emergency doctor

Long Term Effects of COVID (“Long-Haulers”)

"Can the people with COVID suffer long term effects? Including long term effects that affect the brain? Yes. These are the so-called “long-haulers.” And it is not necessarily just people with COVID who have required the intensive care unit."

"Dexamethasone, a steroid medication, specifically a glucocorticoid. Yes, it can cause anxiety, irritation, psychosis, delirium, sleep disturbance. This is why when we do give steroids, we try to avoid giving them before sleep. When assessing someone’s mental status, or psychiatric state, its important to know what they are normally like at their baseline. Are they acting differently? That’s really what you’re looking for. Steroids are prescribed very frequently, and these side effects, are not necessarily rare, its not like we give steroids and necessarily expect them to have these side effects. It's very hard to put a number on how often these side effects occur because there are so many different medications that can cause these symptoms and so many other factors that can contribute towards mental status changes. So you will never get a concrete number on how often these mental side effects occur, but if I had to put a number, I would say less than 10%, at least based on my experience of giving thousands of patients steroids.

Well, let me start out by saying there are over 30 million documented COVID cases and 1 million deaths worldwide, and over 200,000 deaths in the US. The clinical spectrum of disease can range anywhere form no symptoms to mild symptoms, to pneumonia, to ARDS and shock with multiorgan failure, and death. Because COVID is a new disease, the possible long-term health consequences, are still not well-known. So these long-term effects of COVID, we can call this postacute COVID, defined as the presence of symptoms extending beyond 3 weeks from the initial onset of symptoms. And Chronic COVID is beyond 12 weeks.

But postacute COVID syndrome is not just seen in those who had a severe illness and were hospitalized. In a telephone survey conducted by the CDC among a random sample of 292 adults (≥18 years) who had a positive outpatient COVID test and were symptomatic, 35% said they did not return to their usual state of health 2 weeks or more after testing. And this occurred in all ages of adults.

The most commonly reported symptoms after acute COVID are fatigue and dyspnea. And this is exactly what I’ve been seeing with some of my patients with COVID. This persistence of fatigue, and feeling short of breath. Other symptoms include joint pain and chest pain. In addition to these symptoms, there are cases of patients with specific organ dysfunction, primarily involving the heart, lungs, and brain. This might be a result of the viral invasion, by hijacking those ACE2 receptors in our body, but it can also be related to the intense inflammation and cytokine storm, or a combination of these.

In a study of 55 patients with COVID, at 3 months after discharge, 35 had persistent symptoms and 39 had abnormal findings on chest x-ray or CT scan, meaning interstitial thickening and evidence of fibrosis, meaning scarring. In 2 different studies that were done, they looked at patients with COVID who were discharged from the hospital. At about three months after discharge, about 25-30% of patients had at least some impairment in lung function, as evidenced by pulmonary function tests.

Heart damage, aka myocardial injury, as defined by an increased troponin level in the blood, has been described in patients with severe acute COVID. Inflammation of the heart muscle, meaning myocarditis, in addition to heart arrhythmias, has also been described after SARS-CoV-2 infection. I dedicated an entire video to this topic, so you can check that out for more details. The virus that causes COVID, SARS-CoV-2, can infiltrate brain tissue when the virus gets in the blood. It can also get to the brain by invading the olfactory nerve, which is the nerve responsible for the smell. This is why the loss of smell is a common symptom. Besides the loss of smell and loss of taste, the most common long-term neurologic symptoms after COVID are headache and dizziness. Less common, but still possible, is stroke, brain inflammation, meaning encephalitis, and seizures. In previous pandemics with SARS, MERS, and influenza, some people who recovered from those illnesses had neuropsychiatric issues that lingered for months. So were talking about cognitive health here, like depression and anxiety. And the post-COVID is known to cause “brain fog” and mood swings, this has been reported up to 2 to 3 months after initial COVID" illness. [Source: Partial transcript accompanying the video above.]