Many long-COVID symptoms linger even after 2 years, new study shows

More than three years after a mild case of COVID-19, Elizabeth Medina of Levittown still can’t taste or smell food, still has frequent pain and numbness, and continues to have other symptoms that won’t go away.

Medina feels validation from a study released Monday in the journal Nature Medicine that people who had mild COVID-19 are at risk two years later for lung problems, fatigue, diabetes and certain other health problems typical of the sometimes debilitating syndrome known as long COVID.

The analysis is believed to be the first to document the extent to which an array of aftereffects that patients can develop linger beyond the initial months or year after they survived a coronavirus infection.

According to the findings, patients who suffered bouts of COVID-19 severe enough to put them in the hospital are especially vulnerable to persistent health problems and death two years after they were first infected. But people with mild or moderate cases are not spared the consequences when compared with those who never had COVID-19, showing an elevated risk of two dozen medical conditions included in the analysis.

Dr. Sritha Rajupet, who heads Stony Brook Medicine's Post-COVID Clinic in Commack and was not involved in the study, said she isn't surprised by the results. 

"It’s been consistent with what I’ve seen in the clinic," she said.

The study highlights the effects of the virus on millions of Americans and the burden that continues to confront the nation's health care system.

"A lot of people think, 'I got COVID, I got over it and I'm fine,' and it's a nothingburger for them. But that's not everything," said the study's senior author, Ziyad Al-Aly, a clinical epidemiologist at Washington University School of Medicine in St. Louis.

After a couple of years, "maybe you've forgotten about the SARS-CoV-2 infection … but COVID did not forget about you. It's still wreaking havoc in your body," said Al-Aly, chief of research at the Veterans Affairs St. Louis Health Care System.

Medina, who contracted the virus in March 2020, said COVID-19 "is a constant, never-changing situation for me. It affects my quality of life every day."

At 40, she is easily fatigued, and she endures frequent pain and numbness from writing and typing from her job as a school guidance counselor in the Bronx.

Her office is next to the school nurse's office, and she worries about the sick children she is exposed to.

"I’m scared," she said. "I don’t want to catch it again. What if I catch it and something worse happens?"

Rajupet said she has found that patients are more likely to have long COVID if they had multiple infections with the virus — a warning to continue to take the virus seriously, by remaining up to date on vaccines and, especially for those with chronic medical conditions, to wear masks in crowded places and regularly wash your hands.

Long COVID remains a murky syndrome. Investigators participating in a growing body of research define it by different symptoms and different time frames, and some clinicians still do not always regard patients' complaints as a serious phenomenon.

Medina said she has had a hard time finding doctors to treat her, and none that do have found a solution to her maladies.

Medina is part of a long COVID support group in which members share the frustration of problems that stubbornly have stayed with them for years, often with no improvement.

"It's just insane how we're all still in limbo with different symptoms," she said.

Estimates vary of how many people suffer significant aftereffects. One analysis of nearly 5 million U.S. patients who had COVID-19, based on a collaboration between The Washington Post and electronic health records company Epic, found that about 7% of those patients sought care for long-COVID symptoms within six months of their acute illness, which would translate into about 15 million Americans with symptoms typical of long COVID.

The new study is based on electronic medical records from VA databases of nearly 139,000 military veterans diagnosed with COVID-19 from March 2020 through the end of that year. They were compared with a group of nearly 6 million veterans not known to be infected with COVID-19 during that time. 

The relatively small share of COVID-19 survivors who had been hospitalized had a heightened risk two years later of death, subsequent hospitalization and two-thirds of the medical conditions studied, which included cardiovascular issues, blood clotting trouble, diabetes, gastrointestinal problems and kidney disorders.

For the bulk of COVID-19 survivors in the study with milder cases, their long-term risks were less but not entirely gone. By six months after testing positive, they were no more likely to die than people uninfected by COVID-19. But two years later, they still displayed greater odds of medical problems involving some organ systems, including cardiovascular and gastrointestinal trouble and blood clotting, along with diabetes, fatigue and lung issues.

The study's good news is that some people with milder COVID-19 cases do have fewer aftereffects over time, said Eric Topol, director of the Scripps Research Translational Institute who has been immersed in coronavirus research. But he said, "you don't see a lot of optimism in these data. It's basically a continuation of what we see at one year."

The study noted that the COVID-19 survivors tracked in the analysis are not entirely representative of who is most likely to develop long COVID. Because the patients in the study are veterans, the group is older than typical, and nine out of 10 are men, while women account for more than half of long-COVID patients in the general population.

"All of that matters because it affects the overall generalizability of the results," Rajupet said.

In addition, the study followed patients infected in 2020, before widespread availability of vaccines and before Paxlovid, which can reduce the severity of an infection, she said.

“We know the variants have changed, and the strains have changed as well," she said. "We’re now predominantly dealing with omicron-related strains. We're going to need further studies following patients with each of these strains and variants.”

With David Olson