Symptoms Continue for More Than 3 Months
For some people, coronavirus disease (COVID-19) causes symptoms that last for weeks or months after the infection has gone. This is called post-COVID-19 condition or "long COVID". Although most people with COVID-19 experience mild symptoms or moderate illness, approximately 10-15% of cases progress to severe disease, and about 5% become critically ill.
Typically, people recover from COVID-19 after 2 to 6 weeks. While most people with COVID-19 recover and return to normal health, some people can have symptoms that last for weeks or even months after recovery from acute illness though they are not infectious to others during this time. Even people who were not hospitalized and who had mild illness can experience persistent or late symptoms and some patients develop medical complications that may have lasting health effects.
This persistent state of ill health is known as 'post COVID condition' but other names are also used to describe the condition. In February 2021, WHO organized a series of international consultations with experts to reach a consensus on a description of this condition as well as its subtypes and case definitions.
WHO's case definition is as follows: "Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time." This definition may change as new evidence emerges and our understanding continues to evolve.
Symptoms reported after COVID-19 infection
Anyone with COVID-19 can get post COVID-19 condition, irrespective of the severity of disease.
Common symptoms include fatigue, shortness of breath and a decline in mental abilities like memory or brain fog (cognitive dysfunction). The case definition does not include an exhaustive list of reported symptoms. As studies continue, we can expect to learn more.
The most common symptoms are shown in the figure below.
Though less common, serious long-term complications are also been reported, especially in patients with severe COVID-19 who were hospitalized. These have been noted to affect different organ systems in the body as shown below.
How common is post COVID-19 condition?
The burden of post COVID-19 health issues is not very well documented. Yet, preliminary results from a nationally representative sample survey by the UK Office for National Statistics estimate that around 1 in 10 respondents who tested positive for COVID-19 may exhibit symptoms for a period of 12 weeks or longer. Other studies in the USA and Switzerland indicate that around a third of people who tested positive for SARS-CoV-2 had not returned to their usual state of health when interviewed 3 to 6 weeks after diagnosis.
Another recent study in the USA found that 30% of COVID-19 patients surveyed still had persistent symptoms after nine months. The majority of patients surveyed (85%) were outpatients with mild illness. Patients that are admitted to intensive care units may experience Post-Intensive Care Syndrome (PICS) which is a condition where health problems remain after critical illness. A person of any age who has had COVID-19 can later develop a post-COVID condition.
Limited research data also indicates that although post-COVID condition appears to be less common in children and adolescents than in adults, long-term effects after COVID-19 do occur in children and adolescents. Similar to the symptoms seen in adults, the most common symptoms reported have been tiredness or fatigue, headache, trouble sleeping (insomnia), trouble concentrating, muscle and joint pain, and cough. Young children may have trouble describing the problems they are experiencing; information on post-COVID conditions in children and adolescents is limited. It is possible that other symptoms may be likely in younger age groups.
Preventing the long term effects of COVID-19
The best way to prevent post-COVID conditions is to prevent COVID-19 illness. For people who are eligible, getting vaccinated against COVID-19 as soon as you can is the best way to protect yourself from severe COVID-19 disease and it can also help protect those around you. Continuing to observe public health and social measures even after vaccination is important
A vaccine's ability to prevent post COVID-19 condition depends on its ability to prevent infection in the first place. The vaccines we currently have are aimed at preventing severe disease and death. They are not as effective against infection; however, they should have some protective effect. There is emerging data that suggests the same: patients that have received vaccination against COVID-19 and developed disease are less likely to have symptoms for more than a month.
WHO responds to better understand the implications of long term COVID-19
Much is still unknown about how COVID-19 affects people over time and more research and multi-year studies are needed to understand. WHO has designed a post-COVID case report form (CRF) to collect standardized clinical data from individuals after hospital discharge or after acute illness to examine the medium- and long-term consequences of COVID-19. WHO is working with experts to develop a clinical case definition of post-COVID condition. Scientific studies are underway to understand the health challenges and implications of post-COVID conditions.
Bibliography
https://www.who.int/publications/m/item/update-54-clinical-long-term-effects-of-covid-19
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/late-sequelae.html
https://www.ons.gov.uk/news/statementsandletters/theprevalenceoflongcovidsymptomsandcovid19complications
https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm
https://www.acpjournals.org/doi/10.7326/M20-5926
https://www.medrxiv.org/content/10.1101/2021.03.03.21252086v1.full.pdf
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2776560
https://www.nhs.uk/conditions/coronavirus-covid-19/long-term-effects-of-coronavirus-long-covid/
https://www.youtube.com/watch?v=0p-FOLJH8Ag
Source: https://www.who.int/srilanka/news/detail/16-10-2021-post-covid-19-condition
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