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Ongoing Concerns About the Long-Term Effects of COVID-19

AJN, American Journal of Nursing: October 2021 - Volume 121 - Issue 10 - p 16
doi: 10.1097/01.NAJ.0000794208.39070.96
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Abstract

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Figure:
Lisa O'Brien, creator of the Utah COVID-19 Long Haulers, an online support group for people who have experienced long-term impacts of the virus, began experiencing COVID-19 symptoms after a trip to Hawaii in early March. O'Brien says she continues to experience excessive fatigue as well as blood clots and tachycardia. Photo by Francisco Kjolseth / The Salt Lake Tribune.

The surge in COVID-19 cases from the highly contagious Delta variant not only is causing more deaths but will likely result in more people experiencing lingering symptoms. This prolonged phase of the illness—known as “long COVID”—is characterized by an assortment of ailments such as fever, headache, fatigue, and neurocognitive irregularities that can continue for months after patients appear to have recovered from acute illness.

In addition to these symptoms, researchers are documenting more serious aftereffects of COVID-19, including cardiac problems, new-onset diabetes, and autoimmune disorders—even in people who had mild illness and were never hospitalized. Scientists have also begun to probe many unanswered questions, including why most patients seem to recover fully from COVID-19 while others struggle with its aftermath.

Researchers in the United Kingdom compared brain scans of 782 participants from the UK Biobank COVID-19 imaging study: 394 tested positive for SARS-CoV-2 between scans taken before the pandemic and follow-up imaging this year. Results of this medRxiv preprint study found significant grey matter loss in those who had the disease, regardless of hospitalization status, compared with controls who never tested positive for the virus.

Strong evidence for neurologic dysfunction in long COVID exists, with pain as an ongoing symptom. A study in Pain Report found that the disease affects the peripheral nervous system, including changes in nociceptor excitability, thereby inducing neuropathies and worsening existing pain.

Lingering cardiovascular problems are increasingly found in patients diagnosed with COVID-19. According to a review in Current Atherosclerosis Reports of both short- and long-term consequences, some patients are as young as 18 and have no underlying comorbidities. Cardiopulmonary issues include fatigue, palpitations, chest pain, breathing difficulties, and postural tachycardia syndrome. Some 20% of people complain of chest pain and 14% continue to have palpitations 60 days after diagnosis. A study in JAMA Network Open also flagged transient bradycardia approximately 15 days after symptom onset, followed by tachycardia, which did not resolve for several months.

Another serious development is the increase in new-onset diabetes. A letter in the Journal of Diabetes notes that in a retrospective cohort study of more than 193,000 patients age 65 or younger in a large U.S. health plan, new-onset diabetes was the sixth most common clinical finding after approximately three months. The letter also reported that the rate of new-onset diabetes in the same age group in a British study was 29 per 1,000 person-years over an average follow up of 4.6 months after hospitalization.

There are also instances of new-onset autoimmune issues and of skin disorders, such as lesions and rashes. Nonspecific complaints like malaise or fatigue may be signs of more serious complications. In addition to physical symptoms, many patients contend with mental health challenges like depression or posttraumatic stress disorder. Nurses have a vital role in assessing and preparing patients for what could be months or even years of self-management of post-COVID symptoms.—Liz Seegert

References

Douaud G, et al. medRxiv 202110.1101/2021.06.11.21258690; McFarland AJ, et al. Pain Rep 2021;6(1):e885; Chilazi M, et al. Curr Atheroscler Rep 2021;23(7):37; Radin JM, et al. JAMA NetwOpen 2021;4(7):e2115959; Sathish T, et al. J Diabetes 2021;13(8):693-4.
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