COVID-19 After-Effects Can Linger for Weeks

— Even patients with mild cases describe persistent fatigue, trouble breathing, cardiac issues

By Amanda D’Ambrosio, May 13, 2020 | Original Medpage article here.

A tired and miserable looking man lying in bed with his hand on his forehead

When he developed a low fever at the end of March, Jarett DeSanti did not think it was related to COVID-19. But as his fever persisted, his body weakened, and cases continued to emerge in New York, DeSanti’s doctor insisted he get tested. DeSanti, a 35-year-old security officer from Brentwood, New York, tested positive for COVID-19 on March 27, and his moderate illness, doctors said, could be managed at home.

In the following days, his fever worsened, climbing to 102 °F. He had nausea and other gastrointestinal symptoms. On day 10, he got a chest x-ray confirming pneumonia. He lost his sense of smell, and couldn’t sleep. When the fever broke on day 13, his body started to recover. DeSanti tested positive for antibodies, and planned to donate plasma at his local hospital.

But 47 days after first testing positive for COVID-19, his symptoms have yet to completely subside. He still suffers weakness, a daily low-grade fever, shortness of breath, increased heart rate, and the constant anxiety that his illness will worsen yet again.

DeSanti said.

"If one little thing is changing in your body one day … all of a sudden, the anxiety goes through the roof," "This is the toughest and scariest thing I’ve ever dealt with in my life."

More than 230,000 people in the U.S. have recovered from COVID-19, according to Johns Hopkins University. But like DeSanti, many have lingering symptoms long after their initial infection — ranging from fatigue and muscle aches to rashes and heart issues. There are no good data yet on long-term sequelae from COVID-19, but survivors have been taking to social media and support groups to share what they’re experiencing.

The World Health Organization has said that median time from illness onset to recovery is around 2 weeks for mild cases, and between 3 to 6 weeks for those with severe or critical disease. But many even with mild disease have reported symptoms lasting far longer than 14 days.

Natasha Mixon, 42, started wheezing in late March. She thought it was her asthma acting up, so she went to the hospital and ultimately tested positive for COVID-19.

"I was actually in shock," Mixon, who lives in Amityville, New York, told MedPage Today. She never had a fever or dry cough, but a few days into her illness, her body began to ache, she lost her sense of smell and developed chest congestion.

Chest pressure prompted Mixon to return to the hospital. An x-ray revealed ground-glass infiltrates on her lower left side, but doctors said it looked like whatever she had was clearing up. The pressure remained.

"That lasted about 3 or 4 weeks," Mixon said. "The chest pressure was just still there lingering, and it wouldn’t go away."

Around 45 days after testing positive for COVID-19 — and since testing positive for antibodies — Mixon says she has not fully recovered, suffering dull, persistent headaches that she didn’t have before.

Still another patient with prolonged symptoms is Evan Perlo, a 36-year-old psychotherapist from Los Angeles. Around the time that he was tested for COVID-19 on March 16, Perlo experienced fatigue, body chills, and nausea, a wooziness he had not felt before. It became difficult to breathe on his daily walks, his ability to concentrate was impaired, and it took a toll on his mental health, he said.

Around 8 weeks after he first felt symptoms, Perlo told MedPage Today that those symptoms are finally starting to subside. Yet, the sense of uncertainty around how long it will take to return to full physical health has been a challenge. "That in itself became like a source of grief," Perlo said.

Long Road to Recovery

"It definitely is taking a lot of patients a decent amount of time to feel that they are perfectly back to normal," said Aaron Glatt, MD, chair of the department of medicine at Mount Sinai South Nassau in Oceanside, New York. Glatt, who is also chief of infectious diseases and the hospital’s epidemiologist, said that it is common for patients to experience chronic fatigue, low tolerance to exercise, weakness, and acheiness during recovery.

"The body received a tremendous insult, and it just takes a while for the body to recoup from that," Glatt told MedPage Today.

Joseph Conigliaro, MD, chief of general internal medicine at Northwell Health in New York, has seen a variety of lingering effects on the kidneys, gastrointestinal tract, and neurological system, but not necessarily cardiac effects. Rather, his team has been focused on preventing blood clots after patients are released from the hospital. Almost all patients discharged from Northwell Health are given an anticoagulant for 30 days, he said.

When a patient tests negative for COVID-19 — or positive for antibodies — that does not necessarily mean their symptoms will cease, Conigliaro said. These patients may continue to feel symptoms from either the presence of viral remnants or the body’s continued response.

Physicians within his division have seen that patients may test positive for the virus for up to 4 weeks, if not longer. "There’s remnants of the RNA that the test is picking up, but they may not necessarily be infectious," Conigliaro said. Persistent symptoms may indicate that the virus never fully cleared from the body.

Moreover, Glatt said, "it’s not necessarily the virus, it’s the inflammatory response, and all the things the body did to fight the virus, that are actually making some of these symptoms significant for a longer period of time."

For patients with mild-to-moderate disease, the inflammatory response may continue even as viral load is reduced, Conigliaro said. In severe cases, it may result in long-term damage. Hopefully that inflammatory response is reversible, Conigliaro said, though he noted that in severe pneumonia, for instance, lung tissue may be permanently scarred.

For many, the path to recovery is still uncertain. DeSanti, who works in security at a psychiatric hospital, attempted to return to his job last week. After three days, however, he decided he needed more time to recover before resuming his normal life.