The CDC has named this Post-Acute Sequelae of COVID-19. Severe Respiratory Syndrome Coronavirus 2 is the virus responsible for this plague the world has been dealing with. It is a multisystem disease that not only causes inflammation and destruction of several vital organs, but it also changes our immune system so it reacts against our own body and instigates coagulation — blood clots. This post infection syndrome is similar to what was seen after SARS and MERS, two previous coronavirus diseases.

Depending on the source of information, the estimate that these symptoms — fatigue, memory problems, difficulty breathing, headache, depression, insomnia, loss of taste or smell — will last for more than 28 days, is anywhere between 10-30 per cent. Many develop new symptoms such as breathing problems, hair loss and rapid heartbeat (postural orthostatic tachycardia syndrome) weeks or months later.

Many studies are showing surprising effects:

– In an Italian study, 87 per cent of 147 people who were hospitalized still had symptoms at 60 days.

– A German study of 100 patients found those who were previously healthy with mean age of 49 years — many of whom were not hospitalized — showed 60 per cent had heart inflammation two to three months after infection.

– A CDC survey found that 20 per cent of healthy 18–34-year-olds had ongoing symptoms.

– A study in Italy has been looking at people who did not have diabetes, but had high blood sugar when hospitalized with COVID. They found high blood sugar in 50 per cent of the patients studied, 35 per cent of these patients remained hyperglycemic beyond six months after recovery. High blood sugar was associated with a worse prognosis with longer hospitalizations, worse clinical outcomes, such as needing ventilation, oxygen and ICU. They were found to have inflammation of the pancreas. The long-term consequences of this remains to be seen.

– A study from the Mayo Clinic looked at 100 patients 93 days after infection and found even those who were not hospitalized, most under 65 (mean age 45) , were significantly experiencing the symptoms mentioned above and, in addition, 12 had episodes of rapid heart rate. Sixty-eight per cent were women. The only pre-existing condition was obesity. Only one in three people were back at work. Eightyfour per cent reported trouble with household chores, exercising, driving and/or completing tasks required at work.

– An online survey of people in support groups was carried out on 3,762 patients, from 56 countries, with illness over 28 days. They estimated the prevalence of 203 symptoms in 10 organ systems. They traced 66 symptoms over seven months. The most frequent symptoms were fatigue, post exertion malaise and cognitive dysfunction. In 91 per cent, recovery time exceeded 35 weeks and had many symptoms of nine organ systems. Eighty-six per cent experienced relapses primarily triggered by exercise, mental or physical activity and stress. Forty-five per cent required a reduced workload and 22 per cent were unable to work because of illness.

Reports from clinics that are studying this show an interesting pattern. Most of these people were not sick enough to be admitted to hospital — they are generally younger, with an average age of 42-45 — have no pre-existing conditions and have had a significant change in their quality of life. Because they are in the work force, many do not return to work or require rehabilitation to try to recondition them and require a change in their work demands.

This affects women three times more than men. These symptoms are very similar to those who have chronic fatigue syndrome/myalgic encephalomyelitis, chronic Epstein-Barr and many fear they will receive the same lack of support they have experienced with these diseases.

Fortunately, WHO is working to harmonize worldwide research of this disease to find solutions. The National Institute of Health in the USA has launched a $1.15 billion, multiyear research initiative. Major surveys are being conducted to assess the prevalence and outcomes.

What does this mean for people of Saskatchewan? We have had approximately 50,000 cases. It is predicted that 10-30 per cent will have long lasting symptoms, so potentially 5,000 to 15,000 people could be affected. Many affected by this are younger than those who have been hospitalized and died from this disease. These people will require thoughtful management in order to get back to work. Clinics that have been established include care from Infectious Disease specialists, Respirologists, Immunologists, occupational therapists, physiotherapists and psychiatrists.

Fortunately, there are helpful support groups on line such as COVID-19 Long Haulers Support by Laney Bond.

We need to support these people in any way we can and please, get vaccinated to prevent anyone from unnecessarily going through this difficult disease.

Dr. Vicki Holmes is a Saskatoon retired family physician who has a special interest in Palliative Care and Women’s Health. She is passionate about sharing medical information with the public! (Vicki’s Photo: Memories by Mandy)

-Dr. Vicki Holmes