Long Covid - or post-infection problems that linger for months - are estimated to affect between 10 and 20 per cent of people who catch the virus. Photo / 123RF
Long Covid - or post-infection problems that linger for months - are estimated to affect between 10 and 20 per cent of people who catch the virus. Photo / 123RF
As "long-haulers" know all too well, the lingering effects of Covid-19 infection can leave people battling fatigue and chronic pain. But what are some of those symptoms we hear less about? Science reporter Jamie Morton looks at five.
Anxiety
When Victoria University epidemiologist Dr Mona Jeffreys shared preliminaryfindings of an ongoing study into long Covid impacts last week, one group of symptoms stood out among the three most common reported by New Zealand sufferers.
That was depression and anxiety – which around a third of long-haulers in her survey group said they'd been experiencing.
That echoed findings from earlier research: including one major Oxford University study of more than 230,000 people monitored for six months after receiving a diagnosis.
Of those, a quarter reported a mood (13 per cent), anxiety (18 per cent) or psychotic disorder – and it was the first diagnosis of such a disorder for more than 8 per cent.
Another study that tracked a similar number of people, and published in Lancet Public Health in March, found people who were bedridden for a week or more with the virus were at higher risk of mental illness.
As with everything about long Covid, the likely causes of these symptoms are complex – but could represent a combination of immune disturbance, tissue damage and brain toxicity.
Disturbed sleep patterns and insomnia have consistently been listed among long Covid symptoms.
Long Covid has been linked to insomnia and sleep problems. Photo / 123RF
"Having disturbed sleeping habits is bad enough, but if you're living with extreme fatigue and you can't sleep, it's your worst nightmare," University of Auckland immunologist and long Covid researcher Dr Anna Brooks said.
"Unfortunately, this is quite a common occurrence with long Covid."
One recent Italian study found sleep problems to be "significant" among the patients it surveyed, with an overall reduced quality of life.
Another review of evidence found between roughly a quarter and a half of people with long Covid complained of sleep disorders and insomnia.
While different to what some have dubbed "coronasomnia" - or disturbed sleep directly related to stress over the pandemic – post-infection sleep problems are still intertwined with the fatigue and mental health symptoms of long Covid.
Residual inflammation from infection might also have a role to play.
Menstrual changes
Long Covid can mess with our circadian rhythm – but what about our menstrual cycles?
Again, it's been well-documented that the stress stemming from the pandemic – or stress generally - could have an impact on menstrual cycles.
Scientists are increasingly finding it to be an issue widely reported among long-haulers, too – yet there are still many unknowns about what precisely is driving it, and studies are still few.
Infection itself, at least, has been shown to have an effect.
According to one small study published in Reproductive BioMedicine Online, about a quarter of Covid-19 patients it surveyed reported changes in volumes of menstrual blood, and a similar proportion observed changes to cycles, such as lighter bleeding or longer-lasting periods.
Another patient-led study found about a third of participants with an active menstrual cycle experienced problems like abnormally irregular or heavy periods – and a similar proportion had relapses in Covid-19 symptoms during or before their periods.
Another lesser-known - and similarly poorly studied – particular problem raised by long Covid sufferers is erectile dysfunction.
Possible explanations for that range from psychological stress to endothelial dysfunction, or problems with the autonomic nervous system, including cardiovascular and pulmonary issues.
Digestion
Stomach pains have also been flagged as a gripe for long-haulers – and scientists have found these can vary a lot.
In a study of about 120 Covid-19 patients surveyed more than a month after leaving hospital, just under half reported gastrointestinal symptoms – among them nausea, acid reflux, diarrhoea, belching, vomiting and abdominal pain.
In an analysis of evidence, Harvard University researcher Tint Tha Ra Wun further pointed out that patients with severe cases of Covid-19 could go on to develop gastrointestinal complications, such as acute pancreatitis.
"Nevertheless, we have yet to study the frequency, severity, and treatments available for these symptoms as well as investigate other long-term manifestations and complications of Covid-19 on the gastrointestinal system."
It's been well-documented that the stress stemming from the pandemic - or stress generally - could have an impact on menstrual cycles. Photo / 123RF
Many long-haulers have also spoken of developing new allergies – for which inflammatory processes are possibly to blame.
Dysautonomia
It's quite likely most of us have never heard of dysautonomia – but it's a symptom that Brooks sees a lot in her research.
She described it as a disruption of the "autopilot" of our nervous system functions.
The reason why those effects were so varied was because the autonomic nervous system helped control involuntary body functions including heart rate, blood pressure, breathing, body temperature, sexual function – and digestion.
Although dysautonomia is relatively common – it affects about 70 million people worldwide – researchers have found some troubling ties to post-infection with Covid-19.
According to one paper, recently published ahead of peer review, as many as two thirds of long Covid sufferers may be developing dysautonomia.
"Although shortness of breath is relatively common, people may automatically think that's to do with lung damage."
In Omicron cases, especially, it could be dysautonomia to blame – although Brooks said anyone experiencing shortness of breath should be seeing a doctor anyhow.
Amid all of these unknowns, Brooks said Covid-19 shouldn't be brushed off as a "mild" virus – particularly given between around 10 to 20 per cent of those infected might go on to develop long Covid.
"Millions of people in New Zealand have potentially had this virus, and I'm concerned that many of them are thinking, oh that was nothing ... and off they go.
"People still need to be mindful of reinfection, as coming through one infection unscathed does not mean you will be out of the woods with getting long Covid.
"It might be a second or third exposure that triggers this illness."
