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The mysterious debilitating Coronavirus convalescence

In Northern Italy, people are talking about how some people have not recovered even two months later. Patients with mild infections can recover, feel fine, and test negative, but then slide into debilitating fatigue, with strange aches and pains, bouts of diarrhea, and  burning eyes. Some of them even test positive again.

And these were not the serious ICU cases which are paralyzed and ventilated. The head doctor of a hospital in Lombardy said “the discomfort often seems to last even longer for people with lighter symptoms. “

Surviving Covid-19 May Not Feel Like Recovery for Some

Debilitating symptoms can last long after a person’s body has gotten rid of the coronavirus, a reality Italians are now confronting.

Jason Horowitz, New York Times

The stubbornness of the virus and the length of the convalescence have become topics of conversation in northern Italy where some of the longest-suffering Italians are finding themselves in physical and financial uncertainty, unable to shake sickness and fatigue and get back to work.

But even some of the infected who have avoided pneumonia describe a maddeningly persistent and unpredictable illness, with unexpected symptoms. Bones feel broken. The senses dull. Stomachs are constantly upset. There are good days and then bad days without apparent rhyme nor reason.

The ACE2 receptors the virus binds to are expressed in the lung, kidney, heart, stomach, liver, thyroid, bladder, breast, uterus, and prostate. Theoretically, especially with random clots, problems could crop up anywhere.

Edmondo Cirielli, a member of Parliament, got sick on March 7th, he suffered debilitating fatigue, sore throat, diarrhea and intense pain at the base of his neck that made it impossible to concentrate. It was up and down for a month,” he said.

Then things got stranger. After 40 days of feeling lousy, he tested negative for the virus, but his eyes still burned and bouts of diarrhea continued, he said.

At the end of the month, he finally felt better, but another test result came back positive, forcing him to spend weeks more in isolation…

There is so much we don’t know about this virus. We don’t know the long term sequelae, or the productivity cost (how many people does this apply too, and how long will it be before these people return to work?). It’s possible the virus may reduce lung capacity (which is associated with higher mortality). It could affect kidney health, or cause heart muscle scarring. If this virus were to shorten life spans by five or ten years, we won’t even know that for twenty years. And if asymptomatic cases can suffer silent effects like microclots, they could still suffer some longer term damage –even though they might not realize they ever had Coronavirus. And if they wait years to do an antibody test, it may be too late to find out (if natural immunity does not last), so they may never know.

It will be difficult to even do those long term studies if we do not start now.

Lingering and painful: the long and unclear road to coronavirus recovery

Nicola Davis, The Guardian

She is not alone: Fiona Lowenstein, a writer in the US, co-founded a group on the social media platform Slack for people who have experienced Covid-19 after it took her weeks to recover from being admitted to hospital with the disease.

Many report waves of symptoms over a period of weeks – from heart palpitations to headaches, shortness of breath and fatigue.

In a survey of group members, 89% of the 465 respondents said they had symptoms that fluctuated in intensity and frequency; 23% had tested positive for coronavirus, taking on average just over nine days to be tested from the onset to symptoms; 28% tested negative and were, on average, tested after about 15 days; and just 3.5% were admitted to hospital, although 38% visited an emergency department.

The Slack group survey found two-thirds of respondents had a pre-existing medical condition, mainly seasonal allergies or asthma.

But Dr James Gill … said data from the Sars outbreak revealed that almost a third of those who had had that particular coronavirus still had a reduced tolerance to exercise many months later, despite having normal lung function. While Gill stressed that Covid-19 was a different disease, he said it could be that a similar proportion of about a fifth or a third of those with Covid-19 had lengthy recovery time .

Prof David Heymann said concern was starting to mount that the virus might trigger some form of Chronic Fatigue Syndrome.  “We don’t know”.

Of the 712 cases on the Diamond Princess, three months later, 48 are still listed on worldometer as “active cases” and 4 are listed as still in a serious or critical condition. Does anyone know if these numbers are correct?

 

REFERENCES

High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa, Nature, https://www.nature.com/articles/s41368-020-0074-x

Pedone, et al (2012) Association of Reduced Total Lung Capacity With Mortality and Use of Health Services, April 2012Volume 141, Issue 4, Pages 1025–1030 , DOI: https://doi.org/10.1378/chest.11-0899

 

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