Covid 19 coronavirus: Surviving the virus may not feel like recovery for some

Patients affected by the coronavirus at the ICU ward of a hospital in Bergamo, Italy, in March. Photo / Fabio Bucciarelli, The New York Times

Debilitating symptoms can last long after a person's body has gotten rid of the coronavirus, a reality Italians are now confronting.

When Morena Colombi tested negative for the coronavirus March 16, the official tallies counted her among the Covid-19 recoveries, a success amid the tragedies overwhelming Italy. But she was nowhere near recovered, her cough and crippling fatigue nowhere near gone.

Five weeks later, on April 21, she returned to her job developing colours for a cosmetics company, but with shortness of breath and aching muscles, she found herself unable to take even short walks. Another test confirmed that she was no longer infected. But 11 weeks after testing positive, on the same day that Italy first quarantined towns, she is still not back to normal.

"It takes a long time," said Colombi, 59, who lives in Truccazzano, outside the northern city of Milan. "I can't get back into my natural rhythms."

Italy was the first European country to be hit hard by the pandemic — its intensive care units inundated and its elderly dying in droves before the tsunami reached Spain, France, the United States or Britain. And so Italy is also ahead in coming to grips with the long duration of the illness and the lasting consequences for some survivors.

Many Italians have grown painfully familiar with the way the infection can hang on for weeks, the symptoms can linger for weeks more and full recovery can take longer still — if it ever arrives. Of the more than 218,000 people in Italy who have tested positive, more than 30,000 have died and the government lists more than 103,000 as recovered.

The stubbornness of the virus and the length of the convalescence have become topics of conversation in northern Italy, where some of the longest-suffering Italians are finding themselves in physical and financial uncertainty, unable to shake sickness and fatigue and get back to work.

Their experience may also be instructive to other nations struggling to get their economies moving again.

In Milan's subway last month. Photo / Alessandro Grassani, The New York Times

"We have seen many cases in which people take a long, long time to recover," said Alessandro Venturi, director of the San Matteo hospital in the Lombardy town of Pavia, adding that the discomfort often seems to last even longer for people with lighter symptoms.

"It's not the sickness that lasts for 60 days; it is the convalescence," he said. "It's a very long convalescence."

Most people who catch the virus have few symptoms or none, but some get very sick, most often with pneumonia. Any pneumonia damages the lungs, which can take months to heal, and doctors warn that the harm might not be completely reversible.

Studies also point to kidney, heart, liver and neurological damage, often from secondary infections, and no one knows what the long-term prospects are for those patients.

But even some of the infected who have avoided pneumonia describe a maddeningly persistent and unpredictable illness, with unexpected symptoms. Bones feel broken. The senses dull. Stomachs are constantly upset. There are good days and then bad days without apparent rhyme nor reason.

The afflicted find the simplest tasks taxing. Testing is still mostly reserved for the hospitalised, and so people suffering less severe but stubborn symptoms are trailed by doubt about whether they have the virus.

Dr. Annalisa Malara, an intensive care physician in Codogno, southeast of Milan, who diagnosed Italy's first case of the outbreak in February, said there was still no clear understanding of why the virus and its effects lingered so long.

"Lack of energy and the sensation of broken bones" are common, she said, adding that fatigue often lingered "even after the more intense symptoms are gone."

In the north of Italy, the epicentre of the contagion in that country, a partial lifting of the lockdown this month has allowed more family and friends to compare notes on their experiences.

"It never finishes," said Martina Sorlini, a 29-year-old math and physics high school teacher who has been running a low-grade fever since the beginning of March.

She said that the cough and sore throat eventually went away, and that after three weeks she got her sense of taste and smell back, and even found enough energy to run and tend vegetables in her garden.

Then came stomach aches, fatigue and the return of fever. And it hasn't left, making it extremely tiring to teach her online high school classes.

Undergoing serological tests in Cisliano, outside Milan, last month. Photo / Alessandro Grassani, The New York Times

"I was convinced that I was better. They don't know what happened," Sorlini said. "They are seeing everything for the first time too."

Some say the experience of the long-suffering, if not critically ill, deserves more attention.

Edmondo Cirielli, a member of parliament with the right-wing Brotherhood of Italy party, has argued that the health ministry should pay more attention to cases like his.

On the weekend of March 7, Cirielli ran a fever and suffered cold-like symptoms, and became convinced he had picked up the virus by touching an infected surface in the parliament chamber. He tested positive that week.

Almost immediately, he said, his fever and cough faded, and he thought he would be fine. Then he had what he called a "small respiratory crisis" that put him in the hospital.

• Covid19.govt.nz: The Government's official Covid-19 advisory website

But he had no pneumonia, so he went home to self-quarantine. There, he suffered debilitating fatigue, sore throat, diarrhoea and intense pain at the base of his neck that made it impossible to concentrate.

"One day I was fine, the next bad. There was no building to a peak and then coming back down. It was up and down for a month," he said.

Then things got stranger.

After 40 days of feeling lousy, he tested negative for the virus, but his eyes still burned and bouts of diarrhoea continued, he said.

At the end of last month, he finally felt better, but another test result came back positive, forcing him to spend weeks more in isolation, where he kept busy watching "Versailles" on Netflix.

Testing has been imperfect, and not everyone has access to it.

Ingrid Magni, 44, got fever and chills March 21.

"It never left me," she said, adding that she started suffering intense headaches after about three weeks.

Doctors could only recommend over-the-counter painkillers and bed rest. She got winded just making her bed.

"I had to sit down," she said. "I was too tired."

In Milan last month. Photo / Alessandro Grassani, The New York Times

Without the eligibility to receive a swab test, which is usually reserved for hospital patients, she told her boss at a chemical plant that she would get an antibody test, which could be used to trigger an official swab test for the virus itself if antibodies are detected.

But the results have not come back. She is eager to get back to work by the middle of the month and is not sure how many more sick days the doctor will sign off on.

Others just want to feel better.

Albertina Bonetti, 77, from Trescore Balneario, near Bergamo, developed nausea and fever March 7, followed by dry heaves and diarrhoea. After 10 days of fever, her legs began hurting so much that she could not put her feet on the ground.

She needed an oxygen tank from March 20 to the end of April, but when she went to a hospital, the staff refused to admit her — so she, too, remained untested.

Bonetti said that she still had shortness of breath and fatigue and that her senses remained out of whack. She misses normal life and the taste of her latte in the morning.

"It leaves something inside you," she said of the virus. "And you never go back the way you were before."

Written by: Jason Horowitz
Photographs by: Fabio Bucciarelli and Alessandro Grassani
© 2020 THE NEW YORK TIMES