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The Lingering Effects of COVID-19

AJN, American Journal of Nursing: December 2020 - Volume 120 - Issue 12 - p 15
doi: 10.1097/01.NAJ.0000724176.20278.f5
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Malea Anderson, at home in Erie, Colorado, has suffered headaches, fatigue, and other symptoms she suspects are related to COVID-19. Photo by Hart Van Denburg / Associated Press.

In the early months of the COVID-19 pandemic, clinicians mainly focused on how to treat the acute illness and save patients' lives. As time passes, however, it has become apparent that people who have recovered from acute COVID-19 can continue to have debilitating symptoms for weeks, even months, beyond the initial illness.

This postacute phase of COVID-19 infection has come to be known clinically as “long COVID” and the people suffering from it as “long haulers.” Patients report a mix of physical, mental, and emotional symptoms. Many are nonspecific, such as fatigue, neurocognitive difficulties, and depression. Others are obvious, such as fevers, skin rashes, and breathlessness. Such symptoms, continuing three weeks and longer after the acute phase, can plague those who required hospital care as well as those who experienced only mild illness.

It is not known why some people recover completely from acute COVID-19 and others do not. Clinicians and researchers worldwide have begun to gather data on long COVID. A study by Italian researchers published in JAMA found that only 12.6% of patients discharged from a Rome hospital were symptom-free two months after the onset of COVID-19 infection. Nearly one-third had one or two symptoms, and 55% had three or more. A total of 44.1% reported a worsened quality of life. The most common symptoms were fatigue (53.1%), dyspnea (43.4%), joint pain (27.3%), and chest pain (21.7%).

French researchers reported in the Journal of Infection on 120 discharged patients who were interviewed an average of 110.9 days after their COVID-19 admission to a Paris hospital. The patients described fatigue (55%), dyspnea (42%), loss of memory (34%), difficulty concentrating (28%), and sleep disorders (30.8%). Hair loss was reported by 20% of patients. There was no significant difference in the prevalence of these postacute symptoms between patients who required ICU-level care and those who did not, according to the researchers.

In patients with mild illness who did not require hospitalization, the incidence of long COVID is reported to be lower, about 10%. But for these patients, many of whom had good health prior to COVID-19 infection, the long recovery can be frustrating and frightening.

Reports from viral outbreaks in earlier centuries, including the deadly “Spanish Flu” pandemic of 1918-1920, describe an increased incidence of neuropsychiatric symptoms, including insomnia, anxiety, depression, mania, psychosis, and suicidality. Although the full impact of COVID-19 on mental health won't be known for several years, it is likely to be significant—and potentially chronic in some patients, according to University of California, San Diego, psychiatrists writing in Brain, Behavior, and Immunity.

While certain patients are known to have recovered on their own from prolonged symptoms, other long haulers seek care. Some of them report being dismissed by clinicians or belittled as hypochondriacs. As evidence mounts of long-term effects from COVID-19, it is important for health care providers to be receptive and clinically alert to the needs of these patients.—Joan Zolot, PA


Carfi A, et al. JAMA 2020;324(6):603–5; Garrigues E, et al. J Infect 2020 Aug 25. Online ahead of print; Greenhalgh T, et al. BMJ 2020;370:m3026; Troyer EA, et al. Brain Behav Immune 2020;87:34-9.
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