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Update of clinical features

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COVID -19, Update, June, Signs and Symptoms How long does COVID-19 last? https://covid19.joinzoe.com/post/covid-long-term One in ten are sick for three weeks or more COVID-19, short-term illness caused by SARS-CoV-2 Most health sources, people will recover within two weeks Some people report symptoms from 3 weeks to months https://inews.co.uk/news/coronavirus-covid-19-symptoms-uk-latest-fatigue-breathlessness-long-term-effects-429493 https://www.theatlantic.com/health/archive/2020/06/covid-19-coronavirus-longterm-symptoms-months/612679/ 10%, still have symptoms after three weeks Some may suffer for months. Some experience fatigue, headaches, coughs, anosmia (loss of smell), sore throats, delirium, and chest pain for more than three weeks after first symptoms https://covid19.joinzoe.com/post/uk-anosmia-covid In severe cases Symptoms follow a typical pattern Anosmia, fever, cough in the first two days https://jamanetwork.com/journals/jama/fullarticle/2761044 Develops into severe respiratory symptoms often needing medical care after about 1 week In mild cases More likely to have a variety of strange symptoms that come and go over a more extended period Tim Spector The more we learn about coronavirus, the weirder it gets I've studied 100 diseases. COVID is the strangest one I have seen in my medical career Symptoms in long-term COVID Cough and high temperature. Wide range of symptoms as well, e.g. GI, CVS https://www.nature.com/articles/s41591-020-0916-2 'Atypical' symptoms coming and going over time ‘It started like a cold or flu’ ‘By week four, most of the people around me who also had it, including my daughter and my former partner, got better’ (Rachel Pope) Rachel improved during her fourth week, she got worse again in week 5 https://www.dailymail.co.uk/health/article-8378419/Evidence-suggests-mild-covid-19-symptoms-left-long-term-damage-organs.html Her symptoms moved from her airways into her internal organs, resulting in heart problems that took her to A&E ‘The first time they thought I was having a stroke, and the second time they thought it was a heart attack’ (Rachel) ? Heart problems ? caused by post-viral inflammation Rather than an ongoing infection Worry Lasting organ damage, lugs, liver, brain, kidneys https://www.advisory.com/daily-briefing/2020/04/17/organ-damage This damage could also explain ongoing symptoms Are COVID-19 'long-termers' still infectious? May go with the symptoms? https://www.medrxiv.org/content/10.1101/2020.03.22.20040071v1.full.pdf Ongoing infection or damage that persists after immune system has cleared the virus ‘I personally think that there was still a viral tail up to week 11’ ‘I was still having quite violent diarrhoea at that point, so I think it was still viral’ (Rachel) NHS Continue to self-isolate if you have a temperature, runny nose, sickness, diarrhoea or loss of appetite, even if it has been more than 14 days since your symptoms started https://www.nhs.uk/conditions/coronavirus-covid-19/self-isolation-and-treatment/how-long-to-self-isolate/ People with long-term COVID-19 are struggling to get back to normal life ‘These people may be going back to work and not performing at the top of their game’ (Tim Spector) ‘There is a whole other side to the virus which has not had attention because of the idea that, if you are not dead you are fine’ ‘It’s great that we haven’t died, but I’ve now been suffering with serious health problems for three months with very limited support’ (Rachel)

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