Long-Term Sequelae of COVID-19 Infections

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By Stuart M. Caplen, MD

From 1889 to 1892, doctors in England were mystified about the lingering effects of the so called “Russian Influenza“ pandemic; with some of its victims too debilitated to work or return to daily routines, and plagued with mysterious erratic symptoms and chronic illnesses.[1] While the number of deaths from COVID-19 is presently the top news story, a more insidious health problem has emerged, similar to what occurred in the past. People infected with COVID-19, frequently not sick enough to be hospitalized, can develop sometimes crippling long-term symptoms. There have been stories in the press of athletes who can barely carry out simple errands after being infected.[2] Dr. John Brooks, the chief medical officer of the CDC’s COVID response, said he expected long-term post-COVID-19 symptoms would affect “on the order of tens of thousands in the United States and possibly hundreds of thousands.”[3]

This article takes a look at what is known about the causes, effects and possible treatments of post-COVID-19 infection sequelae in people who have been called “long-haulers “or having “long-COVID”.

How Common is It?

Long-hauler symptoms are variable with respect to disease severity, with some hospitalized doing well after recovery, and some less ill patients suffering prolonged symptoms.[4,5]

  • A study of 292 patients found that at a median time of 16 days after testing positive for COVID-19, 26% of those aged 18–34 years, 32% of those aged 35–49 years, and 47% of those aged ≥ 50 years reported not having returned to their usual state of health. In patients who reported cough, fatigue, or shortness of breath at the time of initial diagnosis, 43% still had a cough, 35% fatigue, and 29% shortness of breath 16 days later.[6]

  • In a study of 143 hospitalized patients with COVID-19, assessed a mean of 60 days after disease onset, only 12.6% were completely free of post-COVID symptoms, 32% had one or two persistent symptoms, and 55% had three or more. Worsened quality of life was observed among 44.1% of patients. The most common complaints were…..


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Stuart M. Caplen, MD, FACEP, MSM

Dr. Caplen is a former emergency physician and emergency department medical director, now retired from clinical practice. His current interests include how quality is produced and maintained in health care, and he has greenbelt certification in lean/six sigma.


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