COVID-19 — The Long Road to Recovery

Abstract

Seems like it's been a long journey in the past two months of recovery. I'm making progress and starting to walk independently with a cane. A little at a time but getting there."-Carol Todecheene COVID-19 is a pandemic viral disease that has spread throughout the world in 2020 (1, 2). Nearly half of the persons with COVID-19 are asymptomatic. Older persons, persons with comorbidity and diabetes mellitus are particularly at risk of developing COVID-19. Severe cases of COVID-19 cause a viral pneumonia. In addition, COVID-19 can affect almost any organ in the body, as it enters cells through the angiotensin converting enzyme (ACE) 2 receptor (3). A subset of persons with COVID-19 appear to have a prolonged recovery period. This has been termed "long Covid" (4). The concept of a viral disease leading to a post viral syndrome usually with chronic fatigue, is well recognized (5). In one study where patients were followed after having one of three viral diseases (Epstein Barr virus, Coxiella burnetti or Ross fever virus), 12% were found to have a specific syndrome for 6 or more months. Acute recurrences of the illness occurred in the first 3 months and chronic fluctuating symptoms included fatigue, cognitive disturbances, dysphoria, anxiety and pains in the muscles. This syndrome has also been termed myalgic encephalomyelitis (6). After having had COVID-19, the Boston Red Sox pitcher, Eduardo Rodriguez was fatigued when throwing the ball and an MRI showed that he had myocarditis that will prevent him from pitching this year. There is now good evidence that the corona virus can invade myocardial cells and cause destruction of heart muscle (7). As is shown in Figure 1, myocarditis is not the only long-term side effect of COVID-19. These symptoms of "long Covid" include: fatigue, cough, dyspnea, loss of taste and smell, muscle weakness, muscle and joint pain, headache, confusion, conjunctivitis, chest pain, decreased mobility and falls (8, 9). It is important to recognize that persons who have severe pneumonia due to COVID-19 might take 6 months or longer to return their breathing to normal and that this is associated with decreased mobility. Elevated D-dimer levels are prognostic of poor lung function at 3 months (10).

COVID-19 and the long-term cardio-respiratory and metabolic health complications

“…In addition, viral infections increase mitochondrial production of reactive oxygen species and suppress endogenous anti-oxidant systems [92]. Combined, this hyperinflammatory state leads to cachexia and sarcopenia [93,94]. The resulting loss of muscle tissue alongside disuse atro-phy results in premature loss of muscle strength impeding physical function and potentially future independence of patients with long-COVID.…”

Hyperbaric oxygen therapy for the treatment of long COVID: early evaluation of a highly promising intervention

“…7 One of the most commonly reported symptoms is fatigue, present in up to 65% of long COVID patients, this is accompanied by a substantial proportion also reporting cognitive and affective deficits (described in the literature as 'brain fog'). [8][9][10][11] The fatigue experienced by these patients can be particularly severe, preventing them from performing their usual work and activities, while the age group most affected by long COVID tends to be economically active adults. 12 Currently specific treatment options for long COVID are limited, with even fewer treatment options available for those suffering from fatigue.…”

2020: The Year of the COVID-19 Pandemic

“…It is well recognized that some persons with viral diseases, such as infectious mononucleosis, can have a post viral syndrome that can linger for at least a year (21). There is clearly a "long Covid" syndrome that can linger for a prolonged period of time (22,23). The features of this syndrome are outlined in Table 2.…”