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where we are in terms of discovering its long-term impacts

July 12, 2020 09:09AM

from What we know about the long term consequences of getting COVID-19


Just over six months since we discovered the coronavirus, we can use that same approach to discussing where we are in terms of discovering its long-term impacts.

Known knowns

We know how long people’s coronavirus symptoms normally last. The COVID Symptom Study is a joint project from researchers at King’s College of London and Massachusetts General Hospital. Essentially, they developed an app that asks those with COVID to take one minute every day to describe the symptoms they’re facing. They’ve had a huge response rate: 3,984,380 contributors so far.

The study found that most people do recover completely within 14 days, although even that is a relatively long time for most people when they think about recovering from a disease. But there’s also this long tail for people who seem to have symptoms for 25, 30, 35, or 40 days, perhaps longer. They conclude that about one in 10 people still have symptoms after three weeks. This is the “long COVID” group.

What kind of symptoms are these? They range from mild to severe.

• Sense of smell. You probably know that coronavirus tends to make people lose their sense of smell for a while; various studies have estimated the percentage of coronavirus patients that lose smell to be anywhere from 30% to 98%. In Salt Lake County, 38% of cases have reported loss of smell.

An Italian study checked in on 202 patients who lost their smell to see how long it lasted. Four weeks from when the symptoms started, 49% reported complete resolution, 41% reported an improvement in the severity, and 10% reported that their smell was unchanged or worse. Interestingly, there wasn’t any correlation between how long these people lost their sense of smell and how long they had other COVID-19 symptoms.

• Post intensive care syndrome. Up to 75 percent of people who become critically ill and stay at an ICU develop this. It includes neurological, physical, and psychological symptoms.

• Blood clot issues. Remember, some of what hurts people isn’t the virus itself, but the body’s immune response to it. In particular, one quirk of the immune response is that it can create inflammation in some places in the body and blood clots in others. Blood clots can cause all sorts of problems everywhere in the body with COVID-19, from kidney failure to limb amputation.

• Lung damage. People who have pneumonia or need to go on a ventilator often have long-term lung scarring as a result. The elderly are more likely to experience scarring, but whoever experiences it does see diminished lung capacity and exercise capacity. In addition, the blood clots can cut off circulation in the lungs: studies have found that 23% to 30% of those with severe COVID-19 have this occur. That also creates long-term impacts on lung function.

• Strokes. If one of those blood clots causes a stroke, that obviously has long-term impact. Stokes have been seen in both young and old due to coronavirus. Young people don’t die that frequently, but they are permanently effected: studies have found between 42% and 53% of young stroke victims are able to return to work.

Known unknowns

Because we’ve only known about coronavirus for such a short period of time, there’s much we want to know more about, but just haven’t had the time to figure it out yet. The National Institutes of Health is creating the CORAL study, which will take a look at the long-term health of 3,000 coronavirus patients. Countries all over the world are doing the same thing. Here are some of the questions those studies are trying to figure out.

• Who gets long-term symptoms and why? You’d expect that it was people who faced severe symptoms that lasted longer: the taller the mountain, the longer it takes to get up and down it, right? But according to the COVID Symptom Study researchers, “people with mild cases of the disease are more likely to have a variety of strange symptoms that come and go over a more extended period.”

Why is that? One hypothesis is that those who are hospitalized receive medication to prevent the blood clotting and inflammation issues that can cause some of the unexpected symptoms, but we don’t know if that is true. Of course, that doesn’t explain the number of hospitalized people who get unexpected symptoms anyway.

• How permanent is most lung damage? We know that severe lung damage is known to have long-term effects, but what about mild lung damage? For example, one study looked at 58 people who had tested positive who were completely asymptomatic — except they had visible lung damage on their CT scans. When doctors look for lung damage, they’re looking for translucent spots.

Every study participant had literal pneumonia, but only 16 of the 58 people ever showed symptoms from the disease; 22 of the 58 showed complete repair after a week; and 21 showed at least visible improvement in their lungs. Most of the time, the body repairs itself relatively quickly. But what happens to those with medium-severity lung damage?

A study of hospital patients in the original SARS outbreak found that even young people who avoided the ICU had problems. In particular, when patients who had SARS were asked to walk normally for six minutes, they walked significantly shorter distances than people who hadn’t had SARS. But given what we know about comorbidities, it’s possible that being hospitalized was enough to lower these people’s walk distance even before SARS. What’s really going on here?

• Is COVID-19 really triggering diabetes in people? We know that diabetes is a preexisting condition that tends to make COVID-19 worse. But there are a growing number of cases in which diabetes is seemingly being triggered by the virus, even mild cases. That sounds crazy, but there are a number of viruses that have shown the ability to do that before, including H1N1. How often does this happen? Does this form of diabetes stay around, or do people get better? Who is at risk?

• What in the world is going on in people’s brains? Somewhere between two-thirds and three-quarters of people who go to ICUs as a result of COVID-19 end up facing delirium — which may be related to that post-intensive-care syndrome mentioned above. But ICU doctors are seeing symptoms which go above and beyond typical ICU problems: repeated headache, confusion, seizures they aren’t use to seeing at that frequency.

People who aren’t in ICUs, with even mild coronavirus, are also experiencing weird mental symptoms. Is this just because their brains are getting less oxygen? Will it get better? It clearly does in some people, but others are still experiencing effects from a disease that started months ago. Some doctors worry that the virus can break the barrier between blood and brain cells; if true, that’s no uniquely bad.

What long-term impact does coronavirus have on the immune system? Studies say people who were infected still have wild immune cell numbers four to 11 weeks after recovery — a number limited only by how much time the study had.

“There are some people where lots of really important cells are completely depleted and disappeared from the blood. And there are other people, perhaps people who were more mildly affected, where all the cells look terribly turned on and terribly aggressive and terribly activated,” Danny Altmann, a professor of immunology at Imperial College London, said on a Guardian podcast.

Are the high levels why many mild cases experience long-term fatigue? How much longer is the immune system out of wack? What consequences do these levels of immune system cells have on other infection? We have to start figuring that out.

Unknown unknowns

I think some of the scariest coronavirus articles have focused on some really unlikely possibilities. For example, some have worried about how the virus, like chicken pox or herpes, stays in your body your whole life. That it could result in symptoms decades later. There’s no evidence that coronaviruses of any sort do that, so it’d be pretty illogical if this one did.

Likewise, some are worried about the disease mutating into something more severe. Viral mutations happen all the time, but typically they move in the direction of less deadly rather than more deadly. Viruses want to infect as many hosts as possible, and dead bodies are terrible at going to bars and restaurants and spreading the disease.

It’s just not worth it to spend your whole life worrying about the really unlikely stuff. There’s plenty of real worries above without having to get into sci-fi territory.

We tend to put cases in two buckets — people who die or people who will recover. Heck, the state of Utah explicitly does that: they just add anyone who hasn’t died within three weeks of their positive test to the “recovered” tally in their official stats every day. Long-term impacts, those 10% of cases that last longer, muddy that clean split. “Recovered” doesn’t mean “100%.”

As a relatively young and healthy person, I’m very unlikely to die from the virus. But I don’t want my ongoing quality of life to be hurt, either. I want to be able to play soccer and tennis when all of this is over, and hopefully just as well. It’d be terrific if my brain was at 100%, and if I had my full array of immune system functions.

It’s just another thing to consider before engaging in risky behavior. Do I live my life in fear? No. But am I taking basic precautions everywhere I go? Absolutely.

  covid-19 thread (from 7/8)

zn475July 08, 2020 08:46AM

  My thoughts are...

sstrams55July 09, 2020 07:20AM

  Re: My thoughts are...

zn65July 09, 2020 07:39AM

  I have a bad way..

sstrams49July 09, 2020 09:03AM

  I agree with that

zn44July 09, 2020 09:08AM

  I honestly am done with politics..

sstrams60July 09, 2020 09:52AM

  Re: I honestly am done with politics..

zn47July 09, 2020 12:49PM

  Its all good, man..

sstrams42July 09, 2020 12:58PM

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  Swedish doctors: Don't do what we did. It's not working.

zn22July 21, 2020 08:18PM

  Got my Covid test 2 days ago. Results are in.... "Negative". It's like everyone figured..

Ramgator37July 09, 2020 07:26AM

  like the old Dizzy Dean line........

21Dog54July 09, 2020 09:28AM

  Re: Got my Covid test 2 days ago. Results are in.... "Negative". It's like everyone figured..

zn37July 09, 2020 01:33PM

  LOLOL When the girl rammed the Q Tip up my nose.....

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  Re: and in AZ, TN, TX, SC, FL, and NV Attachments

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ramBRO46July 10, 2020 10:28AM

  Hey I like this thread and appreciate the posts

ferragamo7946July 10, 2020 02:57PM

  Re: Hey I like this thread and appreciate the posts

zn40July 10, 2020 03:22PM

  I agree.

Ramgator24July 13, 2020 05:07PM

  Israel & world's worst second wave

zn38July 11, 2020 07:09AM

  Why are young, healthy people dying of coronavirus?

zn38July 11, 2020 07:28AM

  "Hundreds have died"

PHDram42July 11, 2020 07:54AM


zn32July 11, 2020 08:31AM


PHDram32July 11, 2020 08:48AM

  Re: yup

zn33July 11, 2020 10:29AM


PHDram28July 11, 2020 10:33AM

  is there a "post-covid 19 syndrome" ie. longterm effects

zn43July 11, 2020 09:31AM

  covid survivors can suffer weeks after virus clears

zn41July 11, 2020 12:50PM

  "Though there is no data on long-term effects"

PHDram34July 11, 2020 09:16PM


zn35July 12, 2020 04:28AM

  Re: yet

PHDram23July 12, 2020 06:03AM

  where we are in terms of discovering its long-term impacts

zn34July 12, 2020 09:09AM

  Re: where we are in terms of discovering its long-term impacts

zn29July 12, 2020 09:49AM

  Re: 2 where we are in terms of discovering its long-term impacts

zn35July 13, 2020 03:32PM

  more on longterm effects ... 7/14

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  Count me out!

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ramBRO42July 13, 2020 03:56PM

  (sigh!) So Sad

ramBRO38July 13, 2020 04:27PM

  Only in the US..

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ramBRO39July 14, 2020 01:33PM

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MamaRAMa38July 14, 2020 01:52PM

  Re: Interesting Article About Mask Wearing

ramBRO34July 14, 2020 02:16PM

  Re: Interesting Article About Mask Wearing

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  Re: Interesting Article About Mask Wearing

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zn39July 14, 2020 04:46PM

  Well new is kinda in the title

PHDram24July 14, 2020 05:45PM

  Re: A New Understanding of Herd Immunity

ramBRO33July 14, 2020 05:44PM

  Re: A New Understanding of Herd Immunity

waterfield30July 14, 2020 08:19PM

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zn48July 15, 2020 03:43PM

  Re: Tate Reeves, Republican Governor of Mississippi, on "herd immunity"

Rampage2K-36July 15, 2020 07:13PM

  wishful thinking?

zn38July 15, 2020 08:28PM

  Re: wishful thinking?

Rampage2K-31July 15, 2020 08:42PM

  Re: wishful thinking?

zn32July 15, 2020 08:51PM

  Was wearing masks

PHDram25July 15, 2020 09:53PM

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  out today and less than half people wearing mask

ferragamo7933July 18, 2020 06:31PM

  Re: out today and less than half people wearing mask

waterfield28July 18, 2020 08:04PM

  Re: out today and less than half people wearing mask

zn30July 18, 2020 09:34PM

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PHDram30July 19, 2020 06:16AM

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  What would happen if they got it again?

Atlantic Ram17July 29, 2020 05:48PM

  Re: What would happen if they got it again?

zn17July 30, 2020 06:21AM

  Sweden Sees COVID-19 Cases Plummet as Rest of Europe Suffers Spike

PHDram26July 30, 2020 05:05AM

  Re: Sweden Sees COVID-19 Cases Plummet as Rest of Europe Suffers Spike

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  Re: Sweden Sees COVID-19 Cases Plummet as Rest of Europe Suffers Spike

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zn52August 02, 2020 10:04AM

  A couple of other interesting thoughts from the author

PHDram17August 02, 2020 11:13AM

  Re: A couple of other interesting thoughts from the author

Rampage2K-23August 02, 2020 12:21PM

  Re: it;s not just deaths

Rampage2K-25August 02, 2020 12:17PM

  Re: it;s not just deaths

zn22August 03, 2020 05:32AM

  i was under the impression

PHDram15August 03, 2020 05:56AM

  don;t speak for other people

zn24August 03, 2020 06:42AM

  It contributes nothing.

PHDram21August 03, 2020 07:37AM

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  from that

zn12August 04, 2020 11:55AM

  Re: deja vu all over again: The Mask Slackers of 1918

AlbaNY_Ram11August 04, 2020 01:29PM

  Re: deja vu all over again: The Mask Slackers of 1918

Rampage2K-12August 04, 2020 02:31PM