What Are the Long-Term Effects of Covid-19 Infection? 50 Symptoms

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in China in December 2019. In the year since then, more than 100 million people worldwide have been infected and more than 2 million have died from “coronavirus disease – 2019”, also known as Covid-19.

With an unprecedented effort, the scientific and medical community has managed the genetic sequencing of the SARS-CoV-2 virus (determining its sequence), diagnosis, treatment and prevention through vaccination, but the long-term effects in individuals after the acute phase of the disease have not yet been explained.

What are the chronic symptoms after Covid-19?

To date, no term has been established for COVID-19 persistent sequelae in affected people (disorders remaining after an illness) that describes this persistent condition. Nevertheless, various articles have used the following terms;

• Long-COVID-19
• Long Haulers
• Post-acute COVID-19
• Persistent COVID-19 Symptoms (persistent Covid-19 symptoms)
• Post COVID-19 Manifestations (symptoms after Covid-19)
• Long-term COVID-19 Effects (long-term Covid-19 effects)
• Post Covid-19 Syndrome (syndrome after Covid-19)

What happens after recovering from Covid-19?

Covid-19, caused by the SARS-CoV-2 virus, may involve sequelae and other medical complications (problems) in the weeks to months after initial recovery, referred to as Long – Covid or Covid long – haulers. In other words, not fully returning to baseline health after recovering from Covid-19, along with persistent symptoms, signs or abnormal clinical differences, suggests the potential for long-term effects of the disease.

A systematic review and meta-analysis (analysis of past data) was used in a study aiming to identify the long-term effects of Covid-19. The study involves reviewing related articles to determine how frequently all symptoms, signs or abnormal laboratory parameters reported to date persist beyond the acute phase of Covid-19.

What is a meta-analysis? Meta-analyses are the most comprehensive studies, combining the results of multiple independent studies on a particular topic and statistically analysing their findings. Meta-analysis results provide the strongest scientific evidence.

The study searched for articles using certain keywords up to 1 January 2021 (long Covid, post-Covid chronic conditions, complications, recurrent conditions, persistent conditions and recovery), published in English in peer-reviewed journals, involving at least 100 people and reporting symptoms, signs and parameters.

What are the long-term effects of Covid-19?

In the study, which included 47,910 patients aged 17 – 87, follow-up after viral infection ranged from 14 to 110 days. The study results estimate that 80% of patients developed one or more long-term symptoms, but it was not determined whether symptoms were associated with sex, age, ethnicity, any underlying health problem, viral load or advanced disease. Most of these symptoms resemble those developing during the acute phase of Covid-19.

The 5 most common long-term effects of the novel coronavirus infection are:

• Fatigue (58%) (more common in women)
• Headache (44%)
• Attention disorder (27%)
• Hair loss (25%)
• Shortness of breath (24%)

Although changes of this kind have mostly been reported in people who recovered from severe and critical Covid-19, they have also occurred as long-term effects in individuals with mild infection who did not need hospitalization.

Other long-term effects;

Lung disorders

• Cough
• Chest pain
• Reduced pulmonary diffusion (O2-CO2 exchange in the lungs) capacity
• Sleep apnoea
• Pulmonary fibrosis

Cardiovascular disorders

• Arrhythmias (heart rhythm disorders)
• Myocarditis (inflammation of the heart muscle)

Neurological disorders

• Dementia
• Depression
• Anxiety
• Attention disorder
• Obsessive-compulsive disorders (OCD)

There are also symptoms without an identifiable cause, such as hair loss, tinnitus and night sweats.

• You may be interested in: Can Cancer Patients Have the Covid-19 Vaccine? 

Fatigue

Fatigue is the most commonly observed (58%) long-term effect of Covid-19.

In conditions such as acute respiratory distress syndrome (ARDS), clinically significant fatigue symptoms have been observed in more than two-thirds of patients even a year after recovery. Some people with acute Covid-19 also show fatigue even 100 days after their initial symptoms.

The presence of symptoms after Covid-19 such as partly severe fatigue, pain, neurocognitive disability and insomnia resembles Chronic Fatigue Syndrome (CFS). Causes of Chronic Fatigue Syndrome include viruses, immune dysfunction, endocrine-metabolic dysfunction and neuropsychiatric factors. Infectious agents associated with CFS include Epstein-Barr virus, cytomegalovirus, enterovirus and herpesvirus. SARS-CoV-2 is therefore thought to be a possible addition to the list of viruses causing CFS.

Neurological Symptoms: Headache and Attention Disorder

Among neurological symptoms, headache and attention disorder are among the five most common long-term effects, while anosmia (loss of smell – 21%) is also among the most common long-term symptoms, although not in the top five. Brain fog and neuropathy (sensory and motor loss due to nerve damage) are also thought to be possible long-term effects of Covid-19, although they were not found in the articles reviewed.

Adults may also be at risk of a new psychiatric disorder after a Covid-19 diagnosis. The most commonly observed psychiatric disorders were anxiety, insomnia (which may also lead to other psychiatric problems) and dementia.

Hair loss

Hair loss after Covid-19 is considered Telogen Effluvium, defined as hair loss after a factor causing significant systemic stress or an infection. It results from premature follicular transitions from the active growth phase (anagen) to the resting phase (telogen). It lasts approximately 3 months but may cause emotional distress.

Shortness of breath

Shortness of breath is a symptom in 24% of Covid-19 patients and cough in 19%. Even 60 to 100 days after diagnosis, 35% of patients continued to have this condition and abnormal lung CT (computed tomography) scans. Lung disorders such as reduced pulmonary diffusion capacity are present in 10% of patients. 

In China, a study of hospitalized patients who had Covid-19 but did not have severe disease also reported that two-thirds still had radiographic differences even 90 days after discharge.

Although not mentioned in the articles evaluated, the following symptoms are also among the 50 identified long-term effects;

• Sudden weight loss
• Ear pain
• Eye problems
• Sneezing
• A cold nose
• A burning sensation in the windpipe
• Dizziness
• Palpitations
• Pain or a burning sensation in the lungs
• Pain between the shoulder blades
• Sicca syndrome (also known as dryness syndrome; dryness of the mouth and eyes)
• Vertigo
• Body aches
• Confusion (clouding of consciousness)

Data from the studies also reported increases in the following markers;

• D-dimer (20%)
• NT-proBNP (11%)
• C-Reactive Protein (CRP) (8%)
• Serum ferritin (8%)
• Procalcitonin (PCT) (4%)
• IL-6 (3%)

Why does Covid-19 have long-term effects?

The reason some patients experience prolonged symptoms after COVID-19 is unclear. This may be partly explained by genetic predisposition, the patient's age, the dose and route of infection, the influx of anti-inflammatory cells and proteins, the presence of concurrent infections and previous exposure to cross-reactive agents, among the host-controlled factors that influence the outcome of viral infection.

It is still unknown whether SARS-CoV-2, like HIV, hepatitis C virus (HCV), hepatitis B virus (HBV) and certain herpesviruses, can cause significant tissue damage leading to a chronic form of the disease, such as the chronic lesions observed during recovery from these viral infections.

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