New COVID-19 cases may be trending down worldwide, but the effects of the virus are far from over.
As the pandemic continues, we’re constantly learning the effects that it can have on our organs and overall health. A recent study in JAMA Network Open found that 30% of people who have had COVID-19 still have symptoms up to nine months later. This is commonly referred to as long COVID.
“What is highly unpredictable is determining who will have long-lasting effects from COVID-19 and what types of symptoms they will continue to have after recovering from the acute illness itself,” says Monnie Wasse, MD, MPH, a nephrologist, vice chair of clinical operations for the RUSH Department of Internal Medicine and director of RUSH’s post-COVID care clinic.
Although we may not know the full extent of the damage due to COVID-19, Wasse says one thing remains clear: "Wearing a mask and other safety precautions are better alternatives than even a mild case of COVID-19 and its potential long-term impact."
Experts in RUSH’s post-COVID care clinic discuss five long-term effects from the virus — including pulmonary, cardiovascular and neurological complications, as well as rehabilitation and psychological concerns — and ways that they are helping COVID long haulers manage their symptoms.
1. The way we breathe.
COVID-19 is often connected to a type of pneumonia that can damage the tiny air sacs in the lungs and leave scar tissue, which can lead to long-term breathing problems, such as shortness of breath.
“One reason survivors of COVID-19 may have long-term breathing issues is likely due to the effect that a severe pneumonia has on the musculoskeletal system,” says pulmonologist Jared Greenberg, MD. “Specifically, when the diaphragm — the main breathing muscle — is weakened by inflammation from infection or being on a breathing machine for multiple days, it can affect how much effort it takes to breathe.”
A July 2020 study in The Lancet found that over 60% of the 55 recovered noncritical participants with COVID-19 had persistent respiratory issues three months after their hospital discharge. Additionally, over 70% had abnormal findings on lung CT scans and 25% had decline in lung function.
“We’re seeing lung scarring in CT scans from many patients who have been in the ICU for multiple weeks with COVID-19,” Greenberg says. “However, we suspect to see more physical symptoms of the damage once the patient returns to their normal life — that is whether these findings on CT scans are related to ability to walk and the need for extra oxygen. That’s when we will truly be able to understand the long-term impact of COVID-19 on a patient’s pulmonary function.”
According to Greenberg, everyone’s path to recovery will be unique, depending on your overall health and any underlying conditions. However, research in New Scientist shows that incorporating deep breathing techniques into your daily routine, can help restore diaphragm function, increase lung capacity and, ultimately, play an important role in the COVID-19 recovery process.
If you are having issues with your breathing after recovering from COVID-19, Greenberg suggests contacting your primary care provider or a pulmonologist, who can evaluate your symptoms and help determine a treatment plan to address them.
2. The way we think.
A study in Annals of Clinical and Translational Neurology found that 30% to 40% of people have neurological aftereffects of COVID-19.
“For decades we’ve known that viruses can affect the brain and its function,” says Zoe Arvanitakis, MD, MS, a cognitive neurologist at RUSH. “And since COVID-19 is relatively new, we’ve been able to use the knowledge about other viruses to help us evaluate and treat patients with COVID-19 and their symptoms; however, ongoing research is needed to truly understand the full scope of the long-lasting neurological effects and to identify better treatments.”
Arvanitakis notes that she is seeing patients who have had COVID-19 struggle with a variety of thinking problems, which last for months after their initial infection — including difficulty with concentration and attention, memory and word-finding. And she adds that some patients describe trouble with the speed of their thinking. These symptoms have been called, “brain fog.” Other post-COVID-19 problems, such as sleep disturbances and fatigue, can further contribute to thinking problems — making day-to-day life, work and activities more difficult.
In many minor cases of COVID-19, Arvanitakis adds that cognitive-related symptoms seem to improve gradually over time. “Time can be a great healer,” she says.
In addition to time, however, she recommends other health-promoting approaches and activities. “Regular exercise, mental exercises, safely socializing, a healthy diet and good sleep habits, are all ways to help manage or potentially recover from the cognitive side effects of COVID-19,” Arvanitakis says.
For cognitive symptoms that are not improving, she suggests working with your health care provider to find treatments and medications that may help.
3. The ways our heart works.
A study in JACC Cardiovascular Imaging found more than 50% of imaging tests of participants who have recovered from COVID-19 showed lasting inflammation and damage to the heart muscle, even in participants who had only mild symptoms of the virus.
“When someone has COVID-19, the virus can directly attack the heart muscle cells, which can diminish the heart’s function,” says cardiologist Joseph Mularczyk, MD. “Generally, if you have symptoms of heart damage due to the virus, they will appear within the first two months of your infection.”
Common symptoms due to heart damage from COVID-19 include the following:
- Fatigue
- Chest pain
- Severe dizziness
- Shortness of breath
- Irregular heartbeat
Mularczyk suggests contacting your primary care physician or cardiologist for further evaluation if you’re experiencing any of these lingering symptoms. Left untreated, these conditions could put you at risk for long-term heart complications, such as congestive heart failure, heart attack and losing consciousness.
Some cardiologists also note that a heart-healthy lifestyle — including regular exercise and a healthy diet — can help offset your risk and manage the complications from COVID-19.
4. The way our whole body works.
According to a study in the Journal of Rehabilitation Medicine, 20% of patients recovering from COVID-19 will require physical rehabilitation.
“We have seen many COVID-19 patients who are suffering from a variety of physical conditions,” says physical medicine and rehabilitation specialist Sol Abreu-Sosa, MD. “Most commonly we see patients with joint pain, fatigue and muscle pain.”
Abreu-Sosa emphasizes the importance of movement and exercise, particularly if you were hospitalized with COVID-19. And research suggests that patients lose 2% to 4% of their muscle mass (the amount of muscle in your body) per day in the intensive care unit.
“For patients with COVID-19 who have a prolonged [hospital] stay, they can lose at least 20% of their muscle mass,” she says. “We encourage our patients to incorporate daily exercises — even the smallest movements — to help improve and maintain their muscular strength.”
When working with a rehabilitation specialist post-COVID, our team will start by discussing your health history, identify your signs and symptoms, and either treat or refer you to the right provider who can address your unique symptoms. “As rehabilitation specialists, we see the body and how it functions as a whole,” Abreu-Sosa adds.
Other effective treatments can include physical therapy, occupational therapy, speech therapy and psychological therapy.
5. The way we cope.
Whether you, a family member, significant other or close friend contracted COVID-19, it can take a toll on your mental health.
The Centers for Disease Control and Prevention reports that symptoms of anxiety and depression have increased considerably since the beginning of the pandemic in the United States. There has also been an increase in feelings of isolation, grief and fear, which can trigger mental health conditions or influence existing ones. And research shows that rates of depression, anxiety and PTSD are particularly high among survivors of COVID-19.
Effective treatments to address the psychological effects of COVID-19 include virtual therapy, support groups and mindfulness activities like yoga and meditation. Abigail Hardin, PhD, rehabilitation psychologist at RUSH, adds that there are evidence-based, effective treatments for anxiety, depression and stress, to help with physical changes from COVID-19.
“The virus impacts survivors physically but also psychologically, and it’s critical to treat the whole person,” Hardin says. “After COVID-19, it’s important to seek treatment for all changes in your body and mind”
