Ask Dr. Halverson: COVID-19 'long-haulers' – an emerging concern

web 4 17 Halverson photo
By Dr. Jim Halverson
Prolonged symptom duration and disability are common in adults hospitalized with severe COVID-19. Persistent brain, lung, kidney and psychological difficulties are among the common problems that can linger. As more people recover from milder cases not requiring hospitalization, many are also reporting ongoing symptoms. Facebook support groups now include thousands of people who say they have been wrestling with serious COVID-19 symptoms for at least a month, if not two or three. The groups have coined a name for themselves: “long-haulers.”
Long-haulers are often left out of the COVID-19 narrative. Data sheets count cases, hospitalizations, recoveries and deaths, but these people don’t fit neatly into any of these categories. Many long-haulers say their doctors initially doubted that their symptoms were as severe as they were saying. As time has passed however, more physicians have come to believe and address their concerns. Additionally, medical scientists and epidemiologists are now actively studying the problem.
A recent study, published in the well respected MMWR on July 24, has shed more light on how common these persistent symptoms are. Of 274 people aged 18 and over who were symptomatic, but not hospitalized, and diagnosed more than two weeks before being interviewed by researchers, 95 (35%) reported that they had not yet returned to their usual state of health. 
The proportion differed among age groups: 26% of interviewees aged 18 to 34 years, 32% of people aged 35 to 49 years and 47% aged 50 and older were still not well. Presence of pre-existing chronic health conditions also affected return to health rates: 28% with no or one chronic medical condition, 46% with two chronic medical conditions and 57% with three or more chronic medical conditions were still having symptoms. 


Obesity and reporting a psychiatric condition also were associated with more than a twofold increased chance of not returning to normal health. Fatigue (71%), cough (61%) and headache (61%) were the most commonly reported lingering symptoms. In addition, 29% of patients who reported shortness of breath as an initial symptom were still experiencing that more than two weeks later.
This report validates that even among symptomatic adults not requiring hospitalization, it might take weeks for resolution of symptoms and return to normal health. Even among young adults aged 18-34 with no chronic medical conditions, nearly one in five were still symptomatic over two weeks later. These studies have important implications for understanding the full effects of COVID-19, even in people with mild cases. Notably, convalescence can be prolonged leading to significant absence from work, school,  or the ability to care for children or other family members.
Adults are not the only COVID-19 “long-haulers.” Some children still have symptoms months after falling ill. As the number of cases in children and adolescents goes up (currently more than 300,000 people under 18 have tested positive in the United States since the pandemic started, including nearly 100,000  in the last two weeks of July) more persistent cases are sure to be identified. Researchers are now beginning to study this issue and reports should be coming soon.
I draw several conclusions from this information:
    1) COVID-19 is not just “the flu.” The vast majority of people who get seasonal influenza recover in five to seven days with no lingering symptoms.
    2) Acquiring herd immunity by allowing “low-risk” people to catch the virus and spread it to other “low-risk people” is a dangerous and foolish strategy.  With significant and persistent symptoms, many people will suffer prolonged health issues.
    3) This is not just an “older persons” disease. As testing increases and time goes on, people of all ages and health are being significantly affected.
    4) Much more information is needed. There is good news regarding this. Researchers at Harvard University, Oxford University in England and other outstanding academic institutions are now collecting data and interviewing survivors. Scientifically accurate reports will  be published in the weeks and months ahead.
Stay safe. Stay informed. Get the word out, especially to young people and families with children that there may be significant consequences, both short and long term, from COVID-19. Safe and effective vaccines are now in the final stage of trials and should become available beginning early next year. 
Treatment options for both hospitalized patients and people ill at home are being appropriately studied in clinical trials. I am confident that our scientific and medical community, working diligently around the world, will be successful in controlling this pandemic.
Stay positive, stay committed, stay safe and stay well.

— Dr. Jim Halverson, a longtime Ojai physician, writes a regular column on COVID-19 for the Ojai Valley News.


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