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TORONTO -- A growing body of evidence indicates that long-term “ongoing” COVID-19 may not be a single syndrome but possibly up to four different syndromes, according to a new review by the National Institute for Health Research, a U.K. government agency.

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Susan Taylor knows she’s one of the lucky ones. She feels blessed to have survived COVID-19, but she also acknowledges that the ordeal is far from over.

She’s back at home after long weeks on a COVID-19 ward at Bon Secours St. Mary’s Hospital, followed by inpatient rehabilitation services at Encompass Health Rehabilitation Hospital of Richmond, but the Glen Allen resident has yet to regain full health.

“I have foggy moments like you wouldn’t believe,” she says by phone in early September, almost five months after she contracted the virus. She’s back at work as volunteer coordinator with AT Home Care & Hospice, but only part time. Her stamina is awful, she says: Sometimes she’s in bed at 7:30 p.m., but her sleep patterns are erratic, and at times she’s up half the night.

“I attribute it all to my COVID,” she says.

Taylor is not alone in coping with COVID-19 months after she was first infected. Such patients are being described as long-haulers. Beyond these individual patients, the virus is taking a toll on their families, society and the economy. As the pandemic approaches a year since its onset, COVID-19’s long-term impacts and implications are only now coming into focus.

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The long-term effects of surviving COVID-19 have become a new focus of attention for clinicians and researchers. This focus has been driven partly by concerns about late ill-effects of a previously unknown virus, but recognised generic patterns of chronic disease after critical illness also exist. These patterns are termed PICS, an acronym both for post-intensive care syndrome and for persistent inflammation, immunosuppression, and catabolism syndrome. We recommend unifying post-COVID-19 research aims with those of PICS research and propose a novel approach to its management by repurposing drugs that are approved, inexpensive, and safe.

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The coronavirus disease 2019 (COVID-19) pandemic, due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide sudden and substantial increase in hospitalizations for pneumonia with multi-organ disease.

SARS-CoV-2 is spread primarily via respiratory droplets and/or aerosols during face-to-face contact as well as hand-to-face spread following hand contact with infected surfaces. Infection can be spread by asymptomatic, pre-symptomatic and symptomatic carriers. The average time from exposure to symptom onset is 5 days, and 97.5% of people who develop symptoms do so within 11.5 days.

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Around one in five people have lingering side-effects of Covid-19 up to five weeks after initially falling sick, according to a big new analysis in the UK. Furthermore, around one in 10 people with Covid-19 appear to experience nagging symptoms for 12 weeks or longer.

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Nine months into the pandemic, it’s become clear that the effects of the disease caused by SARS-CoV-2 can last beyond the acute illness. Among COVID-19 patients 18 to 35 years old who were previously in good health, as many as 20% experience prolonged symptoms, according to the World Health Organization. Complaints among so-called long-haulers include fatigue, shortness of breath, “brain fog” and depression. For patients whose illnesses required ICU care, post-intensive care syndrome (PICS) is an ongoing concern, particularly for those who experienced acute respiratory distress syndrome (ARDS).

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People after a stay in an Intensive Care Unit (ICU) often have Post Intensive Care Syndrome (PICS) this is a combination of physical disorders and limitations such as muscle weakness, reduce stamina, shortness of breath, pain and stiffness in the joints. The physical consequences after ICU are usually known, but there may also be psychological and cognitive problems. These residual symptoms lead to long term limitations in daily functioning and reduced quality of life.

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Surviving severe COVID-19 means surviving viral sepsis. And while there is little published data on long-term outcomes of severe COVID-19, what is known is that recovering from sepsis caused by other pathogens is a long and difficult process that includes, among other things, increased odds of cognitive impairment and functional limitations—even down to inability to bathe, toilet or dress independently.

A recent Viewpoint essay published in JAMA, “Recovery From Severe COVID-19: Leveraging the Lessons of Survival From Sepsis,” calls out the lessons physicians should take from sepsis cases generally to prevent overly intensive ICU practices and promote speedier recovery for COVID-19 patients.

The AMA is closely monitoring the COVID-19 pandemic. Learn more at the AMA COVID-19 resource center. Also check out pandemic resources available from the AMA Code of Medical Ethics, JAMA Network™ and AMA Journal of Ethics, and consult the AMA’s physician guide to COVID-19.

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COVID-19 may lead to severe acute respiratory distress syndrome requiring intensive care unit (ICU) support. Patients surviving respiratory distress could develop post-intensive care syndrome (PICS) that includes ICU-acquired weakness (ICUAW). Nearly 66% of COVID-19 patients have clinically important muscle weakness following discharge [1]. Therefore, communication between the critical care and rehabilitation physician is important to evaluate the physical function of COVID-19 survivors to start rehabilitation timely.

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As I discussed last week, from the outset of this pandemic, with each day filled with isolation and uncertainty, mental health issues have continued to worsen in this country. According to a Pew Research Center report, such uncertainty has accounted for one-third of Americans experiencing high levels of psychological distress during the COVID-19 outbreak.

In a more recent accounting, according to a Boston University School of Public Health study, the prevalence of sleep troubles, lethargy, feelings of hopelessness and other depression symptoms in adults across the country have more than tripled since the pandemic began. That means, as noted by Time magazine, that “three times as many Americans met criteria for a depression diagnosis during the pandemic than before it.”

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First described as a cluster of viral pneumonia cases of unknown cause in the Hubei province of China, COVID-19 has rapidly spread across the globe, causing widespread illness and death, with unparalleled global social and economic disruption.

As the disease spread like wildfire, clinical patterns, mortality rate, infectivity and complications seemed to vary considerably from place to place. In an attempt to better characterise this disease, there have been over 50,000 scientific articles published on COVID-19. Many of them became headlines for public consumption with little to no context.

As larger amounts of high-quality scientific data became available, our understanding of the disease and its impact has undergone significant refinement.

Brief description of media:

As I discussed last week, from the outset of this pandemic, with each day filled with isolation and uncertainty, mental health issues have continued to worsen in this country. According to a Pew Research Center report, such uncertainty has accounted for one-third of Americans experiencing high levels of psychological distress during the COVID-19 outbreak.

In a more recent accounting, according to a Boston University School of Public Health study, the prevalence of sleep troubles, lethargy, feelings of hopelessness and other depression symptoms in adults across the country has more than tripled since the pandemic began. That means, as noted by Time magazine, that "three times as many Americans met criteria for a depression diagnosis during the pandemic than before it."