-19 disease to return to the previous normal level, while it only takes 4 days for people in the non-COVID-19 group. Compared with patients with other diseases, the sleep and physical activity levels of patients with COVID-19 disease are also slower to return to baseline levels.

Researchers speculate that this sustained increase in heart rate may be a signal that the new coronavirus has disrupted the autonomic nervous system that regulates basic physiological processes. Many COVID-19 patients have reported that they have symptoms such as palpitations and dizziness, and this study provides objective data support for patients’ subjective symptoms.

How many people will have sequelae of COVID-19?

The real-world evidence surrounding COVID-19 is still accumulating. The limited data so far indicate that 10% to 25% of adults infected with COVID-19 may suffer from long-term sequelae. It should be pointed out that the current related research is very uneven, so this data needs to be treated with caution.

The Dell School of Medicine at the University of Texas at Austin started a project on the sequelae of COVID-19 in July this year. Dr. Michael Broad, the medical director of the project, said, “We still don’t know much about COVID-19. Different studies estimate that 10% to 30% of people infected with COVID-19 will get sick for a long time.

Broad said that long-term sequelae can be divided into three categories:

1. People who are hospitalized in the hospital due to COVID-19, who are in a serious condition and have organ damage,
2. People who need oxygen but take a long time to recover slowly
3. People who have mild to moderate symptoms and recover at home, but then develop new symptoms.

“The third category is the most disturbing.” Broad said.

Bethany Meyer, 44, belongs to the third category. She has no medical history and is an employee of the University of Texas. She used to swim and hike frequently. After contracting COVID-19 for the first time in April 2020, she successively developed about 100 symptoms. These symptoms include hair loss and slurred speech like stroke. Many conditions disappeared after they appeared, but what bothered her most was the beginning of asthma and allergies-she didn’t have these problems before, and now she has to carry an adrenaline syringe wherever she goes.

In a study published in The Lancet, researchers evaluated the response of 3762 patients with confirmed or suspected Covid-19 from 56 countries. More than 91% of patients took at least 35 weeks to recover. The most common symptoms after 6 months are fatigue, discomfort after exercise, and cognitive dysfunction. More than 45% of people need to reduce their working hours, and more than 22% are unable to work at all due to continuous discomfort.

Another study published by The Lancet last Thursday pointed out that about half of patients with COVID-19 may still have sequelae a year after their appearance.

The most common long-term effects include fatigue, muscle weakness, sleep disturbance, changes in taste and smell, dizziness, headache, and shortness of breath. At six months, 68% of participants reported having at least one persistent symptom, which dropped to 49% after one year. Overall, the self-assessment scores of COVID-19 patients on the quality of life were still lower than their peers who did not have COVID-19.

What is strange is that between 6 months and 12 months, the number of patients who reported breathing problems increased, from 26% to 30%.

David Putrino, director of rehabilitation innovation at Mount Sinai Health Systems in New York, believes that people are still recovering 12 months after suffering from COVID-19, which is very unusual and not optimistic. An editorial in The Lancet said: “As the COVID-19 epidemic continues, the need to understand and respond to the long-term sequelae of COVID-19 becomes more and more urgent. Symptoms such as persistent fatigue, breathing difficulties, brain fog and depression may cause millions of people worldwide. People are weak. For a long time, the new coronavirus has been a major challenge to modern medicine.”

Some people still have long-term sequelae even recovered from COVID-19
David Putrino

These are statistics for adults, but what about children? A study conducted by the Office for National Statistics in the United Kingdom in April this year found that 9.8% and 13% of children aged 2 to 11 and children aged 12 to 16 who were infected with COVID-19 virus still survived five weeks later. symptom. After 12 weeks, this proportion is still significant: 7.4% in the younger group and 8.2% in the older group.

In a congressional hearing in April this year, Dr. Francis Collins, director of the National Institutes of Health, cited a study showing that 11% to 15% of infected youth may “eventually produce This long-term sequelae may have a devastating effect on school performance and other aspects.”

Although it is not yet known what caused the long-term sequelae of COVID-19, there are some speculations. One possibility is that the virus or its fragments continue to cause severe damage in the body. Another possibility is that the body needs to heal after fighting the new coronavirus, and various discomforts are only part of the healing process. Another possibility is that because the new coronavirus is a new virus to humans, it may cause the immune system to overreact for a long time. For example, the flu that broke out in Russia in 1810 caused nerve damage to a whole generation of people.

Who is most likely to have sequelae?

Broad and other experts found some commonalities that can be referred to: COVID-19 sequelae are more common in women, more common in people who initially have more symptoms, and more common in the elderly.

In terms of probability, people with severe COVID-19 have more sequelae. A study conducted by the non-profit organization FAIR Health to analyze private health care claims found that patients who were hospitalized with sequelae due to COVID-19 were nearly twice as many as those who had not been hospitalized but who had sequelae.

But then again, these observations are not absolute. In fact, long-term sequelae can appear in any patient with COVID-19, and it is impossible to predict who will have the sequelae.

Daisy Massey of the Center for Outcome Research and Evaluation (CORE) of Yale University School of Medicine explains: “Now we know that many young people and people with mild illness also have sequelae. People who are completely asymptomatic— —For example, a patient in our study — needs to use a wheelchair because of sequelae.”

Boston Children’s Hospital now offers a sequelae research project. The hospital’s neuroinfectious disease expert, Dr. Molly Wilson-Murphy, said that most children “have mild illness after being infected with the COVID-19 virus and have not been hospitalized. , Recovered at home, but the problem is—their symptoms never seem to go away—or they seem to get better for a while, and then after a few weeks or a month or so, the symptoms come back.”

“We don’t have any criteria to predict who will be affected, how much they will be affected, and how quickly they will recover,” said Dr. Wilson Murphy.

The good news is: vaccines may reduce sequelae

For each of us who have been vaccinated, even if a breakthrough infection occurs, will the risk of sequelae be reduced?

This is true in theory.

Dr. Eric Topol, a professor of molecular medicine at the Scripps Research and Translational Institute in California, said: “When you are vaccinated, even if you do have a breakthrough infection, there will be enough immune response to prevent long-term development. symptom.”

But the fact may not be certain. A study by the New England Journal of Medicine tracking Israeli medical workers found that among 1,497 vaccinated health care workers, 39 cases of breakthrough infections occurred, and 7 of them had symptoms that lasted for at least 6 weeks. In other words, the vaccine may not stop the sequelae, but the overall rate is still very low.

But this is only an estimate based on a small-scale study. Akiko Iwasaki, an immunologist at Yale University School of Medicine, is a leading researcher on the sequelae of COVID-19. She is currently paying attention to the problem of sequelae. She said: “We still know very little about the proportion of breakthrough infections that cause sequelae of COVID-19.”

Another research that Akiko Iwasaki is doing is whether vaccination will improve the patient’s sequelae symptoms. She said that as many as 30% to 40% of patients said their symptoms improved after being vaccinated with the COVID-19 vaccine like others. Iwasaki said: “I heard someone say that they no longer have ‘brain fog’, their gastrointestinal problems have disappeared, or they no longer suffer from shortness of breath.”

She explained that this may be because vaccines can help the immune system fight off residual viruses that are trapped in their bodies, or vaccines can prevent harmful immune responses. Or it can also be used to reset the immune system. At this point, researchers can only hypothesize at present.

She also emphasized that about 5%-15% of people feel worse after being vaccinated, and some people have not noticed any changes at all. However, even if the vaccine cannot help everyone with long-term symptoms, at least it can prevent people from being infected again.

No magic medicine

The National Institutes of Health has invested US$1.15 billion to study the sequelae of COVID-19. Now many hospitals provide related sequelae projects, hoping to treat patients’ multiple symptoms in a more comprehensive way.

Broad said his team not only prescribes medicine and treats physical symptoms, but also provides physical therapy and mental health consultation. It also connects patients with resources, such as government assistance and help from non-profit organizations.

His advice is to resume physical activity carefully, increase sleep, improve diet, and not do too many things at once.

Will Grogan is still recovering. He needed physical therapy for chest and left leg pain. About six months after the infection, he joined the high school tennis team, but his hand-eye coordination skills declined.

After slowly returning to exercise, his symptoms have improved a lot, and he has now resumed to start playing, but he has not fully recovered.

Grogan said: “Before I contracted COVID-19, my idea was that even if I got the infection, it could be cured, and then I would have antibodies, and I don’t have to worry about it anymore. But, my God, I never want to experience it again. It’s that kind of thing. Never think about it anymore.”

(source:internet, reference only)

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