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COVID-19 was full of surprises at first, causing mild short-term problems for some people and serious complications for others.
In the long run, it can be just as capricious.
Studies are detecting possible heart and brain problems up to a year after infection with SARS-CoV-2, even in people who have had mild COVID-19.
Possible long-term effects include “a myriad of symptoms that affect different organs,” said Dr. José Biller, director of the COVID-19 neurology clinic at Loyola Medicine in Maywood, Illinois. “So it could be the lungs, it could be cardiovascular, it could be the nervous system, it could be mental health or behavioral issues.”
Estimates vary widely on how many people may be affected. Research suggests that around 10% to 20% of people experience mid- or long-term problems with COVID-19, according to the World Health Organization.
That may seem like a small amount, but COVID has affected hundreds of millions of people, said Dr. Siddharth Singh, director of the post-COVID-19 cardiology clinic at the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles. In the US alone, about 80 million people have been infected with the coronavirus since the start of the pandemic in early 2020.
There are far more questions than answers, including who is most at risk of post-COVID issues and how long the effects might last. But experts say people who have had COVID-19 should be aware of these potential risks:
Heart disease and stroke
A study published in Nature Medicine in February concluded that the risk of heart problems one year after infection with COVID-19 is “substantial”.
These heart problems include irregular heartbeats, heart failure (the heart’s inability to pump properly), coronary heart disease (buildup in the arteries that limits blood flow), heart attacks, and more.
The study included 153,760 US veterans, mostly white and male, who tested positive for COVID-19 between March 1, 2020 and January 15, 2021 and survived at least 30 days. They were compared to a control group of more than 5.6 million COVID-19-free veterans.
The researchers adjusted for pre-existing conditions and found that after one year, those who had COVID-19 were 63% more likely to have some type of cardiovascular problem, resulting in about 45 additional cases per 1,000 people.
Risks were elevated even among people who did not have severe COVID-19. This matches what Singh saw at his post-COVID clinic, which he began treating patients in December 2020. “Many patients we saw with long-term symptoms had mild illnesses and were treated at home.”
Singh also treats many people with postural orthostatic tachycardia syndrome, or POTS, which can cause dizziness, fainting, and heart palpitations. “These palpitations tend to happen mostly when people are standing or sitting,” he said.
In rare cases, “smoldering inflammation around the heart or in the heart” may occur, Singh said.
The Nature Medicine study also found a 52% increase in stroke risk at one year among COVID-19 survivors, or about four extra strokes per 1,000 people.
Among the 113 patients in Biller’s long-running COVID clinic, nearly 3 out of 4 reported so-called brain fog. “They are unable to multitask and have difficulty learning new skills,” said Biller, who also heads the department of neurology at Loyola University Chicago Stritch School of Medicine.
A recent Nature study of 785 people ages 51 to 81 found that those who had COVID-19 lost more gray matter and had more brain shrinkage than those who didn’t.
A study published in February in the BMJ used the same group of US veterans as the Nature Medicine study and found a 35% higher risk of anxiety disorders after COVID-19, or 11 additional cases per 1,000 people after one year compared with those without COVID-19. 19. The risk of depression was slightly higher.
When researchers compared people who had COVID-19 versus the flu, the risk of mental health disorders was again significantly higher with COVID-19.
“Mental health is closely linked to cardiovascular health,” Singh said. If someone is anxious or depressed, “they’re not going to exercise as much. They’re not going to watch their diet, control their hypertension and other risk factors, their sleep is affected, which can affect cardiovascular health and therefore on. ”
He said many COVID-19 survivors also have unresolved grief, grief and post-traumatic stress disorder, which can contribute to a decline in mental health.
At Biller’s post-COVID clinic, patients often describe feeling “overwhelming” fatigue. Fatigue was the most common post-COVID symptom reported in a review of several studies published in August in Scientific Reports.
What can you do
Even though the long-term risks of having COVID-19 may be real, Singh said, they shouldn’t cause most people much concern. Instead, he said, this is a good time to be proactive:
– Take care of yourself. “Many of my family and friends have contracted COVID earlier this year and last year,” Singh said. “What I’m saying to them is just to be a little bit more vigilant when it comes to their cardiovascular health and to make sure their cardiovascular risk factors are well controlled. Obviously, if someone is having chest pain or shortness of breath or palpitations, this must not be ignored.”
– Persistent symptoms? See a doctor. “It can take anywhere from two to six weeks to fully recover from the infection,” Singh said. But if people have persistent physical and mental symptoms beyond four to six weeks, “it’s wise to get checked out.”
– Pay attention to sleep. Sleep disturbances — which are linked to heart problems — can develop after COVID-19, research shows. “The importance of good sleep cannot be underestimated,” Singh said. If you’re having trouble, you might need to see a specialist.
– Stay informed. As research continues to unravel the mysteries of COVID-19, people will need reliable information. The Centers for Disease Control and Prevention provides regular updates on the coronavirus, and the National Library of Medicine provides a tutorial for evaluating health information.
– Get vaccinated. COVID-19 vaccines reduce the risk of infection and serious illness. And while it’s still unclear whether vaccination influences long-term symptoms in people who contract unexpected infections, Biller said “prevention is key.”
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