Long Covid: Your questions about lingering devastation of coronavirus answered
Long Covid could become a more serious public health problem than excess deaths caused by coronavirus, a leading academic has warned.
Prof Tim Spector of King’s College London said the illness behaved like an autoimmune disease, affecting multiple systems even after the virus had gone.
Around one in 50 infected people still have symptoms such as breathlessness and chronic fatigue three months later, according to data gathered from four million patients via an app.
Prof Spector, whose team launched the app with health-science firm Zoe in March, said: “This is the other side of Covid: the long-haulers that could turn out to be a bigger public-health problem than excess deaths from Covid-19.”
An increasing number of sufferers find the virus they thought they had beaten is still affecting their health months on.
They include Paul Garner, professor in infectious diseases at the Liverpool School of Tropical Medicine.
He tested positive in mid-March, but symptoms including sweats, exhaustion and severe headaches lasted until until September, and he still experiences debilitating bouts of fatigue.
He said: “I had these bouts of illness that lasted about three days with a few days in between when I felt like a ragdoll. And it just didn’t stop. One day my speech went and I lost my vision for a minute. It was terrifying. I’ll be happy if I’m fully recovered by April.”
Here Prof Garner, who has kept a British Medical Journal blog on his experience, answers the concerns questions on the illness.
Covid usually starts with feeling unwell, exhaustion and a host of different symptoms – and Long Covid is when people don’t get better after a few weeks.
The acute illness is when the virus is circulating – Long Covid is the after-effects of the virus.
There may be bits of virus still in the body with Long Covid but mostly it is not caused by the virus itself but by the damage it has inflicted to our organs and to our delicate immune and nervous systems.
Some people seem to have damage to their heart muscle, which is seen with other viruses, and appears to improve over time. Given the scale of the pandemic, with many people infected, this is a particular worry. If you have some Long Covid symptoms, it is a good reason to see your doctor before you start running or doing vigorous exercise.
Since May, when there were reports on blogs, in self-help groups and in the press. In early June, it was reported that many people had been wrestling with symptoms for at least a month. Early on it was called the “long tail” of the infection, and the patients “long haulers”. Long Covid is now recognised by both doctors and patients as the best term.
Yes. Initially, government and health authority public health messaging stated that having Covid would be over within a few weeks. When people went to the doctors with lingering symptoms, some were dismissed as having anxiety. Patient groups were prompt to respond. In the early days patients knew more about the disease than the doctors but the advocacy has meant now Long Covid is recognised.
Doctors and patients have known about post-viral syndromes for decades. In the early 18th century they were described as neurasthenia. Doctors thought we were powered by electricity through our nerves, and when people spent their energy too quickly, they developed neurasthenia. Many of these were probably post-viral syndromes.
Post-viral syndromes are widely known, with the virus that causes glandular fever, for example. People have exhaustion, muscle pain and headache that can go on for months or longer.
Viruses are also one cause of long-term illness termed myalgic encephalitis and chronic fatigue syndrome. While Covid-19 is a new virus that causes a wide variety of life-threatening illnesses, many of the symptoms of Long Covid have been seen before in other post-viral conditions. What is new here is the sheer volume of people now suffering, and doing so at the same time.
Exhaustion, severe fatigue, breathlessness, headaches, muscle aches, joint pain, “brain fog”, memory loss, sensation of pressure on the chest, palpitations, diarrhoea, nausea, dramatic mood swings. These come and go.
For some, the virus causes disorders of their heart, with rapid pulse rates, and these effects can limit walking.
Others have postural tachycardia syndrome, so when they stand up their heart rate goes up, they feel dizzy and have to sit down again. Some people have mood swings, and depression is not uncommon, caused by Long Covid rather than just feeling down because you are still unwell.
Symptoms come and go, appear random, but sometimes can be avoided by being careful to rest and convalesce. Some people have post-exertional malaise – so if they over-extend themselves with housework, walking, working on the computer or other activities, the original illness bounces the following day.
Moderate exercise, particularly if it pushes your heart rate up, can bring on severe “busts” in some people. People with brain fog should be careful with driving and returning to work.
Many of this wide spectrum of conditions has been seen before. This includes viral damage to the heart, severe post-viral exhaustion, post-exertional malaise and brain fog. Specialists are looking at whether this is due to the immune system, due to disorders in the brain related to the nervous system and its control over our defence and healing systems, and disorders of how we perceive threats to our health.
Sadly, research on the biological and neurological mechanisms of ME/chronic fatigue syndrome have been marred over the years by doctors and society believing the symptoms were imaginary.
Now, with such huge numbers of people suffering these illnesses there will be a boost to research to people with Long Covid and post-viral illnesses.
People who have been severely unwell are likely to need a long recovery but Long Covid is common across everyone. Some have a mild illness and then Long Covid kicks in – with symptoms far worse than the initial illness.
It seems to affect all age groups, including children. It sometimes appears to be more common in athletes but this may be because they have higher levels of fitness and immediately notice that they cannot go back to what they were doing before.
There are few studies but it might be as common as 20% of all people infected are ill for at least 12 weeks.
What we know from other post-viral syndromes is that it could, in some people, go on longer than a year. However most people notice some improvement after a few months, so fingers crossed, most of us fully recover.
Convalescence. People need to rest to let their bodies and minds heal. Eating healthy foods, avoiding alcohol and being careful not to overdo things.
Your doctors may be able to provide advice but much of the rehabilitation will be about you working out how best to manage this – and some people find forming small self-help groups with others who have Long Covid to be very supportive and helpful – “getting by with a little help from our friends”.
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