the big story

The ‘long haul’ road to Covid recovery

The TLDR: A number of patients who have recovered from Covid-19 are reporting symptoms months after they have been ‘cured’. And some of these conditions have destroyed their quality of life. Doctors are struggling to understand why this is happening. The big reason: the virus can attack virtually every organ in the body, and no one knows exactly how it works. 

The ‘long haulers’ 

That’s what these patients call themselves. They are still displaying a variety of puzzling symptoms up to 100 days after recovery. These can include breathing difficulties, elevated heart rate, chronic fatigue and even cognitive problems—like brain fog, hallucinations and short-term memory loss. 

The important bit: noted by the Wall Street Journal: “Many patients are younger and had previously been healthy, with Covid cases initially considered mild to moderate.” Many were never hospitalised or even required emergency care.

The estimates of the number who experience such problems vary widely. One Oxford researcher puts it at 10% of all cases. A US expert studying such patients claims it may be as high as 5% to 15%.

Not just the lungs

When the pandemic began, scientists thought the virus primarily attacks the lungs. But now they have learned otherwise: 

“We thought this was only a respiratory virus. Turns out, it goes after the pancreas. It goes after the heart. It goes after the liver, the brain, the kidney and other organs. We didn’t appreciate that in the beginning.”

Therefore, the road to recovery has been just as puzzling. As one doctor told BBC News: “I’ve had patients in the ICU recover in two to three days. I’ve got others who have been in hospital now for months.”

To sum up: Doctors thought this coronavirus would behave like all the others. It has instead proved unpredictable with “a number of quirky, unusual and sometimes terrifying traits.” And these gaps in understanding have led to a range of theories explaining ‘long haulers’.

Tracking the cause

Here are a number of different theories as to why some infected cases have not recovered as yet.

It’s our immune system: When the virus attacks the body with ferocity, it summons up all its arsenal to destroy the invader. This overkill is called a ‘Cytokine Storm’. The immune cells spray out too many "cytokines"—molecules that cause inflammation—and perfectly healthy organs become collateral damage. 

Therefore, long haulers never fully recover due to three likely reasons:

“Long-haulers might still harbor infectious virus in some reservoir organ, which is missed by tests that use nasal swabs. Or persistent fragments of viral genes, though not infectious, may still be triggering a violent immune overreaction, as if ‘you’re reacting to a ghost of a virus,’... More likely, the virus is gone but the immune system, having been provoked by it, is stuck in a lingering overactive state.”

The immune system overdrive causes nerve damage. This triggers something called myalgic encephalomyelitis/chronic fatigue syndrome, or ME/CFS—which in turn explains many of the long-term effects.

It’s our brain: More than 300 studies have detected neurological symptoms in Covid-19 patients—which range from headaches to loss of smell to strokes and seizures. And there are some patients that display only cognitive problems, not any lung-related symptoms such as a cough. 

Some doctors now worry that the virus has found a way to break the “blood-brain barrier”—a lining of specialised cells inside the capillaries that run through the brain and spinal cord, and keep them safe from microbes. The growing suspicion: “the virus causes respiratory failure and death not through damage to the lungs but through damage to the brainstem.” Even mild or moderate damage to the brain—which takes longer to repair—can explain why some patients don’t fully recover.

Point to note: This coronavirus isn’t the first to break this protective barrier. The common chicken pox virus infects nerve cells in the spine—and reappears as ‘shingles’ in 30% of the cases.

It’s our nervous system: The autonomic nervous system controls functions such as temperature, blood pressure and heart rate. And when it goes off-kilter, the condition is called dysautonomia—caused, in this case, when the virus damages the nerve fibers that carry messages to our organs. 

The effects are not life-threatening but can undermine a person’s ability to function in daily life. The symptoms include racing heart rate, shortness of breath, hot flashes, numbness and tingling, extreme fatigue, brain fog and gastrointestinal symptoms.

Point to note: “It’s unclear if the condition is triggered by an overactive immune system, if the virus itself is getting into the nervous system, or if it’s a post-viral syndrome.”

Why we did this story

When we started to put together this explainer, one of our team members declared, “This is depressing!” Yes, the research is worrying but it’s also particularly significant right now. 

The massive surge in US numbers has been attributed to young people who are partying hard. Indians in Mumbai and Delhi are happily throwing big birthday and ‘samosa’ bashes as well. They are all under the illusion that a ‘mild’ case of the disease will be like catching a cold.

The message of this story: There is no guarantee of recovery even if you just get a ‘mild’ case of the Covid. Doctors simply don’t know enough about this virus to make any assumptions. So until we get a vaccine, we all need to keep those facemasks on and maintain the critical do gaz ki doori.

Also this: It’s an important reminder to be supportive of friends, family and colleagues who recover from Covid—and not just expect them to snap right back to ‘normal’.

Reading list

• The Atlantic was one of the earliest to spot this trend—and it mainly looks at the role of the immune system. A key angle: many of these long-term patients don’t even know if they have Covid since they were not eligible for testing early in the epidemic. 
• Wall Street Journal focuses on the role of dysautonomia.
• BBC Future does a deep dive into the latest research on the role of the brain.
• Also worth a read: FreeThink, which rounds up all the angles on long-term effects of Covid, including the side-effects of intensive care.
• Stat News explains how the virus attacks every organ in our body. 
• Global News and LA Times report on the lengthy recovery for serious Covid patients.