What do we know about persistent COVID

Following the World Health Organization (WHO) report dated September 6, 2021, in some people some symptoms of COVID-19 may persist or recur weeks or months after an initial recovery. This can also happen to people with mild disease.

In a multistate telephone survey of symptomatic adults who had a positive outpatient test result for SARS-CoV-2 infection, 35% had not returned to their usual state of health after overcoming the virus.

Despite the data, Dr. Sabán Ruiz, an internist with expertise in persistent COVID, acknowledges that to date it is still unknown why SARS-CoV2 can cause prolonged illness, even among young adults without underlying chronic medical conditions. Genetics undoubtedly has a lot to say, and this will be known sooner or later, the current results on this subject are very preliminary. But not only genetics, also epigenetics has a lot to say and the proper use of certain nutraceutical supplements that improve our endothelium (the tunic that lines the inside of our blood vessels) has a lot to say.

Symptoms of persistent COVID

Following the WHO report, the most frequent symptoms are:

  • Chronic fatigue
  • Coughing, congestion or shortness of breath
  • Loss of taste or smell
  • Headaches and body aches
  • Diarrhea, nausea
  • Chest or abdominal pain
  • Confusion ‘COVID mental fog”.
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Some of the patients with persistent COVID will develop medical complications that may lead to long-lasting health problems, although it is still too early to state with certainty how long these will last, as WHO has no studies on this issue at this time.

20% of patients aged 18-34 years reported that their symptoms, after overcoming COVID, lasted for a period of time.

In a telephone survey of symptomatic outpatients who tested positive for SARS-CoV-2, 35% reported not having fully recovered their health 2 to 3 weeks after testing. Of the 18- to 34-year-old respondents with no previous chronic conditions, 20% (1 of 5) felt that some symptoms lingered.

According to the doctor, risk factors that seem to indicate a higher likelihood of persistent symptoms are: high blood pressure, obesity, impaired mental health.

What are the consequences of persistent COVID?

Taking as a reference the 2003 SARS, also due to an animal coronavirus like the current one, and sticking exclusively to the lung, a study showed that there was a persistent and significant deterioration in exercise capacity and health status in SARS survivors after 24 months. Healthcare workers who had SARS experienced even more marked negative impacts for unknown reasons. Another study revealed that 40% of people who recovered from SARS still had symptoms of “chronic fatigue” 3.5 years after diagnosis.

According to the recent WHO report, the organs that can be affected in COVID-19 are:

  • Heart: heart muscle damage, heart failure.
  • Lungs: Damage to lung tissue.
  • Brain and nervous system: Absence of sense of smell (anosmia), Guillain-Barré syndrome, which can lead to weakness and temporary paralysis (rare condition).
  • Thromboembolic events such as pulmonary embolism, heart attack, stroke.
  • General: Chronic fatigue syndrome.
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The Head of the Endothelium, Antiaging and Cardiometabolic Medicine Unit at Clínica d-médical, recommends that patients who have passed COVID undergo an endothelial study because the consequences of an altered endothelium can be unpredictable in the medium to long term and add to those derived from smoking, hypertension, hypercholesterolemia, diabetes, among others.

And this without ruling out that endothelial damage could be behind many of the symptoms of persistent COVID because ACE2, the SARS-CoV2 receptor, is produced by the endothelium and because the most damaged tissue in autopsies has coincidentally been the endothelium. In spite of this, research in this field has been very scarce, or rather null, and several specialists, including myself, have been denouncing it in different forums for more than a year.

Are the sequelae just as harmful as the cases that overcome the disease and remit their symptoms?

We do not have an answer to this question but, apart from pulmonary involvement, there is probably no difference in everything else. Strokes, myocardial infarctions and myocarditis have been described in young people who did not even require admission in the acute phase. Some recovered, but others did not. From the pulmonary point of view, the greater the severity of the disease in the acute phase, the greater the probability of long-term sequelae.

And as for treatment, the doctor points out that, apart from physical and respiratory rehabilitation, the latter in cases that need it, each patient is different.

“There is always room for hope”

The doctor reports that he recently received in his office a patient in her early 40s who had traveled more than 700 km to be evaluated by his team and to try to help her control a diarrhea that forced her to wear diapers, after having failed the treatment prescribed in one of the most prestigious private centers in the country.

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After only one week of treatment with us, everything changed for her and where she felt hopeless she now feels more hopeful than ever. From that experience we learned that there are no lost cases and hers is a good example of that.