Policy Planning for the Post-Pandemic World: The Chronic Illness and Mental Health Needs of Tens of Millions of COVID-19 Survivors

Abstract

Severe Acute Respiratory Syndrome (SARS), which was caused by the SARS-associated coronavirus (SARS-CoV), originated in 2003 in Guangdong, China, infecting over 8000 people globally and killing 774 3 Middle East Respiratory Syndrome (MERS), which was caused by the Respiratory Syndrome Coronavirus (MERS-CoV), originated in 2012, infecting 2000 globally and killing 842 4 [End Page 119] Long-term effects of COVID-19 Among patients hospitalized with SARS and MERS, the most common long-term effects were new-onset psychiatric illness and fatigue 5 Some studies found many post-SARS and post-MERS patients met diagnostic criteria for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) 6 These effects can be debilitating and prevent usual functioning at work The CFS/ME diagnostic criteria include a substantial reduction in usual activities for at least six months, exhaustion after exertion, non-refreshing sleep, and either cognitive impairment (“brain fog”) or feeling light-headed while standing 10 Historical research has found that similar symptoms were noted among survivors of the 1918 influenza pandemic 11 CFS/ME has been noted one year12 and three years13 after SARS infection and one year after MERS 14 A large study of middle-aged SARS survivors in Hong Kong four years after infection found 27% met chronic fatigue syndrome criteria 15 Initial reports of post-COVID-19 illness include symptoms such as extreme fatigue, concentration difficulties, memory lapses, and muscle weakness that are consistent with CFS/ME,16,17 as well as short-term reduced cognitive ability 18 Damage to organs throughout the body COVID-19 also damages organs throughout the body, creating potentially life-long physical health impacts, even for low-risk populations that were not hospitalized 19 COVID-19 symptoms, especially fatigue and difficulty breathing, have been shown to persist for months after infection 20 Lung damage may be life-long for some While this cardiomyopathy is often reversible, some patients who have otherwise recovered from COVID-19 appear to have long-term myocarditis (inflammation of the heart tissue), which can lead to arrhythmias, heart attacks, and irreversible heart failure 23,24 Studies on patients with viral myocarditis have also shown an increase in five-year mortality 25 As the body’s immune system fights the virus, scientists believe the immune system overreacts, leading to many of the acute lung complications seen in the severe form of COVID-19, including acute respiratory distress syndrome (ARDS) 26 ARDS is an illness of acute respiratory failure in which both lungs fill with fluid, often leading to intensive care unit (ICU) admission and intubation with mechanical ventilation During acute disease, many viruses, including SARS, MERS, and COVID-19 cause coagulation disorders, leading to an increase in blood clotting (thrombosis) throughout the body, which can ultimately cause multi-organ failure 31 An observational study in the Netherlands found rates of thrombosis as high as 31% in COVID-19 patients 32 In the lungs, a clot can cause a pulmonary embolism leading to reduced oxygenation;in the kidneys, a clot can cause kidney failure;and in the brain, a clot can cause a stroke