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VERISK PERSPECTIVES | AN ISO EMERGING ISSUES REPORT

COVID-19’s long tail: Why we may be living with the effects of the disease for years to come

By: Brandy Dennis

Early studies indicate that the COVID-19 virus can have serious, lasting effects on an individual’s respiratory, cardiovascular, and neurological health, even in mild cases that required no medical intervention during infection. These concerns and patient experiences with weakness, fatigue, insomnia, and possible mental health issues complicate recovery after infection.1 Will these lasting symptoms complicate preexisting medical conditions or impact mortality? Early studies suggest they might.

How does COVID-19 affect patients?

According to the World Health Organization, most COVID-19 infections are mild or asymptomatic. Approximately 15 percent of patients will have moderate to severe symptoms requiring supplemental oxygen, and another 5 percent are considered critical infections that require artificial ventilation.2 More severe cases are typically occurring in older patients and/or those with chronic health problems. Studies have also shown that previously healthy patients age 18-34 with mild (non-hospitalized) cases of confirmed COVID-19 are reporting continued symptoms anywhere from three weeks to three months after testing positive.3 These lingering symptoms have raised concerns about a recovering patient’s ability to return to normal life, the quality of their post-COVID life, as well as the ability to care for those with chronic conditions when the infection has passed.4

COVID-19, a respiratory virus, invades the body through the lungs. As the virus enters the lungs, it attacks the cells that line the airways, creating a flood of white blood cells. As the body is fighting the infection, inflammation of the tissue and fluid accumulation begins, which can cause pneumonia. This process can also lead to decreased oxygen saturation and damage to the lung tissue.5 In patients with preexisting respiratory conditions—such as chronic obstructive pulmonary disease (COPD)—the body is less effective at fighting the infection, and the already compromised lung tissue is weaker, leading to more severe infections. One early study in the European Respiratory Journal indicates that patients with a history of COPD account for more than 60 percent of severe cases of COVID-19 infection, compared to just over 15 percent of non-severe cases.6

Data published by JAMA Cardiology indicates that cardiac inflammation was present in 60 percent of COVID-19 patients who weren’t hospitalized and had little or no previous cardiovascular concerns. Overall, cardiovascular issues were detected in 78 percent of patients recovering from COVID-19, irrespective of preexisting conditions, the severity and overall course of the disease, the time from the original diagnosis, or the presence of cardiac symptoms.7 If these effects, compounded by fatigue and weakness, endure for weeks to months after illness, mortality could be significantly impacted for a patient with cardiovascular disease, especially if they’re prevented from performing rehabilitative activities, such as walking.8

In addition to respiratory and cardiovascular concerns, COVID-19 appears to adversely affect the brain and central nervous system, according to the American Journal of Emerging Medicine. Impaired level of consciousness, cerebrovascular disease, encephalitis, encephalopathy, and Guillain-Barre Syndrome have all emerged as complications. Additionally, some of the medications utilized to treat COVID-19 pose potential neurologic risks and may adversely interact with medications that individuals are already taking to address a preexisting neurologic disease.9

What about indirect impacts from COVID-19?

In most cases, COVID-19 has compelled people to limit their movement and generally be more sedentary than usual. Based on this, The Journal of Aging Clinical and Experimental Research published an article identifying the indirect effects of COVID-19 on individuals with and without comorbidities. With less time spent outdoors, vitamin D levels decrease, which can play a role in immune function and mental health. Add in the systemic inflammation many patients experience when infected with COVID-19, and concerns surface for those with autoimmune conditions—they may experience an increase in symptoms from preexisting conditions, as well as the onset of a new chronic illness. Additionally, there are many conditions that rely on physical activity as a form of treatment or management, including heart disease, hypertension, obesity, arthritis, and even cognitive decline.10 Prolonged periods of stasis could increase these risks.

Another consideration involves individuals who have diabetes. If a patient cannot shop for or afford healthy food options, what impact could this have on managing diabetes? As with any illness, COVID-19 infection may increase a diabetic’s insulin needs during infection, changes in physical activity, and/or diet.

This all begs the question: will patients be equipped with the knowledge, equipment, and medications necessary to manage these changes during a period of quarantine? Additionally, individuals who are stricken with fear of exposing themselves to COVID-19 may be less likely to seek physicians care in the office, or even on an emergency basis, for their normal health challenges.

Throughout the pandemic, anxiety surrounding exposure to COVID-19, a lack of health insurance due to job loss, and healthcare systems being overwhelmed may limit the diagnoses of other medical conditions as individuals postpone non-emergency medical visits And while more research still needs to be undertaken, some early trends suggest, for example, that fewer Americans received mammograms and other screening procedures during the pandemic.11 This could have major long-term health implications, as the importance of early diagnosis of various forms of cancer can’t be overstated.

A long road ahead

With nearly 55 million cases and over one million deaths reported as of publishing,12 the first-order consequences of the COVID-19 outbreak are painfully obvious. But it’s important to remain cognizant of the second-order impacts as well. Ultimately, while we still have more questions than answers, it’s clear that we may be grappling with the insidious effects of COVID-19 long after the introduction of a successful vaccine or treatment.

Author
Brandy Dennis, DNP, MSN-I, is research nurse, life automated medical underwriting at Verisk. Brandy can be reached at Brandy.DennisDNP@verisk.com.


1. Mark Tenforde, et al., “Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network—United States, March-June 2020,” Centers for Disease Control and Prevention, July 31, 2020, < https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm?s_cid=mm6930e1_w >, accessed on November 9, 2020.

2. Bobby Bouland, “What Long Term Effects Could COVID 19 Have on Your Lungs?” Banner Health, June 22, 2020, < https://www.bannerhealth.com/healthcareblog/teach-me/what-long-term-effects-could-covid19-have-on-your-lungs >, accessed on November 9, 2020.

3. Mark Tenforde, et al., “Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network—United States, March-June 2020,” Centers for Disease Control and Prevention, July 24, 2020, < https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm?s_cid=mm6930e1_w >, accessed on November 9, 2020.

4. Katie Palmer, et al., “The Potential Long-term Impact of the COVID-19 Outbreak on Patients with Non-communicable Disease in Europe: Consequences for Healthy Ageing,” Aging Clinical and Experimental Research, May 26, 2020, < https://doi.org/10.1007/s40520-020-01601-4 > accessed on November 9, 2020.

5. “How COVID 19 Damages the Lungs,” Riverside Health, 2020, <https://www.riversideonline.com/health_information/healthy_you/covid-19-and-lungs.cfm >, accessed on November 9, 2020.

6. Janice Leung, et al., “COVID 19 and COPD,” European Respiratory Journal, August 13, 2020, < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7424116/ >, accessed on November 9, 2020.

7. Valentina Puntmann et al., “Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered from Coronavirus Disease 2019 (COVID-19),” JAMA Cardiology, July 27, 2020, < https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916 >, accessed on November 9, 2020.

8. John Omura et al., “Walking as an Opportunity for Cardiovascular Disease Prevention,”Centers for Disease Control and Prevention, May 30, 2019, < https://www.cdc.gov/pcd/issues/2019/18_0690.htm >, accessed on November 9, 2020.

9. Rachel Bridwell et al., “Neurologic Complications of COVID 19,” Elsevier Public Health Emergency Collection, May 6, 2020, < https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7229718/ >, accessed on November 9, 2020.

10. “The Potential Long-term Impact of the COVID-19 Outbreak on Patients with Non-communicable Disease in Europe: Consequences for Healthy Ageing”

11. Anna Mathews et al., “COVID-19 Outbreaks Led to Dangerous Delay in Cancer Diagnoses,” Wall Street Journal, October 15, 2020, < https://www.wsj.com/articles/covid-19-outbreaks-led-to-dangerous-delay-in-cancer-diagnoses-11602756013 >, accessed on November 9, 2020.

12. “COVID-19 Dashboard,” Johns Hopkins University of Medicine, 2020, <  https://coronavirus.jhu.edu/map.html >, accessed on November 9, 2020.