The existence of the Covid-19 virus and the SARS-CoV-2 virus that causes the disease has been known for less than half a year. It goes without saying that precise pathogenesis has not been fully characterized.
What is also unclear at this stage are the reasons for the differential impact the disease has on those who test positive for the new coronavirus. A clear distribution in all three categories of asymptomatic, mild and severe cases is far too simplistic.
A Dutch study published this week confirms, for example, that some patients in the “slightly symptomatic” category are found to be heavily burdened with Covide-19 for long periods, sometimes months.
From the beginning of the pandemic, there was misconception that a minority of infected people, who are usually elderly or have pre-existing health problems, become seriously ill. They often require hospitalization and, in some cases, intensive care.
And more than 80% of cases, according to the World Health Organization, are mild or asymptomatic. These patients typically recover after two weeks.
However, rapid recovery has not been the experience of thousands- perhaps tens of thousands – of patients worldwide who have been classified as mild cases. Many struggle for months with persistent symptoms of Covid-19 that can be debilitating. They experience shortness of breath, extreme fatigue, intermittent fevers, cough, concentration problems, chest pressure, headaches and heart palpitations, among other symptoms. Literature has a name for them: “long-haul.”
In the Netherlands, the Lung Foundation, in collaboration with Maastricht University and the CIRO group, interviewed 1,622 Covid-19 patients who had reported a number of long-term effects of their disease. Ninety-one percent of patients were not hospitalized, indicating that the vast majority of patients surveyed would fall into the “slightly symptomatic” category. The average age of the patients interviewed was 53 years.
Nearly 88% of patients reported persistent intense fatigue, while almost three out of four had continuous shortness of breath. Other persistent symptoms include chest pressure (45% of patients), headaches and muscle aches (40% and 36%, respectively), high pulse (30%) and dizziness (29%). Perhaps the most surprising conclusion is that 85% of the patients surveyed considered themselves healthy before obtaining Covide-19. One or more months after giving birth, only 6% consider themselves healthy.
Just as the exact biological mechanism that leads to the ons manifestation of symptoms of Covide-19 is unknown, it is not known why some patients have very long-term effects. A number of clinicians postulate that reactivation may occur in a number of patients in which coronavirus, which could remain dormant or latent in a patient’s body for a period of time, “awakens” to an active phase and causes recurrent symptoms. Essentially, this hypothesis suggests that some patients harbor the virus somewhere in their bodies, and they are either still tested positive for the virus or missed by conventional coronavirus tests that use nasal swabs. What is perhaps a more likely scenario, according to immunologists, is that the virus no longer resides in the body, but the immune system continues to be perpetually overworked.
Regardless of the possible reasons for some “slightly” patient patients to be symptomatic in the long term, the Dutch study confirms what is known anecdotally about long-haul flights. For this group, recovery is an exhausting process. Globally, as the number of people infected with the new coronavirus increases, the number of people with (temporary) disabilities will also increase, despite their “slightly symptomatic” status.