Coronavirus may never really go away, doctors say

Doctors discuss the long-term symptoms of the virus that are starting to emerg

A 65-year-old COVID-19 patient who was treated at Sheba Medical Center tested negative for the virus 10 days later and went home and back to work. Two weeks later, he found himself back in the hospital with a fever and shortness of breath. Tests revealed severe inflammation of the heart. Now, he is in the intensive care unit.

A young woman contracted the virus and recovered at home. Weeks later, she made an appointment at Hadassah’s post-coronavirus unit complaining of “brain fog.”

“She had to think about how to prepare a cup of tea,” said Dr. Fares Darawshy, a respiratory and internal medicine specialist at Hadassah-University Medical Center.

These are just two of several stories that Israeli doctors are sharing about what is beginning to be known as “long-term COVID” or “chronic COVID” – patients who recover from the virus but suffer from ongoing and unusual symptoms, some of which can send them back to the emergency room or even cause death.

Dr. Galia Rahav, head of the Infectious Disease Unit and Laboratories at Sheba, said that the symptoms can develop within a month of recovery or even three or six months later and can last just as long.

The individuals who suffer are equally diverse. Some had been hospitalized with severe cases of COVID-19. On the other extreme, some did not even know they had coronavirus, only to have it diagnosed via a serological (antibody) test when they are admitted due to a new medical challenge.

The aftereffects can also range from shortness of breath, fatigue, inability to perform anything that takes effort, difficulty concentrating, memory loss, joint and muscle pains, aches, or weakness and sleeping disorders, to blood clots, stroke and even multisystem inflammation or failure.

Some complain of changes in their sense of smell, taste, sight, hearing and voice, and of pressure in the ears.

Rahav said there is still no indication of how many of the millions of patients who have caught coronavirus will develop chronic COVID because the phenomenon is too new.

“I am now treating a patient that had coronavirus a month ago,” Rahav said. “He came in after having a stroke without any risk factors for stroke. We did a serological test and found he had coronavirus.”

SCIENTISTS STARTED to become aware of the phenomenon back in May, which led Hadassah and several other Israeli hospitals to open up a unit to monitor recovered patients.

Darawshy said that the hospital asked anyone who had been admitted for COVID-19 to come in for a follow up visit. About 60% to 70% of patients came, and the majority of them had some symptoms to report.

The Hadassah specialist’s experience aligns well with a recent study, “Onset, duration, and persistence of taste and smell changes and other COVID-19 symptoms: longitudinal study in Israeli patients,” which was published on the medical content sharing site MedRxiv. The study was led by Hebrew University Prof. Masha Niv, and found that at follow up after six months, 46% of the patients had at least one unresolved symptom, most commonly fatigue (21%), changes in the sensations of taste and smell (14%) or difficulty breathing (9%).

Also, an article in The New York Timescited a French report published in August of 120 COVID-19 patients who had been hospitalized. The study found that 34 of them (28%) had concentration problems even months after.

Prof. Neville Berkman, head of the Pulmonary Department at Hadassah, said “cotton in the brain” or COVID brain fog is starting to impair recovered patients’ ability to work or function normally – like the young woman who could no longer easily make a cup of tea.

The Times article offered several additional examples, including recovered COVID-19 patient Erica Taylor. Several weeks after she tested negative for the virus, “she became confused and forgetful, failing to even recognize her own car, the only Toyota Prius in her apartment complex’s parking lot.”

Scientists and doctors say it is still unclear what causes this brain fog, but doctors are investigating if it arises when the body’s immune response to the virus does not shut down or perhaps from inflammation in blood vessels leading to the brain.

Also, according to Darawshy, these kinds of symptoms are not so uncommon for recovered coronavirus patients. He said that after recovering from severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS), many patients complained of respiratory challenges or even chronic fatigue.

But while annoying and even potentially life-altering, fatigue is not fatal. Blood clots, however, which Darawshy said are unique to the novel coronavirus, can kill.

DR. RONI SHARON, director of the Headache & Facial Pain Center at Sheba, said that doctors are starting to see even young people in their 40s and 50s with no pre-existing conditions develop strokes or embolisms as a result of COVID-19.

“Tiny pieces of gunk go through the heart, get into the brain and cause a stroke,” he described. “This is often irreversible.”

He said some people who suffer from strokes suffer from life-long weakness or even become paralyzed on one side of their body. Stroke can also lead to speech or swallowing difficulties and visual changes.

“People get somewhat better” after strokes, but rarely 100% better, he said.

Another aftereffect is what has become known as pediatric inflammatory multisystem syndrome temporally associated with COVID-19 – PIMS-TS. However, according to Rahav, sometimes this syndrome does not only affect children.

The World Health Organization described the features of PIMS-TS as similar to those of Kawasaki disease – an acute and usually self-limiting vasculitis of the medium calibre vessels, which almost exclusively affects children – and toxic shock syndrome, a rare, life-threatening complication of certain types of bacterial infections.

According to WHO, people with the syndrome have at least two of the following symptoms: rash, hypotension or shock, cardiac arrhythmia, evidence of coagulopathy, or acute gastrointestinal problems. In addition, they have elevated markers of inflammation but no other obvious microbial cause of inflammation – and have either had coronavirus or been in contact with someone who did.

WHEN RAHAV first spoke to The Jerusalem Post about PIMS last May, she said the country had diagnosed three children and one adult with the syndrome. Since then, hundreds more patients have surfaced.

According to experts at Soroka Medical Center, as of this month, around 500 cases of PIMS-TS have been reported in Israeli children – 300 of whom have required hospitalization.

Prof. Shalom Ben-Shimol, an expert in infectious diseases in children at Soroka, said that the children have been treated with a combination of steroids, antibodies and antibiotics.

“The response to treatment, especially steroids, is excellent – and all the children so far have completely recovered,” Ben-Shimol said.

But Rahav told a slightly different story.

She spoke about the case of a 26-year-old who came into the hospital with diarrhea and a rash and quickly developed respiratory insufficiency and then multisystemic organ failure. A serological test revealed he had contracted coronavirus and recovered.

“He developed problems in his heart, lungs and kidneys, and then he died,” Rahav said. “He was 26, totally healthy – he did not even know he had coronavirus.”

Darawshy said that he believes hospitals and primary care physicians will face huge numbers of these patients in the coming months, and that the phenomenon could have an unknown and long-term negative impact on the country’s general health and the health of its workforce.

“People should listen to the regulations, social distance and use masks,” Darawshy said. “And everyone who recovers from COVID should go for at least one follow-up examination.

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