For survivors of COVID-19, beating the virus is just the beginning

©Health Analytics Asia

Other than anxiety, depression, and stigma, coronavirus survivors complain of side effects — grappling with poorer functioning in their lungs, heart, and liver. Some even report breathlessness, fatigue, and body pain weeks after recovering from the initial onslaught of the virus.

By A.Ahmad

When she crossed the four-month period of being sick with COVID-19, Hannah Davis, New York city-based algorithmic composer and research artist explained what ‘long COVID’ does.

In her Twitter thread, Davis said, dying is not the only thing to worry about the deadly virus. “I still have a near-daily fever, loss of cognitive function, essential tremors, GI issues, severe headaches, heart rate of 150+, viral arthritis, heart palpitations, muscle aches, a feeling like my body has forgotten to breathe,” wrote Davis in her long tweet.

She said over the past 124 days since she recovered from COVID-19, she has lost all feeling in her arms and hands, had extreme back, kidney, rib pain, phantom smells like someone barbequing bad meat, tinnitus, difficulty understanding text and reading, difficulty following conversations, sensitivity to noise and light, nonstop bruising.

“Thinking can cause headaches now. I’m not alone in the cognitive issues; it’s as common a symptom as a cough. No one knows when long COVID patients will get some relief; many are alone for months,” said Davis.

“Long COVID” is a term used to describe illness in people who have either recovered from COVID-19 but are still reporting lasting effects of the infection or have had the usual symptoms for far longer than would be expected.

But how long does it take for COVID-19 patients to get back fully functioning and free of all symptoms, depends on how sick patients were and if at all they had any comorbidities. “Generally, patients with COVID-19 who are put on ventilators take a little longer to get fully recovered, as their lung function may not fully recover,” said Dr. Amit Kohli, an intensive-care specialist from Lok Nayak hospital, which is handling the highest number of COVID-19 cases in New Delhi, the capital of India.

Lungs are ground-zero for COVID-19, however, lack of oxygen and widespread inflammation can also damage the kidneys, liver, heart, brain, and other organs.

“Although it’s too early to say what lasting disabilities COVID-19 survivors will face in the near future, studies point of developing severe pneumonia—an infection that inflames the air sacs in the lungs,” said Dr. Kohli.

Even small-scale studies conducted in Hong Kong and China show that COVID-19 survivors grapple with poorer functioning in their lungs, heart, and liver despite recovering from the disease. The studies also reveal that the new virus affects more organs than just lungs, kidneys, and heart.

“Based on preliminary data and few reports coming from across the globe it is now evident that coronavirus is haunting patients beyond their recovery,” Dr. Debanjan Banerjee, a psychiatrist at NIMHANS, Bengaluru, told Health Analytics Asia.

Some recovered patients even reported breathlessness, fatigue, and body pain, months after first becoming infected. “And that may be the tip of the iceberg,” added Dr. Banerjee.

While elaborating her fight with long COVID, Davis elaborated that medications spontaneously stop working, and it causes flare-ups of other viruses, past surgeries, and even other conditions.

“Old injuries are raw and feel new again. My left leg and foot, injured in a moped accident in 2017, feel crushed like it happened yesterday. Intolerance to exercise, alcohol, caffeine, and stress are common,” said Davis.

In fact, the coronavirus is now known to attack many parts of the body – from the eyeballs to the toes, the gut to the kidneys. The list is long. “There could be mild issues such as post-COVID headaches, sleep disturbance, anxiety, and depression. But there could be moderate to major problems like chronic acute respiratory distress syndrome (ARDS), cardiomyopathy, blood clotting, etc., as well,” said Dr. Banerjee.

According to Davis, the symptoms wax and wane. “You think you’re getting better, only to be hit again. New symptoms appear constantly,” she said.

Lucy Bailey, London based Community Equalities Coordinator (London) too speaks about her unending meeting with long COVID.

On June 30, she wrote, “Today marks 3 months since I came down with COVID-19 symptoms. I’m still nowhere near better. I’m 32, was perfectly healthy before and I was trying really hard not to expose myself to the virus, long COVID.”

Struggling with chest pain, joint pain, body aches, headaches, cognitive issues, and fatigue are some of the symptoms that Lucy is still battling with on a daily basis.

Depression, delirium, and anxiety

Researchers from the San Raffaele hospital in Milan, Italy have found that a significant proportion of COVID-19 recovered patients were experiencing mental illnesses. The findings of their new study is expected to be published in the journal Brain, Behaviour, and Immunity.

Significantly, the study notes that when an infection triggers the immune system, it could add to the psychological stress of enduring a fatal disease and to stress-associated inflammation.

Further, “cytokine storms”, which are an immune system response to coronaviruses, can also cause psychiatric symptoms in those infected.

Within the 402 subjects, 26 patients had a pre-COVID diagnosis of major depressive illnesses, 28 had generalised anxiety, 20 had panic attacks, five were bipolar, five had social phobia, 3 had eating problems and 4 had other disorders.

According to Dr. Banerjee, survivors of COVID-19 tend to show a high prevalence of emergent psychiatric conditions including mood disorders, anxiety disorders and insomnia, among other illnesses.

However, patients’ stress and depression might be exacerbated by the uncertainty of the future, stigma, traumatic memories of severe illness, and social isolation that they experience during treatment.

“So patients may experience nightmares, often violent and nightmarish, many reports of dreaming about people who have passed away,” said Dr. Banerjee.

While scientists across the globe are only starting to track the long-term effects of COVID-19, past epidemics caused by similar viruses show that the aftermath can last for more than a decade.

Agrees Dr. Akshay P Jadhav, a paediatrician at Rainbow Children’s Hospital, Bengaluru. According to Dr. Jadhav, “It is not that simple — you contract the virus, it goes away, you are cured, and you are happily ever after. Patients, when discharged from COVID wards, are only recovered from the clinical symptoms. They may still experience the aftermath of COVID-19 and that could be complexities arising from a range of comorbidities which they could have experienced once or even multiple times.”

Even Nicholas Hart, the British physician who treated Prime Minister Boris Johnson, has called the virus “this generation’s polio” — a disease that could leave many marked by its scars.

And if we go by Davis’s first-hand account, COVID-19 certainly isn’t the flu where you can curl up with Netflix and tea for a few weeks. “This is an active, awful illness,” she said. “With neurological effects for most.”