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COVID-19 Long-Haulers: ‘The Second Time, They Got Sicker’

North Texas cardiologists describe the long-term symptoms and lasting effects of the virus. It's not good.
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Man on ventilator iStock

The Centers for Disease Control has released a report showing COVID-19 resulted in about 300,000 more deaths than would be expected in a typical year. Nearly two-thirds of those died from COVID-19. The death tally does include deaths from the regular seasonal flu and other causes, though these medical events rarely overwhelm hospitals like COVID-19 has threatened at various points in this pandemic. This is no ordinary flu. 

COVID-19 symptoms are not only more severe than the regular flu, but they also last longer. The fever, sweating, coughing, and fatigue are common with the flu, but diarrhea is a symptom that wouldn’t usually be associated with the flu. The loss of smell and taste are unique symptoms, appear more widely than fever, and last for months. Patients with those symptoms are now eligible to be screened for the disease.  

But these symptoms can become severe, resulting in hospitalization, oxygen, and even intubation. If a patient becomes so sick that they can no longer take in oxygen, they must be put on a ventilator, where a machine pumps in oxygen into the lungs. While many eventually improve enough to get off the ventilator and leave the hospital, symptoms can remain for months. 

“We’re learning this as we go because we’re seeing that first wave of fully recovered patients coming through from March,” says Dr. Mohanakrishnan Sathyamoorthy, professor and chair of the department of medicine at the TCU and UNTHSC School of Medicine as well as an invasive cardiologist. “The fatigue, lethargy, and cough can be persistent for many months after the initial hospitalized phase.”

Heart disease is another lasting effect of the virus, says Dr. Fahmi Farah of Bentley Heart Medical Center in Fort Worth. She is a cardiologist who has treated several COVID-19 patients in the hospital and follow-up visits and has noticed younger patients coming in with heart conditions they never had before. She has found inflammation of the heart muscle, or myocarditis, in some post-COVID-19 patients. This can lead to heart failure, shortness of breath, irregular heartbeat, high blood pressure, a debilitating swelling of legs, and a severe drop in quality of life. 

Farah also notes that mental stress can physically damage the heart. Stress-induced cardiomyopathy, or broken heart syndrome, shows up in patients who have the disease and those who don’t. It is present in patients of all ages. 

“It’s affecting their work life. They’re just not able to do the things they used to be able to do before the infection of COVID,” Fahmi says. “We’re seeing this in all age groups and very young patients as well–as early as their 20s and 30s.”

One long-term effect is supposed to be immunity, as antibodies for the disease have built up while the immune system has battled the virus. But researchers are still trying to understand how long those antibodies last. Fahmi had a patient who was hospitalized with COVID-19 and eventually recovered. Four or five months later, the patient was reinfected and ended up in the ICU and intubated.

“This was a totally different infection, not a lingering of the first time infection,” Fahmi says. “The second time, they got sicker.”

This month, CNN reported the first known person to die after a second COVID-19 infection, an older woman in the Netherlands suffering from a rare type of bone marrow cancer. While she may have been especially vulnerable, it raises questions about immunity and a potential vaccine’s effectiveness.

“We just won’t know what the long-term consequences of this are until we have many years played out,” Sathyamoorthy says.

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