It is possible that after an acute SARS-CoV2 infection, secondary symptoms remain or occur later. The exact causes of this are unknown and are currently the subject of research.
The frequency of symptoms varies depending on the study population. Currently, a frequency of up to ten percent can be assumed for all patients considered. These are not uniform clinical pictures, but a wide range of symptoms can occur in varying degrees of severity.
In current publications, a distinction is usually made between the following two groups: First, individuals who have continued and persistent symptoms for more than four weeks from an acute COVID-19 illness (Long-COVID). Second, individuals who report new-onset or persistent symptoms lasting longer than two months beyond twelve weeks after the onset of an acute COVID-19 illness (post-COVID, WHO definition).
A new code number has been introduced to code symptoms related to long-term COVID disease. Explanations and examples of the use of COVID-19-related codes are summarized here.
As the pandemic progresses, it is becoming increasingly clear that SARS-CoV-2 infection can have longer-term health consequences, even if the disease course is mild or the condition goes unnoticed. Here you can learn more about possible long-term effects of COVID-19, which can be differentiated between Long-COVID and Post-COVID.
Viral diseases can be treacherous. Sometimes people suffer from symptoms long after they have recovered from an infection. Particularly in the case of infections with pneumonia, longer recovery times are observed. Long-term sequelae are also known from other infectious diseases (Spanish flu, MERS, SARS), but recent studies suggest that long-term sequelae following SARS-CoV-2 infection are more frequent and prolonged than, for example, following influenza infection. In addition, coronavirus is considered a multi-organ virus, occurring in numerous organs in addition to the lungs, such as the kidney, heart, liver, and brain. It might fit this that the health impairments observed after a SARS-CoV-2 infection include very different symptoms even after the acute illness phase of four weeks.
SARS-CoV-2, the COVID-19 disease it triggers, and the prolonged health impairments observed in association with infection or disease are currently the subject of intense research.
In October 2021, the World Health Organization (WHO) published the first case description of the long-term consequences of COVID-19 disease (Post COVID-19). In addition, 16 medical societies, led by the German Society of Pneumology and Respiratory Medicine e.V. (DGP) have developed a patient guide that describes common symptoms of long- and post-COVID and explains what patients can do – although, according to the authors, much is still unknown in this context.
About 80 percent of all infected people feel little to nothing from their Corona infection. In mild cases, a SARS-CoV-2 infection lasts about two to three weeks. For the acute phase of the disease, a maximum of four weeks is expected. The acute phase of illness may last twice as long in severe courses. After intensive treatment, organ-specific long-term sequelae can often be observed. Even less severely ill patients may have health symptoms beyond the acute phase of the disease or may develop new symptoms. According to current guidelines, depending on the time during which the symptoms persist, the term “long-COVID” is used (symptoms lasting more than four weeks after infection or illness) or “post-COVID-19 syndrome” (symptoms or health disorders that persist beyond twelve weeks or are new and cannot be explained otherwise). Often, nonspecific complaints such as constant exhaustion, shortness of breath, concentration problems (“brain fog”), or dizziness are in the foreground concerning their causes. Unfortunately, reliable, representative data on the proportion of sufferers with long-term consequences are not yet available.
Patients with a severe course of COVID-19 are particularly likely to suffer from late effects. Data from England indicate that around 40 percent of those with severe disease require longer-term medical support, for example, to improve impaired lung function or other affected organs. In many patients, lung changes are still evident months after the onset of symptoms. According to one study, 76 percent of the approximately 1,700 patients hospitalized in Wuhan during a COVID-19 episode still had at least one symptom six months after infection: 63 percent suffered from fatigue (rapid and severe exhaustion) or muscle weakness, 26 percent from sleep disturbances, and 23 percent from depressive or anxiety symptoms.
Long-COVID can also affect patients with mild courses and various manifest symptoms. This report describes, for example, memory disorders that occur retrospectively. Also, loss of the sense of taste and smell – a typical sign of corona infection – can persist long after recovery, as this article shows. Finally, among the most common symptoms of long-COVID is fatigue – a rapid and severe exhaustibility that many recovered patients suffer from even months after their acute COVID-19 illness.
Fatigue is the term used to describe rapid and severe exhaustibility. Fatigue often occurs as a side effect of chronic diseases like cancer or rheumatism. Fatigue can also occur after viral infections such as COVID-19. The causes have not yet been researched in detail.
According to the Professional Association of Pediatricians and Adolescent Physicians, initial study results suggest that children with severe course may suffer from persistent symptoms such as fatigue, concentration problems, or muscle pain. An article in the journal Nature, for example, says that statistics from England show that about 10 percent of all children and adolescents up to age 16 still had at least one symptom of the disease five weeks after diagnosis; data from Russia showed that one in four hospitalized children still had symptoms five months after discharge.
However, several more extensive studies, including one from Dresden University Children’s Hospital comparing various symptoms in children with and without SARS-CoV-2 infection, suggest no significant differences between these two groups of children. Therefore, one conclusion could be that, in addition to the virus itself, pandemic control measures (such as closed schools and contact restrictions) play a role as a cause in children and are associated with adverse health effects.
Concerning risk factors, there are indications that chronic and psychological pre-existing conditions, smoking, obesity, and a severe COVID-19 disease course favor the development of long-COVID. Long-COVID also appears to occur mainly in middle age and socially disadvantaged individuals. Women overall seem to be more likely to develop Long-COVID than men. Those who work in healthcare also appear to have an occupationally increased risk for SARS-CoV-2 infection and thus also for long-COVID disease. There is still no causative therapy for long- or post-COVID, so currently, treatment is symptom-based. Therefore, rehabilitation plays a unique role in Long-COVID. Since several organ systems are usually affected, several medical disciplines are often involved in the treatment, especially general medicine/pediatrics and pulmonary medicine, neurology, psychosomatics, psychiatry, and psychotherapy.
The late symptoms of COVID-19 are very nonspecific, including permanent damage. At the same time, precautions are being taken to help those affected and gain further knowledge. Primary contacts for patients with Long-COVID are usually family physicians, who often form good networks with specialists in private practice and can thus ensure interdisciplinary, outpatient care. There are already primary care and specialist COVID practices in some regions that can also be used as contact points for patients.
As part of a research project at Ulm University Hospital, specialists in internal medicine set up a consultation hour for affected people at the beginning of 2021. Most of the people who come to the consultation are between 40 and 50 years old, the youngest only around 20 – “and relatively healthy, i.e., without chronic pre-existing conditions,” says the senior physician in charge, Dr. Dominik Buckert. According to an interim assessment, 20 percent of those affected suffer from organ damage. The physicians mainly observe heart muscle inflammation and its consequences, such as cardiac insufficiency and cardiac arrhythmias. The majority of the remaining patients felt worse than before the disease. Read more about the study here.
In the future, research into long-COVID is to be driven forward to improve care with the involvement of numerous experts. Suggestions include a significantly expanded data and information situation, an examination and, if necessary, supplementation of the care situation, more significant publicity of the care offers, and the existing instruments for reintegration into working life. They conclude that affected persons with a severe or complex long-COVID clinical picture can be considerably limited in their opportunities to participate in social and professional life. Furthermore, because little is currently known about protective factors, the best protection against long-COVID is certainly still avoidance of infection with SARS-CoV-2: infection control measures and vaccination would help reduce the risk for long-COVID as well.
Long-term health effects of COVID-19 include impairment of physical and mental health and limitations in functioning and quality of life. The symptoms reported varying widely. They may occur singly or in combination and may vary in duration. To date, there is no uniform definition of a Long COVID clinical picture.
The most common long-term health effects of COVID-19 reported in inpatient forums or observed in studies to date include fatigue, exhaustion, and impaired exercise tolerance, headaches, breathing difficulties, olfactory and gustatory disturbances, muscle weakness and pain, concentration and memory problems, depressive moods, and sleep and anxiety disorders. Hair loss has also been reported. Other symptoms include chest pain and palpitations, heart palpitations, self-perceived increased or accelerated heartbeats, or even extra beats. Heart muscle inflammation has also been observed. In addition, kidney and metabolic diseases, such as diabetes mellitus (diabetes) and thromboembolism (blockage of a vessel by a blood clot), have occurred after the actual disease phase.
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Currently, national and international studies are being conducted to understand better sequelae, long-term effects, and health-related quality of life following infection with SARS-CoV-2. The focus of these scientific analyses is not only on Long COVID symptoms but also on indirect health consequences of the pandemic. These affect those with COVID-19 and may still impact broader populations. In addition, indirect health consequences may develop, for example, due to increased stress levels, changes in health behaviors, or when early detection screenings and needed medical care are limited.
It is unclear what proportion of those experience long-term health consequences due to COVID-19.
Individuals with severe COVID-19 are more likely to suffer longer-term symptoms than individuals who initially had a mild course. However, individuals who were only mildly ill with COVID-19 may develop long-term consequences.
According to various studies, an estimated 2 to 20 percent of adults affected by COVID-19 continue to suffer symptoms after 12 or more weeks. Among adults hospitalized for COVID-19, 76 percent still had symptoms six months after discharge.
Certain risk factors could favor Long COVID. These include advanced age, being very overweight (obesity), and having pre-existing lung and heart conditions. However, long-term sequelae can also occur in children, young people, and those with no previous disease. Irrespective of age, women are disproportionately affected by fatigue syndrome.
Long COVID is a disease that has not existed for long. Accordingly, new findings are constantly being added. For those affected, their relatives and close persons, experts from various professional societies have drawn up a patient guideline “Long/post COVID” (AWMF guideline). The approach provides a comprehensive overview of the current knowledge on the possible long-term consequences. In addition, those affected receive numerous practical tips.
The World Health Organization (WHO) has produced a brochure with recommendations to support recovery from COVID-19 or Long COVID. These recommendations aim to help sufferers understand their symptoms and, based on this, work actively to improve their symptoms. It is essential to manage one’s strength. By controlling one’s power correctly – this is also known as “pacing” or “pacing strategy” – everyday activities can be managed without aggravating the symptoms.
You can also find help from your doctor and in specialized medical facilities.