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Recovery from COVID-19

Currently, the long-term effects of SARS-CoV-2 are not fully understood. However, we know that those who suffer serious illnesses who contract COVID-19 have significant mortality and morbidity as a short to medium-term effect. Still, many may suffer from physical and psychological difficulties long term.


Data amassed from a UK smartphone tracking app of symptoms shows that one in ten reporting individuals are sick for more than three weeks.


What does recovery mean?


Generally, recovery implies that the individual will go back to pre-infection levels of functionality and quality of life, but this is not as simple for COVID. The full effects of COVID-19 are hard to gauge because many numbers around the pandemic focus on deaths, so many cases that do not require hospitalization (e.g., asymptomatic) are not followed upon.


What does "mild COVID" mean?


Image courtesy of Justin Paget, Getty Images.


Symptoms that persist, including chest heaviness, breathlessness, muscle pains, palpitations, and fatigue, are merely classified as mild even though these symptoms can render an individual immobile and unable to function appropriately for a prolonged period.


Recovery needs to be redefined


Death as criteria of COVID severity undermines and overshadows "mild" cases.


The narrow narrative of death as the only bad outcome from COVID needs broadening to include people becoming less healthy, less capable, less productive, and living with more pain.

- Associate Professor Nisreen A. Alwan, University of Southampton


Besides, although most COVID patients' recovery is anticipated, long-term damage is also possible, including long-term lung damage and a potential impact on neurological function.


CT scan of a patient's lungs shows damage from COVID-19 in red (Gerlig Widmann and team, Department of Radiology, Medical University of Innsbruck).


Evidence from a study by Scott Rooney, Amy Webster, and Lorna Paul indicates that patients exhibit reduced physical activity and function compared to healthy controls due to complex mechanisms, including prolonged immobility, hospitalization, and possible infection factors.


Infection may not equal immunity


Herd immunity is a possible way to control the pandemic. Although vaccines are on their way, it is not sure whether there is post-infection immunity from SARS-CoV-2. An example of viral pathogens that do not produce post-infection immunity is the influenza virus, which does not create a durable immune response.


What's next: How can healthcare systems respond?


Healthcare systems need to take a multidisciplinary (encompassing different specializations) approach to treat patients that are recovering. A wide breadth of symptoms/effects should be assessed, from pulmonary to mental health support.


References


Alwan, N. (2020, August 11). A negative COVID-19 test does not mean recovery. Retrieved December 22, 2020, from https://www.nature.com/articles/d41586-020-02335-z

Butler, M. J., & Barrientos, R. M. (2020). The impact of nutrition on COVID-19 susceptibility and long-term consequences. Brain, behavior, and immunity, 87, 53–54. https://doi.org/10.1016/j.bbi.2020.04.040

Kirkcaldy RD, King BA, Brooks JT. COVID-19 and Postinfection Immunity: Limited Evidence, Many Remaining Questions. JAMA. 2020;323(22):2245–2246. doi:10.1001/jama.2020.7869

O’Brien, H., Tracey, M.J., Ottewill, C. et al. An integrated multidisciplinary model of COVID-19 recovery care. Ir J Med Sci (2020). https://doi.org/10.1007/s11845-020-02354-9

Scott Rooney, Amy Webster, Lorna Paul, Systematic Review of Changes and Recovery in Physical Function and Fitness After Severe Acute Respiratory Syndrome–Related Coronavirus Infection: Implications for COVID-19 Rehabilitation, Physical Therapy, Volume 100, Issue 10, October 2020, Pages 1717–1729, https://doi.org/10.1093/ptj/pzaa129



Article Authors: Mina Chong, Olivia Ye