While COVID-19 infection numbers have turned downward over the past couple of months, there are multiple symptoms of the virus that are causing problems over extended periods of time.

Health officials are just starting to get a handle on how extensive the problem, appropriately called “long COVID,” is and what the longstanding effects are.

Dr. Jeanne Marrazzo, director of UAB Medicine’s Division of Infectious Diseases, said more research is being done to try to pin down what causes some COVID patients to suffer symptoms for months at a time. Loss of the senses of taste or smell are probably the best-known symptoms affecting those who were not hospitalized for COVID, but the range of symptoms is much wider than that for both those who were hospitalized or not.

“It became pretty clear after the first wave, last spring, starting in the Northeast and in Europe, that there was a significant subset of people who really took a long time to get better from COVID, didn’t get better, or got better but had relapses of some very distinct symptom complexes,” Marrazzo said.

The long-lived symptoms and effects attracted enough attention to spur research, culminating in a major study by the National Institutes of Health called the Recover Program. That led to an official name of Post Acute SARS-Cov2 Syndrome, or PASC.

The early studies focused primarily on those hospitalized for COVID, but a recent study in the medical journal BMJ Global Health researched long-COVID effects and symptoms on those infected who didn’t have to stay in a hospital. The study found that non-hospitalized people suffered many of the same symptoms as those who had been hospitalized, particularly fatigue, weakness, dizziness, impaired memory and concentration, anxiety, sleep disorders and depression. However, those who were admitted to hospitals typically had these symptoms in higher percentages, degrees of discomfort and longevity.

“Weakness and fatigue are probably the biggest systemic things,” Marrazzo said. But neurocognitive issues, sometimes called “COVID brain fog” by patients, are also common. “I have talked to several people in the last several months who really feel like their concentration is significantly impaired, their memory is impaired, and they just don’t feel like themselves,” she added.

Cardiopulmonary issues such as chest pain, persistent cough and breathing problems have been less common but more severe and more concerning to health officials. Marrazzo mentioned lightheadedness and heart palpitations felt by people getting up after lying down as another symptom of concern in long COVID sufferers.

Many of these symptoms do not signal conditions that can threaten a patient’s life or ability to function normally in daily life but are concerning enough to encourage people all the more to vaccinate themselves against COVID to avoid lengthy symptoms that make life much more difficult.

Some long COVID symptoms are also associated with other viruses such as influenza, but still others are more puzzling, such as hair loss among hospitalized patients. Marrazzo admitted, “I have no idea what that’s about.”

Marrazzo’s remarks came during the weekly Facebook Live COVID update by the Medical Association of the State of Alabama on Thursday, in which she joined state Health Officer Dr. Scott Harris and MASA President Dr. Aruna Arora.

Harris mentioned that the annual flu season is starting to ramp up already. The flu infected far fewer people than usual last winter.

“We are beginning to see an uptick in flu cases in the state, after really not experiencing much of a flu season last year when people were doing such a great job with masks and distancing,” Harris said. “It’s perfectly OK to get your flu vaccine and your COVID vaccine at the same time. … It looks like this will be, perhaps, a regular flu season, and that’s not a good thing after having somewhat of a break this past year.”

Harris said that parts of west central Alabama, particularly Tuscaloosa County, have seen a marked increase in flu cases already.

Cases, Deaths Continue Decline

In BirminghamWatch’s periodic analysis of the state’s pandemic data, overall new cases for the state continue on a downward trend with both 7-day and 14-day moving averages falling below 500 cases per day for the first time since mid-July.

The cumulative pandemic total of COVID cases stood at 841,956 as of Friday. There were 3,120 new cases in the 7-day period ending Friday, an average of 445.71 per day. That’s down from 525.57 cases per day a week before. The 14-day average is down to 485.64 per day, the lowest since July 15.

Community transmission rates continue to fall as well, with the state’s positivity rate down to 4.5% of all tests conducted in the past seven days. The per-capita new case rate is 8.86 cases per 100,000 population, the lowest since July 9.

COVID-related deaths have slowly but steadily declined in the previous week. There were 129 deaths during the week ending Friday, an average of 18.53 per day, compared to a 7-day average of 21.14 the week before. The longer-term 14-day average is now at 19.79 deaths per day, dropping from 28.71 over the week.

The cumulative death toll for Alabama surpassed the 16,000 mark Wednesday and now stands at 16,063 fatalities attributed to the virus.

Hospitalizations of COVID patients have hovered around the 300 mark for the past week, with 301 inpatients counted statewide as of Thursday.

BirminghamWatch uses data for its analyses provided by the Alabama Department of Public Health and the Alabama Hospital Association.