What are the long-lasting effects of COVID-19?

Ask the doctor

Q. I read that the death rate from COVID-19 is going down, but that people who recover from the infection still can remain sick for a long time. Is that true?

A. It is true, but we don't yet know how big the problem is: COVID-19 has been with us for only a year, and there hasn't been enough time to know the long-term effects.

When people first started getting sick with COVID, doctors thought that it affected primarily the lungs. Unfortunately, we quickly learned that it also could affect the heart, kidneys, brain, and other organs. This surprised many of us. In late February 2020, a previously healthy 30-year-old man I knew told me he had been running fevers, had experienced a seizure, and was worried he might have COVID. I reassured him, but I was wrong and the patient was right. Within the next four weeks, doctors around the world were reporting various brain conditions in people with COVID.

Some previously healthy people who survived COVID have been left with evidence of injury to the heart and kidneys. It is too soon to know whether the damage is permanent and whether it will affect their level of function.

There also are people who survived COVID and have no evidence of injury to the heart, kidneys, or brain — but who nevertheless have not returned to full health. They still have fatigue, body aches, shortness of breath, difficulty concentrating, inability to exercise, headache, and trouble sleeping. Some studies find that more than 50% of people who "recovered" from COVID remain hobbled by these symptoms three months later. They can't return to work. They can't fulfill their responsibilities at home. They are being called "long haulers." Such lingering symptoms have been reported following "recovery" from a number of other infectious illnesses, including mononucleosis, Lyme disease, and SARS (another disease caused by a coronavirus). So, it is not surprising that this illness — which is similar to the illness called myalgic encephalomyelitis / chronic fatigue syndrome — develops following COVID.

In other words, while fewer people who get COVID are dying, not all of them are recovering. We don't know how many people will remain hobbled, long-term. But it is plausible that tens of thousands in the United States may never be the same again.

The first reported cases of COVID in the United States and South Korea occurred on the same day. South Korea implemented containment strategies that were developed by the U.S. CDC. The United States did not. Since then (as of the time I write this), the United States has had 50 times more deaths per capita from COVID than South Korea. We could therefore have 50 times more long haulers, too. And the U.S. economy has shrunk, while South Korea's has grown. Bad mistakes rarely lead to only temporary damage.

— Anthony L. Komaroff, M.D.
Editor in Chief, Harvard Health Letter

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