Several cases of patients who had coronavirus and seemingly recovered, only to have symptoms reemerge weeks or months later, have been reported recently. According to Prof. Galia Rahav, Director of the Infectious Disease Unit and Laboratories at Sheba, there is no indication of how many people will develop “long-term COVID” or “chronic COVID” because it is a new phenomenon. What is known is that the symptoms can develop within weeks after recovery or many months later, and they can last a while.
Recently, a 65-year-old patient who had been treated for COVID-19 at Sheba was sent home and back to work after he tested negative for the virus, 10 days after contracting it. But two weeks later, he had to be hospitalized again, suffering from a fever and shortness of breath. Tests diagnosed severe cardiac inflammation, and now he is in the ICU.
The people who are afflicted with chronic COVID are diverse. Some had such mild cases that they never knew they had the virus, while others were hospitalized with severe cases.
The symptoms are equally diverse, including: fatigue, difficulty doing tasks that require effort, trouble with concentration, memory loss, shortness of breath, joint and muscle pain, aches, sleeping disorders, weakness, blood clots, stroke and even multisystem inflammation or failure.
Other patients report experiencing changes in their sense of taste, smell, sight, hearing and feeling pressure in their ears.
“I am now treating a patient who had coronavirus a month ago,” Rahav said. “He came in after having a stroke without any risk factors for stroke. We did a serological test and found he had coronavirus.”
Last May, scientists started to become aware of chronic COVID, which led a few Israeli hospitals to open a special ward for monitoring recovered patients.
Dr. Roni Sharon, Director of the Headache & Facial Pain Center at Sheba, said that even young people in their 40s and 50s with no pre-existing conditions are starting to come to the hospital with strokes or embolisms as a result of COVID-19.
“Tiny pieces of gunk go through the heart, get into the brain and cause a stroke,” Sharon described. “This is often irreversible… People get somewhat better after strokes, but rarely 100% better.”
Another effect that has been associated with COVID-19 is PIMS-TS (pediatric inflammatory multisystem syndrome). While the syndrome frequently affects children, Rahav points out that it can also affect adults.
According to the WHO, PIMS-TS presents with symptoms similar to Kawasaki disease, an acute and usually self-limiting vasculitis of the medium caliber vessels that typically affects children. PIMS symptoms can also resemble those of toxic shock syndrome, a rare, critical complication of certain bacterial infections.
Patients with PIMS-TS either had coronavirus or were in contact with someone who did, and they generally have at least two of the following signs: cardiac arrhythmia, hypotension or shock, rash, evidence of coagulopathy, or acute gastrointestinal problems. They typically have elevated inflammatory markers, but no other obvious microbial source of inflammation.
Last May, Rahav gave an interview with the Jerusalem Post about PIMS, and she stated that Israel had thus far diagnosed the syndrome in only three children and one adult. Since then, hundreds more patients have been diagnosed.
One case at Sheba was particularly tragic. Rahav shared the story of a 26-year-old who came to the hospital with diarrhea and a rash. Shortly afterward, he developed respiratory insufficiency and multisystem organ failure. A serological test showed he had contracted coronavirus and recovered from it.
“He developed problems in his heart, lungs and kidneys, and then he died,” Rahav said. “He was 26, totally healthy – he did not even know he had coronavirus.”
In addition to listening to regulations, practicing social distancing and wearing masks, medical experts recommend that everyone who recovers from COVID should go for at least one follow-up examination.