Most medical infections leave no lasting effect after patients recover, but some can cause devastating harms long after resolution. The best known is rheumatic heart disease, caused by damage to the heart valves from an inadequately treated streptococcal throat infection, otherwise known as rheumatic fever.
Before the advent of penicillin, in the 1920s, rheumatic fever was the leading cause of death in the U.S. in those 5 to 20 years old. Even for those who recovered, the infection caused heart damage in tens of thousands. Many suffered premature death from heart failure or damaged heart valves. Others, as middle-aged or elderly adults, needed heart valve replacements. (A particularly illustrative example: One of us is caring for a patient who had a heart valve replacement in 2011 for a bout of rheumatic fever in the 1930s.)
Studies have now demonstrated that a constellation of symptoms may persist for weeks, months, and possibly years — we don’t know yet — after recovery from COVID-19. These symptoms appear to be primarily neurological (difficulty in concentration or “brain fog,” headaches, depression, or memory or sleep disorders), cardiovascular (heart rhythm or blood pressure problems), or related to severe fatigue. While these are the most common symptoms, virtually any organ in the body may be affected by invasion of the virus and the inflammatory response it causes. Most concerning is that no one is immune from these symptoms after COVID-19 infection — from those with the mildest cases to those who require intensive care hospitalization.
Consider that at present there have been more than 40 million cases of COVID-19 diagnosed in the U.S. and more than 200 million worldwide. Estimates of the occurrence of long COVID-19 symptoms range from under 5% to as high as 40% of all COVID-19 cases; so we are talking about potentially millions to tens of millions of patients, with millions more in the future. The costs — medical, rehabilitative, and psychological — are incalculable. There is still ample reason to protect oneself and others through vaccination, masking, and social distancing.
Without question, long COVID-19 is a real health problem, but no one is sure how much of a problem. The symptoms are nonspecific and often ill-defined. Many could be related to any acute or chronic illness, or to no illness whatsoever. That is why it is essential to perform systematic studies of long COVID-19. The scientific tools — CT scans, MRIs, computers, and artificial intelligence — now exist to understand long COVID-19 and avoid the uncertainty of the question of sequelae that followed the flu pandemic when such tools were not available.
The United Kingdom has created a long COVID-19 task force. Initial data indicate that an estimated 970,000 people are experiencing long COVID-19 in the U.K. out of more than 7 million diagnosed cases of COVID-19. Although several hundred thousand patients have been suffering symptoms for a year or more, only a small percentage have been referred for special care.
Here in the U.S., last December, Congress provided $1.15 billion over four years for the National Institutes of Health to study the incidence, causes, risk factors, and ways to prevent long COVID-19. (There is anecdotal evidence that vaccination may prevent or at least mitigate some symptoms of long COVID-19.)
The Centers for Disease Control and Prevention has also launched studies of long COVID-19, and one of the most comprehensive multi-state investigations is centered in Chicago. The study is attempting to enroll 4,800 patients, COVID-19-positive and COVID-19-negative, to compare the two groups. It will examine the role the virus plays in who, what, when, and how often patients suffer long-haul symptoms, including a variety of the problems that can diminish quality of life, such as fatigue and sleep disturbances.
We are hardly done with acute COVID-19. Many thousands of patients will die of the acute disease in the near future. It is a sobering prospect that those who survive may believe they are done with COVID-19, only to later find that COVID-19 is not done with them. Society may be dealing with this problem well into the late 21st century and in some cases perhaps even into the 22nd century.
Where COVID-19 is concerned, Faulkner’s words ring true.
Dr. Cory Franklin is a retired intensive care physician, and Dr. Robert Weinstein is an infectious disease specialist at Rush University Medical Center in Chicago. They wrote this originally for the Chicago Tribune.