What to Expect After COVID

A growing number of Americans have now experienced about of
COVID-19, and doctors are only just beginning to learn more about the aftereffects of the infection.
“Reports are coming out describing long-term lung effects—which is not
surprising, as scarring may occur and cause permanent impairment—and
also of neurological, cardiovascular, and kidney effects,” says Dr. David
Christiani, a professor of medicine at Harvard Medical School and a pulmonary physician at Massachusetts General Hospital.
Some people, now referred to as long-haulers, are also reporting that their COVID symptoms keep dragging on for weeks or months from the time
they were initially infected. These symptoms include everything from headaches and cognitive problems to mood changes, fatigue, decreased exercise tolerance, and body ache.
“We are learning more about the consequences of COVID-19 as the months pass and our experience grows,” says Dr. Christiani, who is also director
of the Environmental and Occupational Medicine and Epidemiology Program at the Harvard T.H. Chan School of Public Health. “There do seem to be long term consequences; it will require more study to determine, for example, if some of these long-term effects are the result of long ICU stays with severe illness of any kind, versus specific features of this viral infection.”

Post-COVID effects

While much is still unknown about post-infection symptoms related to COVID, long-term effects appear to be more likely in people with certain risk factors (such as high blood pressure and obesity) and in older adults, according to the World Health Organization. People
may also be more likely to experience lasting symptoms if they had more
severe illness caused by the virus.
However, while many people who experience lasting symptoms have
underlying risk factors, people who are younger and healthier can also be
affected. The World Health Organization reported that in a phone survey of
adults who had symptomatic COVID, 20% of 18- to 34-year-olds reported
feeling lasting effects from the virus.

Many unknowns remain

This may have you wondering what the potential consequences will be if you are infected, and what you can or should do after the fact to protect your long term health. The truth is that because the virus is so new, doctors don’t fully understand why some people aren’t fully recovering from COVID, how many people are actually affected long term, or whether these problems will resolve over time.

“There is little published information on recovery after COVID-19,” says Dr.
Eric Rubin, professor of immunology and infectious diseases at the Harvard
T.H. Chan School of Public Health. So, at this point it’s hard to give people specific guidelines to follow or even to truly know what to expect.
“Since this is a new disease, we have little experience with what recovery will look like. How widespread and severe this is, we don’t really know yet,” he says.
That said, there are some things doctors do feel confident about, even at this early stage.

Recovery may take time. Many people who get the flu or any type of severe
respiratory infection don’t bounce back instantly. Recovery is a process,
and this has already been true of COVID as well. “In general, the more severe the initial infection, the more difficult and prolonged the recovery can be,” says Dr. Rubin. People with the most severe kind of lung illness, acute respiratory distress syndrome (ARDS), no matter what the cause, often face long recovery times. “This appears to be true for patients who develop ARDS as a consequence of COVID-19. Part of this is because of slow or limited recovery of lung function, so shortness of breath, especially with exertion, is common,” says Dr. Rubin.

Hospitalization may lead to a longer recovery. Some of the struggle to get back to normal for many people who experienced severe disease might
be due to the muscle wasting that occurs when people are bedridden in the hospital fighting the virus. So, in addition to recovering from the illness, they also need to regain all that lost strength, says Dr. Rubin.

Complications may need tailored follow-up. For patients who experienced
certain complications, follow-up monitoring and treatment may be needed. What makes the new coronavirus different from other respiratory viruses is that it not only affects the lungs, but may also lead to damaging blood clots that can cause strokes as well as damage to the heart and other organs, says Dr. Rubin. “Some patients might have developed kidney damage during their illness,” he says. “Any patient with damage to organs might require continuing medication and specific follow-up screening depending on the particular complication.”

How to proceed

People with more severe symptoms from COVID are more likely to experience persistent symptoms. However, even infected individuals with mild symptoms may not get back to normal for weeks or even months.

“Since there are no specific treatments for long-term adverse health
effects of COVID, it would not be justified at this point to do screening for
lung or heart disease with specialists. However, it may be worthwhile to follow up with your primary care physician—by telemedicine or in person after recovery—and discuss some basic surveillance, which may include blood tests for inflammatory markers, lung function testing, or a heart test called an echocardiogram,” says Dr. Christiani. “I will note that at this point, there is as yet no specific recommendation to do this in all recovering COVID patients, so it would be important to discuss personal medical management with your doctor.”

If your symptoms are ongoing, there are no specific guidelines yet to follow,
says Dr. Rubin. “Most patients are likely to fully recover even though that might take a while.”

However, people who have continued symptoms should be evaluated as
they would for any persistent illness. Keep in mind that while some symptoms may be related to COVID, they also might be unrelated, so it’s worth investigating for an underlying cause with your doctor.

Protecting yourself going forward

In the meantime, if you’ve recovered from COVID, practice good health habits, just as you would if you were trying to avoid infection in the first place.

“Reinfection, though rare, may still occur. Hence, strict practice of physical
distancing, wearing a mask when in public, and frequent hand washing remain key,” says Dr. Christiani. In the winter, it is particularly important
to not gather indoors in small or large groups. “Also, get a flu shot. Your lungs do not need another insult; not to mention that flu itself can be severe, even fatal, and impairs immunity temporarily, making one susceptible to bacterial pneumonia or maybe even another round of COVID,” he says.

As research continues to reveal new findings about COVID, more information will likely become available in coming months.

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