On March 18, Alexander Bommes returns as a TV presenter. He had to pause for several months for “health reasons”. “Bild.de” now reports, citing those around him, that Bommes fell ill with Corona and is still suffering from long-Covid symptoms such as exhaustion, difficulty concentrating and muscle pain. His TV return now gives hope for improvement.

Like Bommes, many people suffer from long-Covid even after their corona disease. We clarify the most important questions in our check.

The big long Covid check

Sometimes it’s weeks, sometimes months – complaints such as fatigue, mental impairment and pain continue. The corona test has long been negative. Long-Covid or Post-Covid is likely to affect hundreds of thousands of people in Germany. Exact numbers are difficult to give. The clinical picture is too multifaceted, the definition is unclear and it is often not recognized.

And yet, a study published in the British Medical Journal (“BMJ”) provides good news: Most long-Covid symptoms disappear within a year – at least for those who had a mild course of Covid-19 .

Researchers followed nearly 300,000 children and adults suffering from mild Covid-19 (meaning they were not hospitalized). Some were vaccinated when they became infected, others were not. For comparison, the researchers followed about 300,000 people with similar demographics who did not test positive for Covid-19. They examined the period between March 2020 and October 2021, the omicron variant was not yet dominant here.

1. What does “Long Covid” mean?

Doctors distinguish between “Long-Covid” and “Post-Covid”.

• As “Long Covid” The German patient guidelines define complaints that persist for more than four weeks after an infection.
• From “Post Covid” is mentioned if the symptoms restrict everyday life for more than twelve weeks after infection.

In general usage, “Long-Covid” has mainly spread, which is why this text remains with this designation. The term post-Covid syndrome (PCS) defined by the World Health Organization (WHO) has become established in the medical literature, including the S1 guideline of the Association of Scientific Medical Societies (AWMF). A detailed literature review has been published in the German “Ärzteblatt”.

2. How does Long-Covid express itself?

After their infection, patients suffer from symptoms such as

• tiredness and exhaustion
• Headache
• difficulty breathing
• Disorders of smell and taste
• cognitive impairments such as brain fog, impaired concentration and memory
• depressive moods

But heart problems, kidney and metabolic disorders can also occur as a result of an infection. The list of possible symptoms is long: in various studies, those affected have given up to 200 different symptoms for Long-Covid.

3. Who does Long-Covid hit?

Experts assume that at least ten percent of all people infected with corona suffer from long-Covid. In a highly topical Long-Covid-Review, which was published in the renowned “Nature” magazine on Friday, the researchers estimate that

• 10 to 30 percent of non-hospitalized corona infected people
• 50 to 70 percent of hospitalized corona infected people
• and 10 to 12 percent of vaccinated corona infected people

are affected by Long-Covid.

It also affects all age groups, but an increased percentage of people between the ages of 36 and 50. Factors such as previous illnesses, a low socio-economic status and the lack of an opportunity to recover would favor Long-Covid.

However: Many people with a mild course also suffer from Long-Covid. “We found that a staggering 90 percent of people living with long-Covid had only mild COVID-19,” researchers Sarah Wulf Hanson and Theo Vos, both from the University of Washington, write in a paper in “The Conversation”.

You and your team examined data from 54 studies with 1.2 million people from 22 countries with symptomatic corona infection (March 2020 to January 2022). By long-Covid they understood symptoms three months after the initial infection, with symptoms lasting at least two months. Their study was published in the Journal of the American Medical Association (“JAMA”).

Your result:

• Women were twice as likely to develop long-Covid as men and four times as likely as children.
• One in seven infected people still had symptoms a year later.
• People hospitalized with Covid were more likely to develop Long-Covid.

4. Why do so many people with a mild course of Corona suffer from Long-Covid?

According to the Robert Koch Institute, the corona hospitalization rate (i.e. people who have to be treated in a hospital) has been constant at around 14 percent since the beginning of November. So 86 percent have a mild course. Even if they are less likely to contract Long-Covid, there are simply many more people affected.

5. How common is Long-Covid?

The World Health Organization (WHO) estimates that “10 to 20 percent of those infected with Sars-CoV-2 complain of persistent or new symptoms over a longer period after the acute phase of the infection, which are referred to as post-Covid syndrome (PCS)” , according to the “Ärzteblatt” report. A similar magnitude was confirmed by British longitudinal studies, which accounted for between 7.8 and 17 percent of long-term sufferers.

The current “Nature” study assumes that there are at least 65 million people with long-Covid worldwide. However, the actual incidence could be three times as high.

6. How often do the individual symptoms occur?

In the “Nature” review, specific figures are given, citing various studies: Twelve weeks after the infection, 32 percent were still suffering from fatigue, and 22 percent were found to have cognitive impairments. 20 to 40 percent of long-Covid patients still complained of shortness of breath and coughing at least seven months after infection.

It is estimated that around half of long-Covid patients meet criteria for ME/CF (chronic fatigue syndrome). Cardiac MRI examinations also showed that 78 percent of corona patients and 58 percent of long-Covid patients had heart failure.

An examination of the heart, lungs, liver, kidneys, pancreas and spleen in over 500 people previously infected with corona showed that 59 percent had single organ damage, and 27 percent had multiple organs affected. “The organ damage suffered by patients with Long-Covid appears to be permanent,” the researchers comment.

Mental illnesses such as anxiety and depression, on the other hand, normalized over time. This was the result of a study with more than 1.3 million formerly corona infected people. In the case of cognitive impairment (brain fog), seizures, dementia, psychosis and other neurocognitive disorders, the increased risk lasted for at least two years.

7. How high is the long-Covid risk at Omikron?

The extent to which long-Covid or post-Covid also poses a problem with the omicron variant and all its subtypes cannot yet be answered unequivocally. The “JAMA” study mentioned mainly includes people who became infected before omicron dominance. The researchers write that initial studies show a lower risk for omicron. At the same time, due to the easy transferability of the variant, a relatively large number of people contracted it.

8. How does Long-Covid arise?

The disease is still a mystery to experts. But the authors of the “Ärzteblatt” report give good evidence for different overarching and organ-specific causes.

One of the reasons why Corona hits so many organs is that Sars-CoV-2 binds to the ACE2 receptor. This in turn can be found in many places in the body. namely in

• Lung,
• Kidney,
• small intestine,
• olfactory cells,
• Heart,
• testicles,
• muscle cells and the
• Substantia nigra (black substance) in the brain

There are four main theses about the overarching causes:

• autoimmune reaction
• inflammation
• Persistent virus or “residual virus” in the body
• coagulation disorders (blood clots)

Here you can read more about it: How does Long-Covid arise? These are the four most important theses

9. How do vaccinations affect Long-Covid?

According to the current state of knowledge, vaccination is associated with a lower risk or a lower probability of long-Covid. Two doses of vaccine appeared to be more effective than one, according to a preprint study now accepted for publication in the journal BMJ.

Figures from the British “Covid Surveillance Study” (as of July 2022) also show that for those who have been vaccinated three times, the prevalence of long-term symptoms can be reduced to below or to a maximum of five percent.

The current “BMJ” study found with regard to milder Covid-19 courses: The long-Covid symptoms did not differ significantly depending on whether someone was vaccinated or unvaccinated at the time of infection. But those who were vaccinated had a significantly lower risk of persistent breathing difficulties, according to the study.

10. How big is the long-Covid problem going to get?

It is difficult to predict how many more people will be affected and how many of those already affected will continue to suffer from the long-Covid symptoms. The socio-medical and economic effects are not yet foreseeable, write the experts in the “Ärzteblatt”, “but should be immense”.

Experts were alarmed when it came to the clinical picture ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome): “If you calculate the rates of post-Covid courses determined in various studies that meet the ME/CFS diagnostic criteria, total population around the number of people affected by ME/CFS in Germany is expected to at least double in the next few years“, write Carmen disc arc, head of the Charité Fatigue Center of the Charité, and Herbert Renz-Polster, pediatrician and scientist, in their review in “Die Internal Medicine”. According to estimates, around 250,000 to 300,000 people in Germany are already affected. So far it is unknown how many have been added by Corona.

Against this background, the medical profession demands: For clinical care, specialized centers are needed at maximum care facilities (usually university hospitals), in which specialists from several disciplines can offer comprehensive care.