More people than previously thought are COVID-19 long-haulers, according to figures from a new survey of more than half a million people in England.
Researchers from Imperial College London found that about one in three people who caught COVID-19 with symptoms that impacted their daily lives went on to have “long COVID,” defined by the group as at least one self-reported symptom lasting for more than 12 weeks.
Those who received hospital treatment were more likely to experience long-lasting symptoms than those who didn’t, the authors said in a paper posted Thursday.
Women and older people were most likely to be affected, they said. Heavier people, smokers, people on low incomes, and those with long-term medical conditions had the highest risk, they found.
The researchers estimated that as many as 2 million people had long COVID in England, almost double the number estimated by the Office for National Statistics (ONS), at 741,000 people.
The findings come from the REACT-2 study, a community-based survey of more than 500,000 adults commissioned by the Department of Health and Social Care. It’s not clear how badly the symptoms affected people’s lives.
Professor Paul Elliott, director of the REACT programme, said the results “paint a concerning picture of the longer-term health consequences of COVID-19.”
The Imperial College researchers said in the paper that the results could be an overestimate, because some of the 29 symptoms they asked about could occur in other conditions. They also didn’t compare the results with people who hadn’t caught COVID-19, they said.
Kevin McConway, emeritus professor of Applied Statistics at the Open University, who was not involved in the research, said in a statement to the Science Media Centre that the main reason for the discrepancy between the new findings and the ONS results was that they estimated slightly different things. The ONS estimated the number of people who had long COVID on a particular date (May 2), while REACT-2 gave measured how many people had long COVID at some time between September 2020 and February 2021, he said.
Despite this, the REACT estimate was still higher, he added.
Doctors in India claim that the highly infectious Delta variant could cause unusual symptoms such as gangrene and hearing loss, which they say are becoming more common in COVID-19 patients of all ages.
The highly infectious variant has spread to 67 countries and is becoming more common around the world. But, with fewer cases in India sequenced, there isn’t enough data to know for sure whether the symptoms are unique to the variant, or are caused by COVID more generally, which has already been linked to unusual symptoms such as diarrhea and blood circulation issues.
The Delta variant is estimated to be 60% more infectious than the Alpha variant that’s currently the most common in the US. It also has mutations that mean it can partially avoid the immune response.
Dr. Anthony Fauci, President Joe Biden’s chief medical advisor, warned last week that the fast-spreading Delta variant could take hold in the US, if more Americans didn’t get their COVID-19 shots. A Public Health England document from May reported the Pfizer and AstraZeneca vaccines were respectively 88% and 60% effective against the Delta variant after both doses.
Dr. Ganesh Manudhane, consultant cardiologist at Seven Hills Hospital in Mumbai, told Insider that he used to see four patients a year who had small blood clots causing gangrene, a serious condition where a loss of blood supply causes body tissue to die. Now it’s one person every week, he said.
“I suspect it could be because of the Delta variant, because of the increased number of cases,” Manudhane said – but he added that he hadn’t genetically sequenced the patient’s coronavirus tests to check for the Delta variant, which has become the most common COVID variant in the country since first being identified there in October.
Dr. Abdul Ghafur, infectious disease consultant at Apollo Hospital in Chennai told Insider that he had experienced far more cases of people with COVID-19 presenting with diarrhea than in the first wave in 2020.
But “all of the inferences from local doctors across the country were based on their clinical experience and not on any published data,” he said.
It isn’t clear how many people in India are infected with Delta compared with other variants. It is one of three similar virus strains that all originated in India.
Some statistics group these three together, and not all positive coronavirus tests are sequenced in the lab to check for variants. As of April, 0.75% of all India’s cases were sequenced, according to a report in Nature. The country has had 29.45 million recorded cases since the pandemic began.
This lack of data is holding back doctor’s understanding of the variant.
Ghafur added that “despite having the second highest number of [COVID-19] patients in the world, India’s premier research institute, the Indian Council of Medical Research, hadn’t conducted any scientific studies of value.”
Anurag Agarwal, director at the Institute of Genomics and Integrative Biology in Delhi, told Insider that there was no clear link between the Delta variant and atypical symptoms.
Agarwal said the rise in people with atypical symptoms may be because of the increases in overall COVID cases in India, rather than the rise of the Delta variant.
Neil Ferguson, director at the MRC Centre for Global Infectious Disease Analysis at Imperial College London, explained at a briefing in the UK on Wednesday that, when a large number of people get sick, there can be a spectrum of rare conditions that aren’t typical at all.
Dr Jeffery Barrett, director at the COVID-19 Genomics Initiative at the Wellcome Sanger Institute, UK said at the same briefing that the UK processes up to 20,000 tests each week.
INSACOG, a group of research labs that conducts India’s sequencing, said it had sequenced more than 10,000 samples since it was set up in December.
Barrett told the briefing there was no data to suggest the Delta variants caused different symptoms to other variants.
Dr. Harsh Vardhan, India’s health minister, said Monday that there were more than 28,000 recorded cases of black fungus infection that occurs in people with compromised immunity or diabetes. Of these, 86% had had COVID-19.
The link between black fungus and suppressed immunity or diabetes is not proven – but it’s been suggested the high numbers of both in India could explain the number of cases of it.
Ghafur said he believed the Delta variant was most likely the cause of the rise in black fungus cases.
“India has always been the diabetes capital of the world and use of [immune system suppressing] steroids was rampant in the first wave,” Ghafur told Insider. “The only difference this time is the Delta variant.”
Dr Shailesh Kothalkar, an ear, nose, and throat (ENT) surgeon at Seven Star Hospital in the western city of Nagpur, told the Telegraph that the Delta variant was “causing damage to the beta cells in the pancreas, which produce insulin and regulate blood glucose levels.”
“We need more investigation into this but […] around 40% more patients are developing diabetes after having COVID-19 during this second wave,” he said.
Professor David Denning, a professor of infectious diseases at the University of Manchester and chief executive of the Global Action Fund for Fungal Infections told the Telegraph: “It’s possible that a different variant would produce more disruption of the lining of the nose or the lungs… and then that would allow fungus to get in more easily.”
“People could be suffering from long COVID and not knowing it because they have not gotten the knowledge to identify themselves as having it,” Fidaa Shaib, a pulmonologist at Baylor College of Medicine’s long COVID clinic, told Insider.
Long COVID presents with a huge variety of symptoms, Shaib added, which makes it difficult for doctors to spot.
That is, in part, why estimates of how common long COVID is vary widely. A large UK study found that about one in 10 COVID-19 survivors will develop long COVID – defined as experiencing lingering symptoms for more than three weeks after being infected. A University of Washington estimate, meanwhile, put the figure at closer to one in three COVID-19 patients.
Dr. Ziyad Al-Aly, an epidemiologist and chief of research at a Veterans Affairs teaching hospital in St. Louis, told Insider that the syndrome “can affect nearly every organ in the body.”
It is not yet clear if the symptoms of long COVID are caused directly by the virus, or if some are triggered by the stress and trauma of infection and the pandemic. Regardless, people urgently need help managing their symptoms, Shaib said, especially those associated with chronic illness.
Here are 12 ways patients can be affected by long COVID.
One in five long-haulers experienced brain fog six months after having COVID-19, according to an analysis of 51 long COVID studies that has not yet been peer-reviewed. This was the case regardless of whether the patients had been hospitalized or not.
Gut symptoms, such as loss of appetite and diarrhea
A small study from China found that more than 40% of patients hospitalized with COVID-19 reported issues related to the gut three months after their primary infection. The most common symptoms were loss of appetite, nausea, acid reflux, and diarrhea.
Skin rashes and hair loss
COVID-16 survivors reported skin rashes six months among after infection, according to the study of US veterans.
Odd-looking nails could be a sign of previous coronavirus infection, a top UK scientist has said.
Horizontal lines across the nail that appear several months after catching coronavirus can happen in both fingers and toes, Tim Spector, professor of genetic epidemiology at King’s College, told Insider.
Spector, who leads the world’s largest coronavirus symptom study, said that he’d received multiple anecdotal reports of so-called COVID nails from people using the ZOE COVID Symptom Study app, a symptom tracker with more than 4 million users globally.
Spector’s hunch is that this isn’t a random phenomenon as it can happen after other infections too.
The underlying theory is that a stress line forms after the body shuts down for a brief period of time to fight the infection. During this time period nails don’t grow. It also can happen after other stresses like chemotherapy and severe malnutrition.
“It’s like a mark on a tree when an event happened,” Spector explained.
Dr. Tanya Bleiker, president of the British Association of Dermatologists, told HuffPost UK that dermatologists have seen COVID-19 patients with horizontal lines on their nails too.
“These changes have long been recognized as ‘Beau’s lines’ and are transverse indents in the nail of many, or all, fingernails and sometimes toenails,” she said.
Beau’s lines are not harmful themselves and usually grow out after several months.
Spector said that it’s not yet clear whether the nail changes are linked to disease severity for coronavirus. With other infections, the more severe the disease, the more likely you are to have a marker on your nail, he said.
“It may be a marker of severe infection [for COVID-19], but it would be more helpful if it wasn’t,” Spector added.
Spector explained that if nail changes were a marker of previous coronavirus infection then it could help people figure out whether they’ve had COVID-19 before without the need for a test that can be invasive and expensive.
“If we get enough numbers that are associated with asymptomatic COVID-19, that’s a cheap antibody test,” he said. “People just need to look down at their nails.”
A few months ago, a young athletic guy came into my clinic where I’m an infectious disease physician and COVID-19 immunology researcher. He felt tired all the time, and, importantly to him, was having difficulty mountain biking. Three months earlier, he had tested positive for COVID-19. He is the kind of person you might expect to have a few days of mild symptoms before recovering fully. But when he walked into my clinic, he was still experiencing symptoms of COVID-19 and he could not mountain bike at the level he was able to before.
Tens of millions of Americans have been infected with and survived COVID-19. Thankfully, many survivors get back to normal health within two weeks of getting sick, but for some COVID-19 survivors – including my patient – symptoms can persist for months. These survivors are sometimes dubbed long-haulers, and the disease process is termed “long COVID” or post-acute COVID-19 syndrome. A long-hauler is anyone who has continued symptoms after an initial bout of COVID-19.
Numerous studies over the past few months have shown that about one in three people with COVID-19 will have symptoms that last longer than the typical two weeks. These symptoms affect not only people who were very sick and hospitalized with COVID-19, but also those with milder cases.
Long COVID is similar to COVID-19
Many long-haulers experience the same symptoms they had during their initial fight with COVID-19, such as fatigue, cognitive impairment (or brain fog), difficulty breathing, headaches, difficulty exercising, depression, sleep difficulty and loss of the sense of taste or smell. In my experience, patients’ symptoms seem to be less severe than when they were initially sick.
Patients who were hospitalized for COVID-19 are the most likely to have persistent long-term symptoms.
In a study published in July 2020, Italian researchers followed 147 patients who had been hospitalized for COVID-19 and found that 87% still had symptoms 60 days after they were discharged from the hospital. A more recent study, published in January, found that 76% of hospitalized COVID-19 patients in Wuhan, China, were still experiencing symptoms six months after first getting sick.
This Wuhan study was particularly interesting because the researchers used objective measures to evaluate the people reporting lingering symptoms. People in the study were still reporting persistent breathing problems six months after getting sick. When researchers performed CT scans to look at the patients’ lungs, many of the scans showed splotches called ground-glass opacities. These likely represent inflammation where SARS-CoV-2 had caused viral pneumonia. Additionally, the people in this study who had severe COVID-19 could not walk as fast as those whose illnesses were less severe – these lung problems reduced how much oxygen was moving from their lungs into their bloodstream. And remember, this was all measured six months after infection.
The medical community still does not know just how long these symptoms will persist or why they occur.
According to recent research that has yet to be peer-reviewed, many long-haulers cannot return to work or do normal activities because of brain fog, pain, or debilitating fatigue. Before my patient got sick, he would bike up a mountain in our Colorado town almost every day. It took him four months to recover to the point where he could climb it again.
SARS-CoV-2 hurts people in more ways than the medical community originally recognized. At Colorado State University, my colleagues and I are studying long-haulers and exploring whether immune system imbalances play a part in their disease process. Our team and many others are diligently working to identify long-haulers, to better understand why symptoms persist and, importantly, to figure out how the medical community can help.