Lingering symptoms among COVID-19 'long-haulers' remain a mystery

Chandra Pasma's seven-year-old daughter still has a cough, and it's not going away.

Her other two children also have symptoms that come and go, as do she and her husband, months after the Ottawa family contracted presumed cases of COVID-19.

They're among a group being classified as "long-haulers," people who contracted the illness weeks or even months ago, and continue to experience symptoms long after the virus itself has become undetectable in their bodies.

Pasma's family began experiencing symptoms in March — everything from the usual sore throat, cough, fever and fatigue, to symptoms considered unusual at the time, such as conjunctivitis, or pink eye, and abdominal cramps.

At the time, testing wasn't available to the family but a doctor told them they likely had COVID-19.

"We weren't that concerned at first because they said that kids did not get seriously ill," she told CBC Radio's Ottawa Morning.

Symptoms persisting

But two of her three kids did get very sick.

"It was hard to see them be that sick. I don't think I've ever seen them be that sick, but at that point we were still feeling really hopeful that it didn't affect kids very badly, and that all the reports were that if you had a case of COVID that didn't require hospitalization, it would be really short and in about two weeks we could all count on being better again."

The problem is some of those symptoms have never really gone away, and the family has even experienced some new ones.

"It has been frustrating at times," Pasma said. "In the first month, when there was literally no talk of long COVID symptoms, it felt like we were some kind of anomaly. Our bodies didn't work normally, and everybody else was getting over it and we weren't."

Her kids are supposed to start school next month, but Pasma has chosen to keep them home to learn remotely. She said her family can't afford to live through all that again.

Lingering symptoms a mystery

There are three general hypotheses for what's behind the ongoing symptoms, according to Marc-André Langlois, a professor in the Faculty of Medicine at the University of Ottawa who specializes in viruses.

One possibility is that when the virus enters a cell, the body's immune response kicks in and the virus degrades, but part of it gets left behind. When the cell dies and breaks apart, it releases some of that degraded virus back into the body.

Another hypothesis is SARS-CoV-2, the virus that causes the illness, is slow at replicating and could lay dormant for a while, creating a "viral reservoir."

"Viruses are very good at this," Langlois said, pointing to both the herpes simplex virus and HIV, which is "notoriously good" at creating viral reservoirs, making it especially difficult to cure. HIV can go into hiding for years before all of a sudden reactivating, he said.

A third possibility is that the body's immune response goes into overdrive, creating a chronic or autoimmune condition.

Langlois said researchers are hoping to test more long-haulers to find out what may be causing their ongoing symptoms.

"Being infected and recovering is only part of the story there. There might be some long-term effects from getting the virus," he said.

"It is really a disease that seems to have long-term effects on those that have been infected, and therefore you know we really have to do our best to prevent infections."