As clinicians struggle to understand why some COVID-19 patients continue experiencing symptoms long after the initial infection, a group of researchers in Ireland set out to find a connection between these long-term complications and initial disease severity. Published in Annals of the American Thoracic Society in January 2021, the study revealed, much to the scientists’ surprise, that even mild cases of COVID-19 may result in long-term symptoms.*

Surprising developments

To conduct the study, the authors invited patients who had been diagnosed with COVID-19 to attend a follow-up evaluation several months following their diagnosis. Most reported continued breathlessness while walking, and nearly half complained of persistent fatigue.

Some of the patients with lingering health effects had been hospitalized with COVID-19. Others, however, had experienced only mild initial infections. “We expected a greater number of abnormal chest X-rays,” said Dr. Liam Townsend, lead author of the study and an infectious disease specialist at St. James’s Hospital in Dublin, Ireland, wrote in a press release. “We also expected the measures of ongoing ill-health and abnormal findings to be related to severity of initial infection, which was not the case. We were surprised by our findings.” 

Not an isolated incident

Dr. Allison Navis, a neurologist with the Mount Sinai Center for Post-COVID Care in New York City, was not surprised by the study’s findings. The Mount Sinai clinic opened in the spring of 2020 to treat COVID-19 patients who continued to experience symptoms. 

Like the study authors, Navis shared, providers at the clinic had thought that most of the patients would be people who’d been hospitalized with serious cases, but they discovered that many of the people requiring post-COVID-19 care had not been hospitalized at all. They’d only initially presented with mild symptoms of the disease.

Some common symptoms that Navis and her colleagues have been treating at the clinic include:

• Neurological issues, such as:
  • Brain fog
  • Headaches
  • Unusual nerve sensations 
• Shortness of breath
• Fatigue

Cause of long COVID-19 symptoms a mystery

Why some people who develop COVID-19 experience persistent symptoms after the virus is no longer detectable in their body is still a mystery. Most chest X-rays, CT scans, and other tests ordered by providers in response to long-haul symptoms come back negative.

“Objective evidence on diagnostic imaging—something that would explain the symptoms—is showing up in a very small number of patients that we’re looking at,” Navis said.

The authors of the new study confirm similar findings regarding their patients. More than 60% of participants reported not having returned to full health an average of 75 days after their diagnosis, but only 4% showed signs of lung scarring on CT scans.

How to manage symptoms

Supportive care may help manage symptoms, prevent further complications, and boost overall well-being for people experiencing lingering effects from COVID-19. 

“Having appropriate resources in place is essential for aiding recovery in the painful and long months after acute infection,” said Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City. “Long COVID-19 takes not only a physical but a psychological toll on recovery, which directly impacts how people are able to resume their lives.”

Clinicians are doing what they can to help patients manage chronic symptoms and hasten recovery. Supportive care can include treatments to help patients sleep better and therapies to address potential mental health challenges arising from struggles with the disease, such as:

• Depression
• Anxiety
• Post-traumatic stress disorder (PTSD)

Long-haulers can get better

While statistics indicate the likelihood that more supportive care for long-haulers will be needed, Navis is hopeful that reporting, research, and collaboration will improve both treatment options and health outcomes. Supportive care does help, and Navis has already seen many of her patients get better. “It can take time,” she said, “but we are seeing a lot of people improve.” 

*Grey, H. (2021, Jan. 11). A Mild COVID-19 Case May Still Result in Long-Term Symptoms. Healthline. https://www.healthline.com/health-news/a-mild-covid-19-case-may-still-result-in-long-term-symptoms

Much about the novel coronavirus, i.e., COVID-19, is still not fully understood. As research progresses and our knowledge of the virus increases, information can change rapidly. We strive to update all of our articles as quickly as possible, but there may occasionally be some lag between scientific developments and our revisions.