And now for the next thing: in recent days, especially in the oversea media, we’ve seen stories about people who became ill with COVID-19 weeks ago, are now free of the virus, and yet continue to have debilitating symptoms.
These aren’t necessarily old people or patients hospitalised with the virus. And they aren’t people who had severe symptoms.
This week, The New York Times wrote about an Italian woman returning to work five weeks after contracting the illness, and still struggling for breath, aching in her muscles and unable even to take short walks.
NBC ran an online piece about a Massachusetts woman, Katie Porter, 35, who is free of the virus but continues to run a fever 50 days after she first became ill. She also suffers from “extreme exhaustion” that began with the infection.
“I know it sounds crazy,” Ms Porter told NBC, “but is this permanent?”
The scary answer is: possibly
A months ago, New Scientist published a piece that suggested COVID-19 might trigger chronic fatigue syndrome in some people.
A similar thing happened with SARS. “After the SARS outbreak of 2002 to 2003, some people in Toronto, Canada, who were infected were recorded as experiencing fatigue, muscle weakness and sleep problems up to three years later,” New Scientist wrote.
Dr Harvey Moldofsky, a psychiatrist and sleep specialist at the University of Toronto, studied 22 patients who had been infected with SARS and “had ongoing health problems that stopped them going back to work.”
He found the participants in the study “generally had disturbed sleep, daytime fatigue, pain and weakness in muscles all over their body, and depression.”
These are the symptoms described by Ms Porter, who noted that days start out okay but get progressively worse.
So maybe she, and other people in long recovery from COVID-19, have chronic fatigue. Or maybe not. We can’t really know for at least four months, and even then it will be an educated guess.
As the Victorian Government’s Better Health channel advises: “Currently, there is no single test to diagnose (chronic fatigure syndrome). Doctors make a diagnosis by excluding all other illnesses after a person has had symptoms continually for six months. The person’s results from routine medical tests will often be normal, but additional tests will show abnormalities.”
We can’t really know how many people have had the viral pneumonia characteristic of COVID-19. Many cases of viral pneumonia are mild, and may even go undiagnosed. In those cases people recover pretty quickly. But COVID-19 pneumonia has its own quirks.
In people who self-isolated at home, and may have had mild COVID-19 pneumonia without knowing it, there may or may not be quirks in their recovery.
In severe cases of COVID-19 pneumonia, there is no missing it.
Within in a day or of becoming ill, hospitalised patients can quickly worsen and develop acute respiratory distress syndrome (ARDS). This severe condition involves profound inflammation in the lungs, where the air sacs fill up with fluid.
The amount of oxygen in the blood stream goes down, and the amount of carbon dioxide starts to rise. Deprived of sufficient oxygen, organ function drops and can eventually fail.
Some people suffer permanent lung damage, although it’s not common.
Professor Jo Douglass, head of the Department of Clinical Immunology and Allergy at the Royal Melbourne Hospital, and an Honorary Clinical Professor at the University of Melbourne told The New Daily: “People who have been critically ill and have come through severe lung disease often do take a long time to recover, and there is some concern about how quickly they clear the virus.
“I would expect someone who has had severe viral pneumonia to be unwell for quite a long time.”
There’s something special about COVID
But COVID-19, she said, has “something special about it, in terms of its distribution in the lungs, which has a particular pattern to it.”
The COVID-19 pneumonia, she said, “typically presents in the periphery of the lung, for some reason.”
This has led to patients being turned to lie on their front, contrary to normal practice with pneumonia patients.
“This means they can use parts of their lung that would be normally consolidated (blocked with fluid),” she said.
COVID-19 also causes an abnormality of the blood vessels. And in severe disease, there appears to be excess clotting.
“Because we have tiny blood vessels in the lungs, if they’re being blocked by clotting, or inflamed, they will diminish the person’s capacity to oxygenate (take up oxygen into the bloodstream),” said Professor Douglass.
“That is one of the features that can occur in COVID that is different.”
Professor Douglass made the point that we may not see many cases of unusually prolonged recovery in Australia.
“As there’s been very few patients in Australia who have had COVID-19, not many of us have had the experience people have had overseas,” she said.