What are long (lasting) COVID-19 and its associated health problems for people who have been infected with Acute Respiratory Syndrome 2 (SARS-CoV-2)?  

Because we hear daily about the high number of new cases of COVID-19 nationwide, due to the delta variant, we don’t pay as much attention to what happens to people who have been infected, treated and discharged from care.

What is underreported in lay press articles is that 80 percent of symptomatic people with COVID-19, regardless of severity,  develop one or more long-term symptoms. A literature review of medical articles published in Scientific Reports, August 2021, reports that there have been 50 different medical complications reported by physicians.

The terminology is confusing and not standardized for these conditions that we will discuss. For the purpose of this article, we will describe these complications under the heading of “long COVID.” Lay press will refer to these people as “long-haulers.”   

A mild-to-moderate COVID-19 infection lasts about two weeks in most people, but others experience lingering problems that can extend out weeks to months. People with severe symptoms that require hospitalizations and stays in the ICU require a long period of time to rehabilitate. Even people who are treated as outpatients can develop a long-term disability. Additionally, we are now beginning to see long COVID in children due to return to the school setting.

For people over the age of 18, SARS-CoV can attack the lungs, heart, kidneys, liver, central nervous system, and other organs. Common long-lasting symptoms are fatigue, shortness of breath, persistent cough and joint and chest pain. Other associated problems include difficulty in concentrating (“brain fog”), depression, dizziness, headaches, rapid heart rate and periodic fever. [See box for more detail.]

Diabetes is considered a risk factor for developing severe COVID complications.

Long COVID-19 in children

Fortunately, most children infected with COVID-19 are either asymptomatic or have mild symptoms that last less than four weeks. The Journal of the American Medical Association reported that about one in every 25 children with COVID-19 has symptoms extending beyond 12 weeks. There is a need to study children who have been vaccinated with unvaccinated kids to see if there is a difference in long COVID-19 side effects.   

At this time, vaccines are available for children aged 12 to 17.

A study reported by King’s College in London used caretaker data from 1,734 children aged five to 17 to track the most common long-term symptoms. Of this group, 37 were hospitalized but there were no reported deaths. Older children, 12-17 years of age, were more likely to have long COVID-19 symptoms compared to younger kids, aged five to 11. [See box.]

Long-term COVID-19 in children

The most common long-term symptoms in children include:

“Brain fog” or trouble concentrating

Chest pain

Cough

Depression/anxiety

Heart palpations  

Joint and muscle pain

Lightheadedness when standing up

Loss of taste and smell

The sensation of trouble breathing

Severely symptomatic children in the ICU, who may have been on a ventilator, can develop weak muscles, fatigue, persistent rapid heart rate and brain fog. These symptoms can exist for a long period of time, as with adults.

WebMD reports that COVID-19 can overlap with other existing problems in children and young adults. Chronic fatigue syndrome clinically looks similar and can co-exist with COVID-19. Orthostatic intolerance can develop as a long-term complication of COVID-19; it includes lightheadedness, weakness, dizziness, or faintness when they sit or stand for more than a few minutes, especially after showering or more physical activity.  

What is the treatment for long COVID-19?

Treatment of these long-term complications for adults and children center mostly around breathing exercises, physical therapy, medications, and other supportive therapies.  Because there is not yet a clear understanding of how COVID-19 causes damage to various organ systems, targeted therapies are not available.   

The best way to avoid post-COVID-19 complications is the prevention of infection in the first place. Practice physical spacing, hand washing and mask-wearing when in crowded settings, along with getting vaccinated.   

If you think that you are becoming symptomatic from COVID-19, an urgent referral to your family doctor is essential, because of the potential permanent heart and or lung damage. Do not ignore a loss of the sense of smell, depression, anxiety or insomnia. If you experience new chest pain, difficulty breathing, bluish lips or any incapacitating symptoms, call 911 or emergency services immediately.