At this point, we are all well aware of the acute or short-term symptoms of the novel coronavirus: fever, cough, shortness of breath, fatigue, muscle and body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea and vomiting, and diarrhea .
We also know that the virus affects people differently. Some people become infected and are completely asymptomatic, some experience very mild symptoms, and others end up fighting for their lives on a ventilator in a hospital emergency room.
Six months into the COVID-19 pandemic we are still learning new information about this highly contagious virus. As time wears on one thing is becoming abundantly clear: the effects of the novel coronavirus do not necessarily stop once an individual has been declared virus-free.
The Long-Term Symptoms of COVID-19
Dr. Gregory Poland, a COVID-19 expert at Mayo Clinic, says that what is starting to emerge is the idea of COVID-19 “long-haulers”- people who are developing long-term and ongoing complications from the virus.
“We’re really seeing a number of reports of people who report long-term fatigue, headaches, vertigo (and), interestingly enough, difficulties with cognition, hair loss, cardiac issues, and diminished cardiorespiratory fitness,” he explained .
Long Term Effects Becoming More Clear
Poland suspects that a large portion of those long-term symptoms and complications will relate to the significant cellular-level damage that the novel coronavirus can cause.
While it is still too early to definitively say what the long-term effects of the virus are, the best evidence comes from the patients themselves, some of whom experience a variety of symptoms long after their infections have cleared. So far, the most common long-term effects appear to be exhaustion, headaches, anxiety, and muscle aches that can continue for several weeks after these patients are declared virus-free .
Severity of Cases Linked to Long Term Issues?
Not surprisingly, patients who had more severe cases of the virus or who required ventilators or kidney dialysis tend to experience more serious long-term issues. Those who developed pneumonia may have lung scarring, and heart inflammation, irregular heartbeats, and worsening kidney and liver function have also been reported. It is unclear yet whether or not these issues will be permanent.
Additionally, those who endured long stays in intensive care may require oxygen therapy or dialysis at home, and some could develop a condition known as post-intensive care syndrome, which could include persistent muscle weakness and memory problems.
Another complication that has been arising are strokes caused by blood clots that developed during or after a COVID-19 infection. Because of this, even patients with less serious cases are being prescribed blood thinners, which also require lifestyle changes to reduce the risk of bleeding.
Dr. Thomas McGinn of the Feinstein Institutes for Medical Research in New York, who was involved in one of the largest U.S. studies of COVID-19 patients says that for the most part, symptoms do appear to go away.
“It’s just a matter of when. For some patients it may take longer than others,” he said .
Athena Akrami’s Story
Athena Akrami is one of these “long-haulers”. The 38-year-old first experienced symptoms of the novel coronavirus on March 17, and for weeks she struggled to recover at home. Contrary to what many people assume happens when you get sick, her symptoms did not gradually go away over time. Instead, they continued to get worse, then better, then worse again, without ever really going away.
Akrami did not fall into either category, and the successful woman who used to go to the gym three times per week now has an exercise routine of moving from the bed to the couch. Her neuroscience lab where her students learn how the brain organizes memories to support learning has reopened without her, while she remains home, struggling to think clearly and battling muscle and joint pain.
There are thousands more like Akrami, and COVID-19 online support groups and outpatient clinics for survivors are now popping up everywhere. Many of these clinics are already receiving more patients than they can handle, and Akrami has now been on the waiting list for one of them for more than four weeks.
Survivor Studies are Underway
As more and more COVID-19 survivors have been speaking up about their ongoing symptoms, research teams around the world are beginning to launch in-depth survivor studies in order to better understand what these people are experiencing, and of course how to help them.
In July a team from the United Kingdom launched a study that will follow ten thousand survivors for one year to start, and up to twenty-five years thereafter. The hope is to understand the long-term impact of the disease as well as who is at the highest risk for lingering symptoms and whether treatments in the acute phase of the illness can prevent them.
A Disease that Must be Taken Seriously
Dr. Poland argues that the emergence of these long-term complications is an important reason why the disease must be taken seriously, even for young people or those who only suffer mild cases of the virus.
“People who are thinking, especially young people: ‘(It’s a) mild disease, you know. I might not even have any symptoms, and I’m over it.’ Whoa,” he says. “The data is suggesting otherwise. There’s evidence of myocardial damage, cardiomyopathy, arrhythmias, decreased ejection fractions, pulmonary scarring and strokes.” 
Just as the acute phase of the virus surprised doctors and researchers with the wide range and variability of symptoms, so too have the long-term effects. What’s even more surprising is that even people with mild symptoms in the acute phase are at risk for long-term complications.
Götz Martin Richter, a radiologist at the Klinikum Stuttgart in Germany, describes two patients he has treated. One, a middle-aged man with mild pneumonia from COVID-19, and the other, an elderly woman already suffering with chronic leukemia and arterial disease. Unfortunately, the woman nearly died from the virus and required resuscitation, but eventually recovered.
Three months after both patients healed, the woman has minimal lung damage and feels fine, while the man has extreme difficulty staying awake all day and cannot work .
Severe Illness Followed By Chronic Illness
For many experts, these last implications do not come as a surprise, since many illnesses, diseases, and infections come with lasting effects.
“What we’re experiencing is an epidemic of severe illness,” says Michael Marks, an infectious disease specialist at the London School of Hygiene & Tropical Medicine. “So therefore, there is an epidemic” of chronic illness that follows it.” 
Dr. Poland says that these long-term complications are going to be just as important to study as the acute symptoms.
“We’re going to see more and more of the longer-term consequences come out, and we’re going to need to study those as vigorously as we did the acute symptoms. Catalog them, understand them and then do clinical trials to figure out how best to treat them.”