COVID-19 Can Result in Prolonged Illness

"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 when interviewed 2-3 weeks after testing. 

"Among persons aged 18–34 years with no chronic medical conditions, one in five had not returned to their usual state of health.”

(Mark W. Tenforde, MD, PhD et al. “Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network – United States, March–June 2020.” CDC Weekly. July 31, 2020.)

The findings above support evidence that COVID-19 can result in prolonged illness, even among young adults without underlying chronic medical conditions. Effective public health messaging targeting these groups is warranted. COVID-19 can have long-lasting effects.

The Centers for Disease Control and Prevention acknowledged that a significant number of COVID-19 patients do not recover quickly, and instead experience ongoing symptoms, such as fatigue and cough. As many as a third of patients who were never sick enough to be hospitalized are not back to their usual health up to three weeks after their diagnosis, the report found.

In addition, two recent British studies – one that looked at the neurological impact of COVID-19 on 43 patients ranging between the ages of 16 and 85, and another published in the Lancet examining 153 patients, ages 24 to 93 – found that in those cases symptoms were varied but severe.

“They can have seizures, fever, they can have hallucinations that could be very disturbing for them or their family members, psychotic symptoms,” said Dr. Mike Zandi, a lead author of one study, co-author of the other and a consultant neurologist at Britain’s National Hospital for Neurology and Neurosurgery. “It can be very hard to distinguish what is psychiatric disease from medical disease.”

Research into the neurological effects of COVID-19 is still in its early stages, he said, but the adult patients included in the studies were infected by the coronavirus first, then exhibited a similar pattern of inflammation, allowing for “no other reasonable explanation.”

(Olivia Sumrie and Willem Marx. “COVID-19 and children: Doctors see link between virus and neurological side effects.” NBC News. August 05, 2020.)

One Case

Nia Haughton, 15, had a lengthy treatment in a London hospital In early April, the British teen had been battling a cough and a high temperature for about 10 days, but when her condition significantly deteriorated her mother, Justina Ward, called for help.

The first emergency room to admit her recognized that her illness was both acute and complex, and transferred her to one of central London’s top children’s hospitals. Soon after her arrival there with several recognizable COVID-19 symptoms, she was sedated and placed on a ventilator inside an intensive care unit, where she remained for two weeks.

For days, her lungs labored to stave off collapse until the medical staff tried “proning” her for 16 hours a day. During proning, Nia was turned to lie on her front at a slight incline, but kept on ventilation with the help of an anesthesiologist. This approach allows oxygen to be blasted to the back of a patient’s lungs, and has been beneficial for many COVID-19 sufferers.

Eventually, Nia turned a corner and was able to breathe again unaided. But after several days in recovery, her condition worsened once again. This time, it was her brain rather than her lungs that was affected. Awake night after night, she began hallucinating, seeing and hearing people in the hospital who were not really there.

After repeated, violent seizures that left Nina exhausted and sleeping for long periods, she was taken back into the ICU where her doctors were struggling to understand what was happening inside her nervous system and brain.

“I don't know which was scarier, her being on the ventilator not being able to breathe, or the fact that she came out of it with a completely different personality,” Ward, 42, said.

During this period, Nia’s voice and behavior appeared to regress to a younger version of herself. Pediatric neurologist Dr. Ming Lim of the Evelina London Children’s Hospital diagnosed her with encephalitis, an inflammation of the brain.

Lim said Nia’s diagnostic and antibody tests had both come back negative, but he had seen other patients with the same "COVID picture” of symptoms who had tested positive.

(Olivia Sumrie and Willem Marx. “COVID-19 and children: Doctors see link between virus and neurological side effects.” NBC News. https://www.nbcnews.com/health/health-news/covid-19-children-doctors-see-link-between-virus-neurological-side-n1235501. August 05, 2020.)

Many Questions Remain

Why and how the does the coronavirus produces neurological symptoms in some? Does it target the nervous system directly? Or is the brain merely a victim of the body's reaction to the infection?

Sherry Chou, associate professor of critical care medicine, neurology and neurosurgery at the University of Pittsburgh, says …

“We definitely don't know enough … We're really in uncharted waters here. Most of what we do know about how the virus attacks the body is still anecdotal due to its newness and the current focus on care and containment.”

Chou is hopeful the gap in knowledge will soon narrow, however. She's leading a research consortium of physicians and scientists from around the world to better understand the virus’ impact on the brain and the nervous system. Chou adds …

"We need to figure out as quickly as we can, and as accurately as we can, how big a problem this is, how often is this happening, and who is it happening to.”

(Rachel Nania. “This Is What the Coronavirus Can Do to Your Brain.” AARP, May 7, 2020.)

History may show a similar link. At around the same time as the 1918 flu pandemic, there was an epidemic of encephalitis lethargica, or “sleeping sickness.” Between 1917 and 1927, millions of people likely developed this issue worldwide. Many of the survivors experienced lasting behavioral changes and extreme lethargy. Some lived in catatonic states.

(L.A. Hoffman and J.A. Vilensky. “Encephalitis lethargica: 100 years after the epidemic.” Brain; 140 (8):2246–2251. 2017.)

In addition to the risk of death in a relatively large number of patients, other manifestations of post-encephalitic Parkinsonism may have developed over time, which could have been years later.

(J.R. Berger an J.A. Vilensky. “Encephalitis lethargica (von Economo’s encephalitis) Handb. Clin. Neurol; 123:745–761. 2014.)

Medical experts agree that understanding exactly how an infection with the new coronavirus causes these symptoms will require more research. Dr. Allen Aksamit Jr., a Mayo Clinic neurologist, says what's unclear is whether that is direct effects of the virus actually getting into the nervous system and damaging the brain or an indirect effect as a consequence of the respiratory and other compromise of the rest of the body. Whatever the case, the symptoms are frightening.