Most people who develop COVID-19 recover in 2-6 weeks, but between 10 percent (BMJ, Aug 11, 2020;370:m3026) and 70 percent (JAMA, 2020;324(6):603-605) of recovered COVID-19 patients develop “Long COVID-19 Syndrome,” suffering at least one symptom for many weeks or months after their initial infection. In a study from China, 16 percent of COVID-19 patients still suffered from significant symptoms three months after they had appeared to recover (EClinicalMedicine, Aug 25, 2020:100463). Young children are least likely to develop severe COVID-19, but 66 percent of recovered children had some sign of organ damage four months after their initial symptoms (BMJ, Nov 17, 2020;371:m4470).

The U.S. Centers for Disease Control and Prevention (CDC) lists the following Long COVID-19 symptoms:
• chest pain
• shortness of breath
• irregular heartbeats
• fatigue
• muscle weakness
• fever
• difficulty concentrating
• forgetfulness
• irregular periods
• impotence
• diabetes
• hair loss
• mood changes
• insomnia
• headaches
• diarrhea
• vomiting
• loss of taste and/or smell
• sore throat
• difficulty swallowing
• skin rash

Lungs: A three-month follow up of mildly infected people found that more than 70 percent had abnormal lung scans (EclinicalMedicine, Aug 25, 2020:100463). More than half of infected people had “ground glass” opacities in their lungs, a sign of lung damage that can lead to long-term breathing problems (Radiol CardioImag, Mar 17, 2020;2(2)).

Heart: Up to 30 percent of people hospitalized with COVID-19 have signs that the illness has affected their heart muscle (JAMA Cardiol, Mar 27, 2020;5(7):831-840). These researchers speculate that in some people, COVID-19 may also cause an inflammation of the heart muscle called myocarditis. Lasting damage to the heart muscle can occur even in people who experienced only mild COVID-19 symptoms.

Impotence and irregular periods: Testes and ovaries both have ACE2 receptors, through which the COVID virus enters human cells. The virus can damage endothelial cells lining your blood vessels (Eur Heart J, Aug 21, 2020;41(32):3038–3044), a common cause of erectile dysfunction. Men hospitalized for COVID-19 are at increased risk for having low levels of testosterone (medRXiv preprint, Dec 20, 2020), and low testosterone is associated with more severe COVID-19 disease (Andrology, published online May 20, 2020) and future infertility (Eclinical Med, Nov 1, 2020;28:100604). Almost 30 percent of women infected with COVID-19 had menstrual cycle changes, primarily decreased blood flow or prolonged cycle time (Reprod Biomed Online, Sep 29, 2020).

The nervous system: People who have had severe COVID-19 were significantly more likely to suffer nerve damage including dizziness, nerve pain, and impaired consciousness (JAMA Neurol, Apr 10, 2020;77(6):683-690).

Mental health: People who have been infected with COVID-19 often suffer stress, anxiety, depression, and sleep disturbance, and are at increased risk for psychiatric disease (Lancet, November 09, 2020).

Diabetes: There has been a significant increase in the diagnosis of diabetes during the pandemic (N Engl J Med, Aug 20, 2020; 383:789-790). COVID-19 can damage every organ in your body including your pancreas.

Chronic fatigue syndrome: Many people with lasting COVID-19 symptoms report episodes of what is now called myalgic encephalomyelitis, a long-term condition that can follow any viral infection: severe physical fatigue and pain during exercise, difficulty breathing, joint pain, chest pain, loss of memory and usual ability to think clearly, difficulty sleeping, and muscle pain after trying to exercise (JAMA, 2020 Aug 11;324(6):603-605).

My Recommendations
As the COVID-19 pandemic continues, we are learning more about the long-lasting or possibly permanent damage the virus can cause. The apparent frequency of Long COVID-19 Syndrome makes getting a vaccination even more important. The pandemic will last until we have herd immunity, when about 80 percent of the population is immune. This could occur within a year now that widespread distribution of effective vaccines has begun. Watch the news in your area for information on local vaccine availability.

Meanwhile, I remind you once again to protect yourself and help limit spread of COVID-19:
• Wear a face mask any time you expect to be close to people who are not members of your household.
• Try to stay at least six feet away from other people.
• Avoid anyone with respiratory symptoms.
• Use 20-second soap hand washes frequently throughout the day.
• If you feel sick, stay home.
• If you decide to travel, go by car if possible. Personally, I am still avoiding group travel such as trains, planes, buses and ships.
• Spend lots of time outdoors. Transmission of the virus occurs most often in closed spaces, particularly crowded places or rooms with poor air circulation.