We know that older adults, with underlying chronic diseases and weakened immune systems, are at greater risk of infection with COVID-19, at greater risk of severe symptoms, and more vulnerable to the ravages of the disease. As the CDC reports, 8 out of 10 COVID-19-related deaths reported in the United States have been among adults aged 65 years and older. What is also now becoming clear is that the impact of the disease is not black and white: while you may survive and “recover” from the coronavirus, it now appears that a significant number of patients experience longer-term and lingering symptoms, such that the impact of the infection may greatly affect your health and quality of life once the initial acute phase passes.

Scientists have come to learn that while COVID-19 is a respiratory virus that affects the lungs, once inside the body it can wreak havoc in an array of organs and systems. So far, there have been few formal studies of lingering symptoms (what The Atlantic Magazine calls the virus’s “long haulers”) though we do have one study out of Italy and published online in JAMA that found 87% of patients who had been hospitalized and eventually “recovered” from COVID-19 reported at least one persistent symptom, the most common of which were fatigue and labored breathing. The NIH is now undertaking what they call the CORAL study to better understand the long-term implications of COVID-19 both for those who survive and for the broader health care system. 

Anecdotally, from various health system and individual providers’ reports, there are an array of troubling symptoms that seem to plague COVID “survivors.” The symptoms can range from mild to severe, including loss of sense of smell, blood clots, lung damage, and even strokes. While we don’t know how long-lasting these symptoms can be, we do know that such issues as scar tissue in the lungs, abnormal blood clotting and damage to heart muscles have been reported and could have lasting repercussions for patients. In fact, a recent study published in the European Heart Journal showed that in a study of 1200 COVID patients across dozens of countries, 55% had abnormal echocardiograms, with 1 in 7 having “severely abnormal” scans, suggesting that recovering COVID patients may be left with significant cardiac damage (though we don’t yet know if this damage is permanent). Moreover, there have been dozens of reports of neurological problems following coronavirus infection. While it’s too early to know the long term impact, it’s possible, as one researcher posited, that we could see an epidemic of brain damage following a significant number of COVID infections.

While we don’t yet know if these “long haulers” with continuing symptoms are in any way infectious, we have reports of patients becoming “reinfected” after their COVID-19 infections were thought to be cleared. So we can’t rule out that immunity following infection is long-lasting or permanent. As coronavirus physician Dr. John Wright recently conveyed to the BBC, “Four months on, and this new foe has become an old foe, and sometimes it seems our only foe. We have also become increasingly aware of the longer-term legacy for patients – not just those who have been in hospital, but those who have self-treated at home and recovered from the acute infection only to suffer from relapses and persistent symptoms. Patients who had the infection months ago are struggling to resume their normal lives.” So before we all drop our guard, we need to remember that there’s still much we don’t know about the coronavirus, and our best protection at the moment continues to be to socially distance from others and keep up the handwashing and mask-wearing.