Woman with coronavirus, sick at home
The existence of Covid-19 and the SARS-CoV-2 virus that causes the disease has been known for less than half a year. And so it stands to reason that the precise pathogenesis hasn’t been fully characterized.
What’s also unclear at this point are reasons for the differential impact the disease has on those who test positive for the novel coronavirus. A neat breakdown into the three categories asymptomatic, mild, and severe cases is far too simplistic.
A Dutch study released this week confirms, for example, that some patients in the “mildly symptomatic” category turn out to be substantially burdened by Covid-19 for long periods of time, sometimes months.
From the outset of the pandemic, conventional wisdom has indicated that a minority of infected people, who are typically elderly or have pre-existing health conditions, get seriously ill. They often require hospitalization and, in some cases, intensive care.
And over 80% of cases, according to the World Health Organization, are mild or asymptomatic. These patients typically recover after two weeks.
However, the rapid recovery has not been the experience of thousands - perhaps tens of thousands - of patients worldwide who’ve been classified as mild cases. Many struggle for months with lingering Covid-19 symptoms that can be debilitating. They exhibit shortness of breath, extreme fatigue, intermittent fevers, cough, concentration issues, chest pressure, headaches, and heart palpitations, among other symptoms. The literature has a name for them: “long-haulers.”
In the Netherlands, the Lung Foundation, together with the University of Maastricht and the CIRO group,* surveyed 1,622 Covid-19 patients who had reported a number of long-term effects from their illness. Ninety-one percent of the patients were not hospitalized, which indicates that the vast majority of the surveyed patients would fall under the category “mildly symptomatic.” The average age of the patients surveyed was 53.
Nearly 88% of patients reported persistent intense fatigue, while almost three out of four had continued shortness of breath. Other enduring symptoms included, among other things, chest pressure (45% of patients), headache and muscle ache (40% and 36%, respectively), elevated pulse (30%), and dizziness (29%). Perhaps the most startling finding was that 85% of the surveyed patients considered themselves healthy prior to getting Covid-19. One or more months after getting the disease, only 6% consider themselves healthy.
Just as the exact biological mechanism(s) that leads to the manifestation of Covid-19 disease symptoms is unknown, it’s uncertain why some patients exhibit very long-term effects. A number of clinicians posit that a reactivation may occur in a number of patients in which the coronavirus, which could lie dormant or latent in a patient’s body for a period of time, “awakens” to an active phase and causes recurring symptoms. Essentially, this hypothesis suggests that some patients harbor the virus somewhere in their body, and they either still test positive for the virus or it is missed by conventional coronavirus tests that use nasal swabs. What is perhaps a more likely scenario, according to immunologists, is that the virus no longer resides in the body but the immune system continues to be in perpetual overdrive.
Regardless of the possible reasons for some “mildly” ill patients being symptomatic long-term, the Dutch study confirms what has been known anecdotally about long-haulers. For this group, recovery is a grueling process. Globally, as the the numbers of people infected with the novel coronavirus increases, so will the number of people with (temporary) disabilities, in spite of their “mildly symptomatic” status.
*The Dutch CIRO group - a treatment, resource, and knowledge center - specializes in care for patients with chronic medical conditions, including acute and chronic pulmonary diseases.
