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Life After COVID: Some 'recovered' patients report persistent symptoms

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Stroke

Kidney failure

Scarring of the lungs

These are just some of the potential long-term effects of COVID-19, according to The International Journal of Clinical Practice, as well as medical professionals in South Dakota.

“I’m not trying to go rogue, but I’m very concerned that people don’t understand [the virus,]” Dr. Wendell Hoffman, an infectious disease specialist at Sanford Clinic in Sioux Falls, said. “Death is the ultimate harm, but overall harm [reduction] is about morbidity, not just mortality.”

“I’ve seen patients that were healthy [before contracting COVID] and are now completely debilitated,” Hoffman added.

The NumbersWe see the statistics rise every day: More than 8 million cases and 220,000 deaths in the U.S. alone from COVID-19.

It is difficult to translate numbers on a screen to human lives, and as case counts continue to rise with no end in sight, it is easy to tire of restrictions, mask policies, and social distancing. There is a lot the public still does not know about the coronavirus, including the full scope of its long-term effects. However, people who have recovered from the virus sometimes do not regain full health. Due to the emergence of “post-COVID syndrome,” even a mild case of COVID can have lasting implications.

The definition of “recovery” in the context of COVID means the infected individual has been released from isolation, at least 10 days have passed since the onset of symptoms, and at least 24 hours have passed after other symptoms improve and fever has resolved. And according to Hoffman, this is a misleading definition.

“‘Recovered’ in this context is a technical definition, not a clinical definition,” Hoffman told the Capital Journal in a phone interview Wednesday. “We’re now seeing what’s called ‘post-COVID syndrome.’ We’re getting lots of reports from a high percentage of recovered COVID patients having persistent symptoms.”

The most common of these, he said, is debilitating fatigue, which can dramatically impact a COVID survivor’s daily life. Hoffman said he has had many recovered patients come back to him weeks later saying they still do not feel well enough to return to work. Patients have also reported it has become harder to get back to regular activities like exercising, according to Regional Medical Director of Clinical Quality and Medical Director for Avera@Home Dr. Chad Thury.

According to a study on post-discharge symptoms in COVID survivors published in the Wiley Journal of Medical Virology, those surveyed reported “extremely high levels” of fatigue that had a severe impact. Those with severe fatigue symptoms also had “markedly higher” levels of post-traumatic stress disorder (PTSD) symptoms, cognitive issues, and breathlessness.

Mental health issues have also become a “real concern,” according to Thury. He said he noticed how scared patients are while they’re sick.

“It can be a scary experience when you can’t breathe,” he said. “It’s traumatic.”

According to a study published in Brain, Behavior, and Immunity, “In addition to the immunological mechanisms, fear of illness, uncertainty of the future, stigma, traumatic memories of severe illness, and social isolation experienced by patients during the COVID-19 are significant psychological stressors that may interact in defining psychopathological outcomes.”

Both studies noted that females and people with previous psychiatric diagnoses suffered more from any mental distress and young people had higher levels of depression and insomnia.

Thury said health care professionals try to provide these patients with resources to help control their anxiety and prevent more mental health issues from occurring, but in the long-term, it can take a while to mentally recover from the experience.

In addition to respiratory problems, COVID can cause heart conditions such as myocarditis or pericarditis. Any heart damage brought about by COVID can also cause long-term symptoms such as shortness of breath, chest pains, and heart palpitations, according to the Centers for Disease Control and Prevention.

“It can be a long course, and people may not recover their pre-COVID heart function,” Thury said.

COVID survivors also can have a higher risk of heart attacks, strokes, and pulmonary embolisms, which can have an even more lasting impact on a person. Hoffman said that 20-30% of patients hospitalized due to COVID will have heart problems after they are recovered.

According to the CDC, “The risk of heart damage may not be limited to older and middle-aged adults. For example, young adults with COVID-19, including athletes, can also suffer from myocarditis. Severe heart damage has occurred in young, healthy people, but is rare. There may be more cases of mild effects of COVID-19 on the heart that can be diagnosed with special imaging tests, including in younger people with mild or minimal symptoms; however, the long-term significance of these mild effects on the heart are unknown.”

While some more severe after effects correlate to more severe cases of COVID, even patients with mild cases have reported more serious symptoms of post-COVID syndrome.

COVID is a new disease, so there are still many unknowns. Researchers have started to conduct studies on COVID survivors and have also relied on studies focused on the long-term impact of the 2003 SARS virus, which induced symptoms similar to COVID.

“We don’t know where this is headed — we want to open up the economy, but I want to see things open up responsibly. If we don’t, there are a lot of people that will be debilitated,” Hoffman said.

With the possibility of lasting physical and mental damage to COVID victims, Hoffman said South Dakota’s leaders should cast the conversation around COVID in a different, more compassionate way.

“We need to see this more holistically. This is about the entire population and how to prevent the spread, not just about deaths or hospitalizations,” Hoffman said. “COVID has infected 34,000 people in South Dakota, and there are an increasing number of patients with continuing symptoms. We can’t allow this to run [free] without doing more.”

Hoffman does not believe, however, that masks should be mandatory, or that lockdowns are an effective method of curbing the spread. Rather, he said individual actions will have the largest impact on slowing the spread.

“We need to persuade people that their rights aren’t being taken away. This is a test for our state. The Founding Fathers knew that personal freedoms are always ground in personal obligations. We need our leaders to get out in front of it and act in the best interest of all South Dakotans. The best politics is always doing the right thing,” Hoffman said.

“The more we can reject this false binary of either lockdowns or no restrictions, the more we can explain this virus,” he said.

Ultimately, more individuals need to be conscious about their actions and habits in order to protect as many people from getting sick as possible: wearing a mask in public, cleaning high-touch surfaces, washing hands, and avoiding even small social gatherings.

“Everything we do is impacted by how we handle this. The more we can do our part, the longer kids can be in school and businesses can stay open. This is bigger than health care,” Thury said.

“It should be a no-brainer to act in the best interest of our fellow man,” Hoffman said. “Do we not care about every person in South Dakota with COVID? I think when it comes down to it, most people would say they do care.”

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