'Like you were hit by a truck': why millions of people cannot recover from COVID-19 for months

Months after officially recovering from Covid-19, millions of people around the world still cannot return to normal life. For some, shortness of breath, increased fatigue, and lack of smells and tastes do not go away. For others, coronavirus symptoms that had disappeared suddenly reappear after a few weeks - and sometimes new ones are added to them. In still others, Covid even develops into a severe chronic disease, affecting almost any organ, writes Air force.

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Scientists and doctors of various specialties are working together to understand how and why in 10-15% of those infected, coronavirus develops into “long Covid” (doctors call it PKS - “post-Covid syndrome”) - a disease that does not yet have a formal definition or an established name . In the United States there are already calls to equate it with disability.

The BBC's Russian service tells which versions seem most plausible to scientists today, and tries to answer the question of what awaits patients, some of whom have not been able to recover for more than a year.

"This is a catastrophe"

Muscovite Polina T. suffered from Covid-19 last fall. In September, when the first mild symptoms appeared, she mistook them for a common cold and decided to rest for a couple of days - but just in case, she ordered a coronavirus test - and it gave a positive result.

Polina lost her sense of smell the next day, after the diagnosis was made, when in the morning she “went to smell mustard and didn’t feel it.” But in general, according to her, “the disease proceeded very calmly - without high temperatures and any complications: I was just very weak, and my temperature stayed around 37,2.”

The temperature did not subside for more than three weeks. During this time, Polina managed to pass the test twice: the first again showed the presence of the virus in her body, the second came back “clean”. Around the same time, the temperature returned to normal, but general weakness and increased fatigue lingered for another month after the official recovery. The missing smells returned even later - already by the New Year.

Polina decided that she had completely recovered, but her joy about this did not last long: just a couple of weeks later, strange things began to happen to her sense of smell again. The familiar aromas began to turn one after another into an extremely unpleasant smell, which Polina herself describes as “a compost pit, such fermented rotten vegetables.”

At first, bell peppers began to smell like this, then other foods were “infected” with the stench from it - meat, poultry, cauliflower - but the most unpleasant thing happened when, with exactly the same disgust, a Muscovite began to perceive the smells of human bodies - both her own and those of others .

This continues to this day, and no improvements have been observed - although four months have passed since January, and tests stopped detecting the presence of the virus in Polina’s body in mid-October, that is, more than seven months ago.

Polina’s story is a case, although not the most common, but far from unique. Impaired sense of smell is one of the symptoms of “long Covid”, now well known to doctors and described in detail in the scientific literature. Unpleasant, of course, but not fatal - and there is even hope for a complete cure.

However, it also happens that after “recovering” from Covid-19, the patient is left with a whole bunch of symptoms that fall under the description of PCS. Here, for example, is how Ashley Nicole, a 35-year-old lawyer from Alberta, described her condition.

“This morning I woke up for the 255th time with a blinding headache: the picture blurred before my eyes, so that almost nothing was visible. It was as if broken glass had been pushed into my throat, and my chest was so twisted that it took my breath away..."

The tweet was published in December last year, although Ashley suffered from coronavirus back in March, at the very beginning of the epidemic, and was officially cured in April 2020. Only the symptoms of the disease have not gone away to this day - except that they have weakened slightly.

In addition to fatigue (one of the most common symptoms), Ashley has lost almost all of her hair in the 14 months since the onset of her illness; the skin on the hands became hypersensitive, as after a burn, and the nails were loosened and darkened.

All of these are quite rare, but also common symptoms of “long Covid”, which manifest themselves very individually in different patients and are characterized by amazing diversity.

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"Real Problem"

The UK National Institute of Health suggests that post-Covid syndrome is “signs and symptoms that appear during or after an infection consistent with the clinical picture of Covid-19, and lasting more than 12 weeks, unless they can be explained by another, alternative diagnosis.”

The WHO has been trying to compile a list of such “signs and symptoms” for several months, but it is much more difficult than it might seem at first glance.

Since Covid-19 is transmitted primarily through airborne droplets, we are accustomed to consider it a respiratory disease: once it enters the body through the nose or mouth, the virus infects the upper respiratory tract and then “descends” to the lungs.

However, a year ago, scientists found out that once a new virus penetrates from the nasopharynx into the blood, it quickly spreads throughout the body and “hits” the most vulnerable organs. It has been proven that SARS-CoV-2 is capable of disrupting the functioning of the nervous system, gastrointestinal tract, genitourinary and cardiovascular systems, and so on.

This means that long-term complications of Covid-19 can manifest themselves almost anywhere.

“ACL affects a wide variety of organs, so the problem is clearly multidisciplinary,” agrees WHO’s chief technical officer for combating the Covid-19 pandemic, Maria Van Kerkhove. According to Maria, over the past year she has met with many patients who complained of a very prolonged illness and asked the WHO to at least publicly acknowledge that PCS is real - that the syndrome actually exists and is not a figment of the imagination of those who have been ill.

And on this issue, the position of the WHO is unambiguous.

“We know this is a real problem,” Van Kerkhove told the BBC. “We know that ACL affects a variety of organs. Now we are trying to organize a systematic collection of data in order to develop treatment protocols, rehabilitation protocols based on them, so that any person, no matter where in the world he is, can get the help he needs.”

So far, according to Maria Van Kerkhove, one thing is clear: “This is actually a dangerous virus […] Even if a person suffered from Covid relatively easily and recovered from the disease itself quickly enough, it can have extremely unpleasant long-term consequences.”

Three long covid months

Her words are confirmed by statistics. According to the UK's National Statistical Office, nearly one in seven patients with a confirmed Covid-19 diagnosis have symptoms of coronavirus stretching for at least three months.

Considering that by March of this year the number of confirmed cases of infection worldwide exceeded 110 million, it can be assumed that today at least about 15 million people may experience signs and symptoms of “long Covid” to varying degrees.

Given the problems with counting and testing for the virus in different countries and at different stages of the pandemic, this figure could be higher. In the UK alone, by the end of February of this year, almost 500 people complained that they had not been able to get rid of their ACD symptoms for at least six months. But this half a million, by definition, does not include the patients of the second wave, which began in the country in October.

Francis Collins, head of the US National Institutes of Health, speaking to Congress at the end of April, estimated the number of Americans for whom Covid-19 has already caused chronic health problems at 3 million people. “This poses such a huge problem for the health of the nation that it is difficult to overestimate,” he said.

At the same time, experts pay special attention to an interesting fact: the vast majority of patients who develop post-Covid syndrome (90%) did not have concomitant chronic diseases before infection, which usually complicate the infection, and suffered Covid-19 itself in a relatively mild form - and even if and consulted a doctor; they did not require hospitalization. So they never expected that in a couple of months the virus would make itself known again.

Basically, the symptoms of Covid-19 last for several months in relatively young patients (the average age of people with signs of PCS is 40 years), and there are significantly more women among them than men (70-80%).

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Fog in the head

So what are these symptoms - is there at least an approximate list of them? Yes and no. Most of the reputable studies that have been peer-reviewed by the scientific community are small in size and include, at best, a hundred patients with ACL.

The largest study in this area to date is an online survey conducted last fall by British and American scientists in conjunction with a group of activists from among the coronavirus patients themselves. It was attended by nearly 3800 people who listed a total of 205 different manifestations of the disease. A third of these symptoms, according to those surveyed, haunted them for at least six months.

The very format of the Internet survey assumes a rather skewed sample. And patients' perception of their own symptoms, of course, is inferior in reliability to laboratory tests. Therefore, the results of such studies should be treated with caution.

Nevertheless, the results of the survey can give some general idea about the well-being of patients, as well as about when and in what combination certain symptoms appear and how long they persist.

Most survey respondents listed a bunch of symptoms they had, but the most debilitating long-term manifestations of the disease were generally cited as severe breathlessness, fatigue and post-exertional malaise or brain fog.

The authors of the study pay special attention to the syndrome of increased fatigue (fatigue). The majority of the observed patient respondents experienced incredible weakness, barely allowing to get out of bed.

Six months after infection, three quarters of those who still had any symptoms (that is, developed PCS) continued to complain of a catastrophic lack of strength. Up to the point where even the simplest everyday tasks - say, getting dressed, having breakfast or going to the toilet - are so exhausting that they require proper rest.

“You feel like you’ve just been hit by a truck and left for dead on the side of the road, so you can’t say a word or move,” one of the “long Covid” patients, Shannon Riley, describes her feelings.

Many experts are also alarmed by the fact that one of the most common symptoms of PCS is impaired cognitive function, including mental fog, which is more typical of mental disorders that usually develop in very old age.

Many patients described problems with concentration and inability to retain attention, difficulty in solving simple problems or in making decisions. These problems started from the first week of illness and increased over the course of three months. Only after this does the condition begin to improve, however, even after six months, if the symptoms do not go away completely, about every second survey participant complains of blurred consciousness to one degree or another.

Further everywhere

At the same time, scientists are absolutely sure that, in addition to fatigue, breathing problems and cognitive impairment, PCS can also cause a lot of other side effects - sometimes completely unexpected.

For example, if last spring we learned that one of the characteristic symptoms of Covid-19 is a temporary loss of smell (anosmia), now patients who have already recovered from coronavirus are increasingly experiencing disruption of the normal functioning of the olfactory receptors (parosmia) - when the most familiar things suddenly they start to smell like sewage, rotten fish or burnt plastic.

This is exactly the diagnosis Muscovite Polina T. should have been given in January: “When I came to the doctor with a complaint about distorted odors, he told me that this was a very popular treatment associated with Covid, and that most likely it would go away on its own.”

Professor Nirwal Kumar, head of the British Association of ENT Physicians, also assured journalists that parosmia is a reversible disorder of smell that will sooner or later go away on its own, although with the help of special therapy this process can be accelerated.

In April, Academician of the Russian Academy of Sciences Alexander Chuchalin, who heads the Russian Respiratory Society, said that doctors began to often diagnose so-called “post-Covid myocarditis” in patients with PCS. According to him, along with the lungs, the main impact of the virus falls on the heart muscle.

In addition, Chuchalin said, Covid-19 can provoke fibrosis (that is, scarring) not only of the lungs, but also of any organ that the virus has reached. This occurs when the patient's immune system ceases to cope with the infection and begins to actually “immune” the virus, turning working cells of the liver, kidneys, pancreas, spleen or other organs into connective tissue.

It has also been proven that the virus sometimes leads to bleeding disorders and increases the risk of thrombosis. In the long term, this can cause very unexpected symptoms in some patients. In particular, medical journals describe cases of loosening of teeth and hair loss in coronavirus patients: according to doctors, changes in blood vessels could lead to impaired blood circulation in the gums or around hair follicles in patients.

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Four theories and cautious optimism

However, Covid-19 is by no means the first and certainly not the only disease that causes such unpleasant and such varied long-term consequences, says Amy Proal, head of research at the PolyBio Research Foundation, which specializes in the study of autoimmune diseases.

In an interview with the BBC, Dr Proal listed four possible causes of “long Covid”.

First: During the acute phase of the disease, the coronavirus severely damages an organ - for example, due to the aforementioned fibrosis. When the acute phase passes, the affected organ cannot always restore its functions in full, that is, in fact, Covid-19 provokes a chronic disease not directly related to the virus.

The second: Despite the fact that PCR tests cannot detect the virus, it does not leave the patient’s body completely, but remains in one or another organ (“reservoir”) - for example, in liver tissue or in the central nervous system. In this case, chronic symptoms may be caused by the presence of the virus itself, since it prevents the organ from functioning normally. These are the cases described in patients who have “recovered” from the Zika or Ebola viruses.

Third: Since childhood, the Sars-Cov-2 coronavirus disrupts the inherent settings of the body's immune system and knocks down the signals of interferon proteins that restrain other viruses constantly living in our body, as a result of which these other viruses are activated and begin to actively multiply. For example, according to Dr. Proal, during the pandemic there have already been several studies proving the reactivation of herpes viruses in coronavirus patients.

“You and I are not sterile: trillions of microorganisms—bacteria and viruses—live in our bodies,” she explains. “It is logical to assume that in conditions of immunity shaken by the coronavirus, the usual balance is disrupted - and as a result, entire colonies of these microorganisms begin to get out of control, causing some chronic symptoms. Such cases [in Covid patients] have already been documented in several studies.”

Finally, fourth a possible cause is explained by genetics, when, as a result of a random coincidence, the coronavirus actually comes into conflict with the patient's DNA, turning Covid-19 into a chronic autoimmune disease. This happens when one of the proteins produced in the patient’s body turns out to be similar in shape and size to the protein of the virus itself. This phenomenon is known as “molecular mimicry,” and even if the composition of two protein molecules has almost nothing in common, such a coincidence may be quite enough. The aggressive immune response launched by the body to infection will inevitably simultaneously destroy the patient’s own cells that produce the proteins he needs.

All of the above explanations, says Dr. Proal, are not mutually exclusive and can occur in a particular patient with ACD in any combination.

Before answering the question of whether patients who have had unpleasant symptoms for more than a year should wait for a full recovery, Amy Proal pauses for a long time.

“I think... I think patients will get better,” she finally answers. “Yes, I’m optimistic.”

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