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Experts are learning how COVID-19 may cause long-lasting symptoms. Getty Images
  • As the pandemic continues, we’re learning that many people who experience COVID-19 endure long-term health consequences called post-viral syndrome.
  • Symptoms include fatigue and brain fog.
  • The syndrome may be related to cytokines that cross the blood-brain barrier and affect the brain.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.

COVID-19 can bring severe illness that may take weeks to overcome.

But even after surviving the initial infection, some people have symptoms that persist.

Six months after the disease was first identified, experts are learning about its long-term effects. We now know that the disease can cause heart damage, neurological issues that include stroke, and lung damage.

Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases and member of the White House Coronavirus Task Force, recently spoke on another, potentially debilitating, consequence of the infection: post-viral syndrome.

“Brain fog, fatigue, and difficulty in concentrating,” Dr. Fauci said at the International AIDS Conference. “So this is something we really need to seriously look at because it very well might be a post-viral syndrome associated with COVID-19.”

This condition is called myalgic encephalomyelitis (ME)-like illness. ME was previously called chronic fatigue syndrome (CFS).

“We see this with any virus, and it’s basically unexplained, persistent, relapsing fatigue. It’s most documented in women, twice as much as men,” Dr. Donna Casey, internist at Texas Health Presbyterian Hospital Dallas told Healthline. “We can now see documented abnormalities in your nervous, immune, and metabolic systems. So we’re seeing abnormalities in all three that creates myalgic encephalomyelitis.”

She added that it can affect people at all ages, but if you’re older and have other health issues, it can have a more lasting effect.

Casey emphasized that people with post-viral syndrome do improve with time. “Of course, we’re not at the six month mark for COVID, but my hospitalized patients, I’m seeing a lot of them once a week, and I can see them getting better.”

“I think, if you have diabetes and hypertension, you are more likely to have the cytokine storm which in turn means you’re going to end up in the ICU on a ventilator,” said Dr. Amir K. Ghiassi, pulmonologist with St. Joseph Hospital in Orange County, California.

“If your immune system isn’t able to fight it but you still have some degree of health — I think it just becomes kind of a long battle.”

Ghiassi underscored that, “What we do know is the people who get it, it takes a long time for them to recover.”

He warned that COVID-19 isn’t the regular flu “where you get it and recover, that’s what we’re trying to tell people.” Also, a big question is whether this is because of the live virus or “because of the immune system reacting the way it does that causes symptoms.”

Ghiassi said if a patient is experiencing the same symptoms, it’s likely they haven’t defeated the virus yet, but, “If symptoms go away, then a new set of symptoms come on, that’s a different story.”

“Treatment is focused on reassurance, self-care, and symptomatic control,” said Dr. Minh Nghi, internist at Texas Health Harris Methodist Hospital Southwest Fort Worth and Texas Health Physicians Group.

“Sleep disturbances are addressed with sleep hygiene measures: turn off lights in bedroom at night, no TV in bed, try not to be very active in bed such as trying to read a tablet,” specified Nghi. “Sometimes sleep medications or even low-dose antidepressants are used to help with sleep.” He added that meditation and yoga might also be effective.

Nghi affirmed that pain issues are addressed, but sometimes therapies such as cognitive behavioral therapy (CBT) and exercise can be used. “Acupuncture and massage have also been tried.”

“One has to be careful due to a phenomenon called post-exertional malaise (PEM),” he cautioned. “Which is a loss of stamina both mental and physical after exercise. So gradual exercise and monitoring is recommended.”

He expressed frustration that there are currently no FDA-approved treatments specifically for this condition.

It should be noted that, for people experiencing ME, the CDC currently advises “While vigorous aerobic exercise can be beneficial for many chronic illnesses, patients with ME/CFS do not tolerate such exercise routines.” The Centers also warn that “Standard exercise recommendations for healthy people can be harmful for patients with ME/CFS.”

Dr. Robert Glatter, emergency physician, Lenox Hill Hospital in New York, explained that an accumulation of inflammatory cytokines in the central nervous system could lead to post-viral symptoms, especially when they cross the blood-brain barrier.

“The result of pro-inflammatory cytokines crossing the blood-brain barrier in the hypothalamus,” Glatter said. The hypothalamus is an area of the brain that helps regulate temperature, controls hormone release, and controls appetite among other functions.

As a result of the cytokines crossing the blood-brain barrier, it can lead “to autonomic dysfunction such as high fevers, abnormalities of the sleep/wake cycle, cognitive abnormalities, and severe fatigue,” said Glatter, “Which are characteristic of ME/CFS.”

He confirmed this is similar to what happened during the SARS outbreak in 2002-2003. A percentage of COVID-19 patients may go on to develop post-viral COVID-19 syndrome.

“The truth is we don’t know the long-term prognosis as well as the timeline for those with residual symptoms after initial infection with COVID-19,” he concluded. “But the harsh reality is that we’re learning that many patients who ‘recover’ after their initial infection continue to experience prolonged symptoms.”

Glatter pointed out a study revealing that 87 percent of patients who have recovered from COVID still have one persistent symptom.

However, “We don’t know all the reasons behind those who continue to have lingering symptoms such as fatigue, difficulty breathing, chest pain, and joint pain.”

He said one explanation for these symptoms, seen in patients with ME/CFS, suggests a possible defect in mitochondrial functioning, an important part of cells involved in energy production and regulation.

“Another theory suggests a disturbance in the lymphatic system that drains a specific part of the brain known as the cribriform plate,” said Glatter. “The defect involves special cells known as microglia that surround neurons or brain cells.”

He explained that this disturbance could cause an accumulation of pro-inflammatory compounds.

“Long haulers, or those with lingering symptoms beyond two weeks, may be developing a condition similar to those persons who have ME/CFS,” said Glatter. “What’s clear is that we need to devote considerable research to the study of the post-COVID viral syndrome. Ironically, COVID-19 is shining light on the often ignored patient population with ME/CFS.”

As the pandemic continues, we’re learning that many people who experience COVID-19 endure long-term health consequences called post-viral syndrome.

Symptoms include fatigue, difficulty concentrating, and brain fog.

There are no FDA-approved treatments for post-viral syndrome, but experts say patients with post-viral syndrome can get better with time.