It’s been just over a year since the onset of the COVID-19 pandemic, and the good news is that even among the most at-risk populations, the vast majority of people who have contracted COVID-19 have recovered from the acute illness. But that bright cloud sports a dark underbelly: the growing number of “long-haulers.”
These are people in whom the post-viral illness lingers long after the acute infection resolves. They can present with symptoms ranging from joint pain to fatigue. While long-term data is still limited, we are beginning to understand how the SARS-CoV-2 virus impacts the body and what we can do to support recovery.
The body on SARS-CoV-2
What’s striking about long-haulers’ experiences is how varied they are, likely due to the virus’s ability to bind to any body cells that contain angiotensin-converting enzyme 2 (ACE-2). These cells exist in tissues in the nose, lungs, kidneys, liver, blood vessels, immune system, brain, nerves, and muscles.
In the acute stage, this can cause a “cytokine storm,” resulting in hypercoagulability (excessive blood clotting), vascular permeability (an increase in the number of molecules allowed through blood vessel walls), edema (swelling), widespread inflammation, and consequent tissue damage in multiple organs.
Theoretically, the long-term effects of inflammation, tissue injury, and latent viral load could manifest in diverse symptoms that may hang around for quite some time.
“I’m not yet fully recovered,” says Erica B., a 55-year-old college English professor who is going into her sixth month of dealing with long-term COVID-19 symptoms. “I still experience greater-than-usual (though not debilitating) tiredness, as well as occasional lung symptoms.”
Patient-reported long-term COVID-19 symptoms include
- brain fog and poor concentration
- shortness of breath
- joint pain
- chest pain
- weakened sense of smell
- chills or sweats
- loss of appetite
- skin symptoms, such as red/swollen hands and feet
- reduced quality of life
Before developing COVID-19, Erica would walk her dog, tend to household chores, and do strength training and rowing, all of which she wasn’t able to do once she got COVID-19.
“My life as I’d known it was more or less on hold for over four months,” she says. Whenever Erica attempted to exercise and run errands after her acute infection had resolved, she would relapse into lung symptoms, post-exertional malaise, and fatigue.
“The fatigue felt like a cross between jet lag and hypoglycemia,” Erica says. “Like numerous long-haulers, I developed a severe skin rash that took weeks to heal.”
Erica’s weakened lung function is common among those with severe viral pneumonias. It’s expected that although most COVID-19 survivors will be able to return to work and a normal life, a significant number of recovered patients may show abnormalities in lung function tests. It was at about the five-and-a-half-month mark that Erica felt she had enough energy to resume exercise and her regular activities, although she’s now rebuilding the fitness she lost.
Although all populations may become infected by the SARS-CoV-2 virus and develop COVID-19, the data consistently shows that older adults, some racial and ethnic minority groups, and those with underlying medical conditions are at an increased risk of severe disease and mortality from COVID-19.
Type 2 diabetes and obesity often underlie the health disparities in these groups, but the good news is that these conditions can often be managed with lifestyle changes.
It is well established that eating patterns of the typical Western diet contribute to the prevalence of type 2 diabetes and obesity. The Western diet has also been shown to inhibit T-cell and B immune cell functions, which are crucial for host defense against viruses. Notably, T-and B-cell counts have been found to be low in COVID-19 patients.
These underlying conditions can affect the risk and severity of COVID-19.
- Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of developing severe pneumonia and having poor outcomes once when they develop COVID-19.
- Hypertension, prediabetes, and obesity are major risk factors for cardiovascular and cerebrovascular events (stroke) in patients with COVID-19.
- Obesity is a risk factor for developing COVID-19, and mortality from COVID-19 is higher in patients with obesity.
Looking into the future
The extent to which COVID-19-related myocarditis (heart inflammation) may affect cardiovascular health in the long term has yet to be seen. Likewise, the long-term effects of intracranial hemorrhage and stroke from COVID-19 are, so far, unclear but likely correlated to the damage inflicted on the nervous system.
It’s projected that some patients with COVID-19 may be at increased risk of neurological disease in the future, as there have been instances of dementia in the elderly following a viral illness, including respiratory viruses such as influenza. The SARS-CoV-2 virus can remain inside neurons without being acutely toxic and, therefore, may theoretically lead to neurological symptoms and nerve degeneration months or years after acute infection.
It’s also possible that COVID-19 may increase the risk of anxiety, depression, post-traumatic stress disorder, insomnia, and psychosis down the road. Regularly checking in on mental health and seeking support when not feeling well will be of particular importance both for long-haulers and for those who have already recovered.
Reclaim health for the long haul
Although data is lacking on the direct relationship between nutrition therapy and COVID-19 outcomes, we can infer the likely benefit of eating a diversity of vegetables and lean protein in lieu of sugary and processed foods. Studies have shown that a healthy lifestyle, regular exercise, balanced nutrition, quality sleep, and a strong connection with loved ones have positive effects on the immune system.
Most importantly, practice self-compassion. If you’ve had COVID-19, go easy on yourself with resuming work and high-intensity exercise. Avoid self-imposed timelines for recovery. Take the time to rest, engage professional help for dealing with complicated feelings, and redefine your measure of productivity until you feel more like the “you” that you remember.
Information is current as of the writing of this article. Some long-term COVID-19 symptoms are patient-reported and have not yet been appraised by rigorous research.