Sick and tired of COVID-19: long haulers and post viral (fatigue) syndromes, 2020, Outhoff

Dolphin · Oct 12, 2020

Free full text:
http://www.sagpj.co.za/index.php/SAGPJ/article/view/41

South African General Practitioner 2020; 1(4):132-134
https://doi.org/10.36303/SAGP.2020.1.4.0041

Sick and tired of COVID-19: long haulers and post viral (fatigue) syndromes

Kim Outhoff

Abstract

COVID-19 patients may face a long and winding road to recovery.

Outcomes of critically ill patients have been well described, including in China, Italy and the USA, and particularly in the comorbid elderly.1-3

However, short-, medium- and long-term health consequences are being realised not only in those that were hospitalised, but also in outpatients with milder or asymptomatic illness.

At the end of July, the Centers for Disease Control and Prevention (CDC) in the USA reported that 35% of 292 COVID-19 patients, young and old, with mild disease, had not returned to their usual state of health, 2–3 weeks post testing positive for the virus.4

Common residual symptoms included cough (43%), fatigue (35%), or shortness of breath (29%).

Noteworthy, was that prolonged convalescence occurred in 20% of young adults who had no chronic comorbidities, potentially leading to loss of function at work, studies, or other activities.

In Germany, enduring cardiac involvement in 100 recently recovered COVID-19 patients (median age 49 years) has also been described.5

Cardiovascular MRI performed during the early convalescent stage at a median time interval since COVID-19 diagnosis of 71 days, revealed signs consistent with persistent myocardial inflammation in 60% of patients, which importantly, was independent of the severity of the original presentation and pre-existing comorbidities.

Prolonged coma in COVID-19 patients following ventilation is a new perplexing concern, while post-infectious neurological complications, including Guillain-Barré syndrome and other diseases of the central and peripheral nervous system, may also rarely manifest after COVID-19.6

The latter are likely the result of immune activation.7
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The full article is available at https://doi.org/10.36303/SAGP.2020.1.4.0041

Author Biography
Kim Outhoff
Editor: SA General Practitioners Journal

Dolphin · Oct 12, 2020

Long-lasting symptoms such as unrelenting exhaustion, diffuse myalgia, depressive symptoms, and disordered sleep are reminiscent of the complex debilitating mysterious illness, myalgic encephalitis/ chronic fatigue syndrome (ME/CFS), previously associated with not only Epstein-Barr virus, but also with SARS and MERS coronaviruses.9-12 ME/CFS symptoms classically include at least six months of fluctuating post-exertional malaise (PEM) following minimal physical or mental activity, severe and disabling fatigue, cognitive impairment making it difficult to concentrate, muscle or joint pain, non-restorative sleep, as well as immune, autonomic, neurological, endocrine, and gastrointestinal symptoms. The overall prevalence of this chronic condition ranges from 0.89– 1.14% depending on which diagnostic criteria are used.13 The severely affected may be house- or bedbound, unable to move, speak or tolerate noise or light.14,15 Limited treatment options include good nutrition, sleep hygiene, graded exercise therapy and cognitive behavioural therapy.16
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