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With vaccine manufacturing delays, mutant variants and continuous breaches in hotel quarantine the pandemic has dug its claws in and shows no sign of going away.

And the long-term symptoms and effects of COVID-19 seem similarly stubborn. Referred to as “long-COVID-19”, the effects on recovered patients’ mental and physical wellbeing are only just starting to be understood.

While just 10-15% of COVID patients have developed severe disease, 80% developed long-term symptoms. More than 50 long-term effects have been studied. They have affected not just those who were hospitalised but also young, healthy people who only had mild symptoms.

Neurological issues

The most widely reported long-term symptom is fatigue. More than half of recovered patients reported feeling fatigue months after infection, and 44% reported headaches. Nearly a third developed an attention disorder, and 21% struggled to sleep.

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A recent Australian study found that 40% of recovered COVID-19 patients still had symptoms 69 days after diagnoses — mostly fatigue, shortness of breath and chest tightness.

A follow-up study of patients in Wuhan six months after they were infected had similar findings, with fatigue or muscle weakness present in 63%, sleep difficulties in 26% and anxiety or depression in 23%.

Scientists worry this could develop into chronic fatigue syndrome, characterised by severe incapacitating fatigue, pain, neurocognitive disability, poor sleep and a poorly functioning nervous system.

A study published this week found that one in three COVID patients who had to be put on a ventilator exhibited symptoms of post-traumatic stress disorder (PTSD) symptoms. Patients with more severe respiratory problems were more likely to develop PTSD symptoms — although this is unique.

Another study found COVID-19 can infect brain cells, causing brain damage in mice and lab-grown human brain cells. So far brain damage has not been found in living patients.

One of the most concerning outcomes of the 2009 SARS pandemic was the way it affected survivors’ mental health. One study found that more than 40% had an active psychiatric illness. Another 40.3% reported a chronic fatigue problem. There were also high levels of depression, anxiety and PTSD.

Organ damage

The virus can enter organs by gaining access through the ACE2 and TMPRSS2 enzymes — which means it can travel easily across the body and enter multiple organ systems.

It’s pretty common for viral infections to cause some organ inflammation — but what’s unusual is that the inflammation isn’t going away when people stop testing positive for COVID-19. One small German study found 60% of patients who had recently recovered still had inflammation of the middle layer of their heart wall, independent of pre-existing conditions and how severe their infection was.

Another study found almost 20% of COVID patients developed cardiac injury.

In another study, which measured mostly healthy patients about four-and-a-half months after recovery, two-thirds of people were found to have impairment in at least one organ system. A quarter had multiple organ systems affected.

The most common impairment was in the lungs and heart at 33% and 32%, followed by the pancreas, kidneys, liver and spleen.

Thankfully it seems heart and lung injury can be reversed with proper follow-up care and rehabilitation.

Worryingly, one study in the New England Journal of Medicine found COVID-19 could not only worsen the effects of diabetes for those who already have it — it could even lead to people developing the disease. The virus that causes COVID binds to receptors in pancreatic beta cells, adipose tissue, the small intestine and the kidneys and could affect the way sugar is metabolised.

Compromised immune system

Researchers at the University of Alabama at Birmingham have also found evidence of cellular immune dysregulation: immune cells were becoming less effective and exhausted from being activated so long fighting the virus, even after the patient no longer tested positive.

Importantly this was found both in those hospitalised and those who weren’t. The number of cells affected increased over time, and researchers are trying to find out whether these changes are linked to long-term symptoms. The still-stimulated cells could be the reason people experience symptoms long after recovery.