"Everybody talks about a binary situation, you either get it mild and recover quickly, or you get really sick and wind up in the ICU," says Athena Akrami, neuroscientist at University College London, who falls into neither category. Thousands echo her story in online COVID-19 support groups. Outpatient clinics for survivors are springing up, and some are already overburdened. Akrami has been waiting more than 4 weeks to be seen at one of them, despite a referral from her general practitioner. The list of lingering maladies from COVID-19 is longer and more varied than most doctors could have imagined. Ongoing problems include fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys, and brain. See: From 'brain fog' to heart damage, COVID-19's lingering problems alarm scientists.

Also from the above article: Mitrani and Goldberger, who co-authored a June paper in Heart Rhythm urging follow-up of patients who might have heart damage, worry in particular about the enzyme troponin, which is elevated in 20% to 30% of hospitalized COVID-19 patients and signifies cardiac damage. (Troponin is sky-high during a heart attack, for example.) How the heart heals following COVID-19 might determine whether an irregular heartbeat develops or persists, Goldberger believes. "We have one guy in the hospital right now who had COVID 2 months ago and had all sorts of arrhythmia problems" then, Goldberger says. "He's recovered from his COVID, but still has the arrhythmia." For some patients with coronavirus-induced heart problems, treatments as simple as cholesterol-lowering drugs, aspirin, or beta blockers could help, Goldberger says.

Also from the above article: But other patients are affected without apparent risk factors: A paper this week in JAMA Cardiology found that 78 of 100 people diagnosed with COVID-19 had cardiac abnormalities when their heart was imaged on average 10 weeks later, most often inflammation in heart muscle. Many of the participants in that study were previously healthy, and some even caught the virus while on ski trips, according to the authors.

Dr. Curt Daniels, the director of sports cardiology at Ohio State, had also been busy, working to publish a three-month study whose preliminary findings were presented to Pac-12 and Big Ten leaders before they shut down football earlier this month. Daniels said that cardiac M.R.I.s, an expensive and sparingly used tool, revealed an alarmingly high rate of myocarditis - heart inflammation that can lead to cardiac arrest with exertion - among college athletes who had recovered from the coronavirus. The survey found myocarditis in close to 15 percent of athletes who had the virus, almost all of whom experienced mild or no symptoms, Daniels added, perhaps shedding more light on the uncertainties about the short- and long-term effects the virus may have on athletes.. See: Penn State athletics doctor cautions about COVID-related heart disease.

Also from the earlier article, From 'brain fog' to heart damage, COVID-19's lingering problems alarm scientists: BY NOW IT'S CLEAR that many people with COVID-19 severe enough to put them in a hospital face a long recovery. The virus ravages the heart, for example, in multiple ways. Direct invasion of heart cells can damage or destroy them. Massive inflammation can affect cardiac function. The virus can blunt the function of ACE2 receptors, which normally help protect heart cells and degrade angiotensin II, a hormone that increases blood pressure. Stress on the body from fighting the virus can prompt release of adrenaline and epinephrine, which can also "have a deleterious effect on the heart," says Raul Mitrani, a cardiac electrophysiologist at the University of Miami who collaborates with Goldberger.

If someone is left with scarring (in the lungs), also known as fibrosis, there is no way to reverse it, says Chalmers. All people can do is try to improve their aerobic fitness to compensate for their lower lung function and learn to cope with breathlessness. As well as scarring, there may be other mechanisms that cause long-term problems. Severe covid-19 makes blood more prone to clotting, so people develop tiny clots in the blood vessels of their lungs. To compensate, new blood vessels grow, but these can be disorganised, leading to high blood pressure in their lungs. "You don't get as much oxygen," says Chalmers. See: The coronavirus is leaving some people with permanent lung damage.

health care workers with SARS in 2003 found that those with lung lesions 1 year after infection still had them after 15 years: .

Available data shows that about 40 percent of people with COVID-19 develop ARDS (Acute respiratory distress syndrome), and of those, 20 percent are severe. "At this point," added Mila, "there is no definitive answer why a certain population recovered while others had severe lung damage. It's too early to say." See: Lifelong Lung Damage: The Serious COVID-19 Complication That Can Hit People in Their 20s.

Dr. Brittany Bankhead-Kendall, assistant professor of surgery with Texas Tech University, in Lubbock, has treated thousands of patients since the pandemic began in March. "Post-COVID lungs look worse than any type of terrible smoker's lung we've ever seen. And they collapse. And they clot off. And the shortness of breath lingers on... & on... & on. Everyone's just so worried about the mortality thing and that's terrible and it's awful. But man, for all the survivors and the people who have tested positive this is — it's going to be a problem." She says patients who've had COVID-19 symptoms show a severe chest X-ray every time, and those who were asymptomatic show a severe chest X-ray 70% to 80% of the time. "There are still people who say 'I'm fine. I don't have any issues,' and you pull up their chest X-ray and they absolutely have a bad chest X-ray." See: Post-COVID lungs worse than the worst smokers' lungs, surgeon says. If there are roughly equal numbers of people with COVID-19 who are symptomatic and asymptomatic then 85% to 90% of people who have had COVID-19 have severe chest X-rays.

Rare, but this 20-year old in Chicago required a lung transplant: Lifelong Lung Damage: The Serious COVID-19 Complication That Can Hit People in Their 20s.

Long-term follow-up studies are required to establish the true prevalence of post-COVID-19 fibrosis, but it is speculated that the consequences of COVID-19 could include a large cohort of patients with fibrosis and persistent or progressive lung impairment: Pulmonary fibrosis in the aftermath of the Covid-19 era. This article references a lot of useful information.

Kidney involvement is frequent in COVID-19; >40% of cases have abnormal proteinuria at hospital admission (>3.4% of all cases): Management of acute kidney injury in patients with COVID-19.

The bradykinin hypothesis also accounts for Covid-19's neurological effects, which are some of the most surprising and concerning elements of the disease. These symptoms (which include dizziness, seizures, delirium, and stroke) are present in as many as half of hospitalized Covid-19 patients (this suggests 4.25% of cases). According to Jacobson and his team, MRI studies in France revealed that many Covid-19 patients have evidence of leaky blood vessels in their brains. Bradykinin - especially at high doses - can also lead to a breakdown of the blood-brain barrier. Under normal circumstances, this barrier acts as a filter between your brain and the rest of your circulatory system. It lets in the nutrients and small molecules that the brain needs to function, while keeping out toxins and pathogens and keeping the brain's internal environment tightly regulated. If bradykinin storms cause the blood-brain barrier to break down, this could allow harmful cells and compounds into the brain, leading to inflammation, potential brain damage, and many of the neurological symptoms Covid-19 patients experience. Jacobson told me, "It is a reasonable hypothesis that many of the neurological symptoms in Covid-19 could be due to an excess of bradykinin. It has been reported that bradykinin would indeed be likely to increase the permeability of the blood-brain barrier. In addition, similar neurological symptoms have been observed in other diseases that result from an excess of bradykinin." See: A Supercomputer Analyzed Covid-19 - and an Interesting New Theory Has Emerged. A closer look at the Bradykinin hypothesis.

Brain fog: Difficulty thinking can occur after acute COVID-19infection. The virus may damage brain cells, and inflammation in the brain or body may also cause neurologic complications. Other viral infections can also lead to brain fog. See: From 'brain fog' to heart damage, COVID-19's lingering problems alarm scientists which also links to The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings.

Little is known yet, but this article suggest that COVID-19 may trigger diabetes in 14.4% of hospitalized cases: New diabetes cases linked to covid-19. Using a 10% to 15% hospitalization rate this is 1.4% to 2.2% of cases.

This is the scientific article that the above article refers to: Proportion of newly diagnosed diabetes in COVID-19 patients: A systematic review and meta-analysis.

Little is known yet, but this article suggest that around 1% of those who have had COVID may have some permanent hearing loss: Covid may cause sudden, permanent hearing loss - UK study.

Also from the earlier article, From 'brain fog' to heart damage, COVID-19's lingering problems alarm scientists: The likelihood of a patient developing persistent symptoms is hard to pin down because different studies track different outcomes and follow survivors for different lengths of time. One group in Italy found that 87% of a patient cohort hospitalized for acute COVID-19 was still struggling 2 months later. With an 8.5% hospitalization rate this is 7.4% of Covid-19 cases struggling 2 months later. Data from the COVID Symptom Study, which uses an app into which millions of people in the United States, United Kingdom, and Sweden have tapped their symptoms, suggest 10% to 15% of people-including some "mild" cases-don't quickly recover. But with the crisis just months old, no one knows how far into the future symptoms will endure, and whether COVID-19 will prompt the onset of chronic diseases.

https://www.theguardian.com/world/2021/sep/28/covid-37-of-people-have-symptoms-six-months-after-infection.

Also from the earlier article, From 'brain fog' to heart damage, COVID-19's lingering problems alarm scientists: Although scientists hope they'll learn how to avert chronic symptoms and help patients currently suffering, this latest chapter in the COVID-19 chronicle has been sobering. The message many researchers want to impart: Don't underestimate the force of this virus. "Even if the story comes out a little scary, we need a bit of that right now," Iwasaki says, because the world needs to know how high the stakes are. "Once the disease is established, it's really hard to go backward."

The Coverscan study aims to assess the long-term impact of Covid-19 on organ health in around 500 "low-risk" individuals - those who are relatively young and without any major underlying health complaints - with ongoing Covid symptoms, through a combination of MRI scans, blood tests, physical measurements and online questionnaires. Preliminary data from the first 200 patients to undergo screening suggests that almost 70% have impairments in one or more organs, including the heart, lungs, liver and pancreas, four months after their initial illness. From the Mayo clinic: COVID-19 (coronavirus): Long-term effects.

From the Mayo clinic: Damage to multiple organs recorded in 'long Covid' cases. Exclusive: study of low-risk individuals finds impairments four months after infection.

'Autoantibodies' may be driving severe Covid cases, study shows. Scientists find aberrant immune system in patients with virus could also be cause of 'long Covid'.

Almost 30% of Covid patients in England readmitted to hospital after discharge - study. Readmission rate for Covid patients 3.5 times greater, and death rate seven times higher, than for other hospital patients.

Long Covid: 'It's a year since I've felt like myself''.