Almost eighteen months ago I wrote a piece about what was then termed ‘Long Covid’, the persistence of symptoms in multiple organ systems beyond the acute phase of SARS-Cov2 infection. At the time it was understood that the symptoms spanned 10 organ systems: neuropsychiatric, systemic, reproductive, cardiovascular, musculoskeletal, immunological, head-ear-eye-nose-throat, pulmonary, gastrointestinal and dermatological. A combination of the neurological-cognitive and systemic symptoms were shown to persist the longest, and at the time 91% of respondents in the survey had a recovery time exceeding 35 weeks1.
A recent study has sought to determine the prevalence of Myalgic Encephalomyelitis (ME, aka Chronic Fatigue Syndrome) among a sample of 465 patients with Long Covid2. ME is a serious, long-term illness that affects many body systems. People with ME are often not able to undertake common everyday activities. At times, ME may confine sufferers to bed. People with ME have severe fatigue and sleep problems. ME may get worse if sufferers try to do as much of their daily activities they want or need to do. This symptom is called post-exertional malaise (PEM). Other symptoms can include problems with thinking and concentrating, pain, as well as dizziness3.
In this recent survey of people suspected of having Long Covid, the participants completed three questionnaires and the sample population was predominantly white, female, and living in North America. The mean duration since the onset of Covid-19 symptoms was 70.5 weeks. Among the 465 participants, 58% met a case definition for ME. Of respondents who reported that they had ME, only 71% met criteria for ME, while among those who did not report they had ME, 40% did meet criteria for the disease. Therefore, both over-diagnosis and under-diagnosis were evident on this self-reporting2. This study has also confirmed previous research showing that a substantial percentage of people who contract Covid-19 develop a condition that meets the criteria for a diagnosis of ME, and that this can persist for longer than was suspected earlier in the pandemic.
It is known that SARS-Cov2 is airborne, and can be transmitted by simply breathing in someone else’s exhaled air, not only by inhaling droplets from coughs or sneezes. The World Health Organisation was slow to realise that the pathogen was airborne and only came to this realisation in the middle of 20214. This was despite there being a considerable amount of evidence that aerosol was the dominant method of transmission a year earlier5.
It is also known that people can contract Covid-19 several times and that this increases assorted risks. A recent study analysed 5.3 million health records from the U.S. Department of Veterans Affairs, of people who did not test positive for SARS-Cov2 from March 2020 to April 2022, and compared their health records to 443,000 people who tested positive once during that period and to another 41,000 who tested positive more than once. They studied adverse outcomes, like hospitalisations and deaths, in the health records for these groups for six months6, 7.
They found that people who had more than one Covid-19 infection were three times more likely to be hospitalised and twice as likely to die from Covid-19 than those who only had one infection. Those with multiple infections were also more vulnerable to other dangerous conditions; they were 3.5 times more likely to develop lung problems, 3 times more likely to have heart conditions, and 1.6 times more likely to have brain changes requiring care than people who had only had Covid-19 once6, 7.
The findings supported other studies documenting the effects that COVID-19 has on the body. Most recently, it has been reported that the inflammation caused by COVID-19 can have lasting effects on the brain, including in children. In another study, adults who had even mild COVID-19 symptoms also demonstrated brain changes four months after infection6, 7.
Repeat infections may also increase the risk of Long Covid. It’s not clear what puts people at risk of developing symptoms that can persist long after the infection is gone, and any encounter with SARS-CoV-2 could trigger whatever process is driving Long Covid. Repeated infections only increase the odds6, 7.
So, if you haven’t had Covid-19, wear a mask when in indoor public areas. If you have had Covid-19 once or twice, or more, you don’t want it again, wear a mask when in indoor public areas. It might just save your life.