• New research shows that people with mild SARS-CoV-2 infection can have lingering symptoms for weeks, including signs of inflammation in the heart.
• Boston Red Sox pitcher Eduardo Rodriguez had heart inflammation after developing COVID-19 earlier this year.
• A study, published this week in the medical journal JAMA Cardiology, found that the vast majority of people with a mild form of COVID-19 are also showing signs of heart damage, sometimes months later.

Boston Red Sox pitcher Eduardo Rodriguez has been benched for a least a week after being diagnosed with inflammation of the heart muscle, possibly stemming from a SARS-CoV-2 infection earlier this year.

The condition, known as myocarditis, is typically caused by a viral infection and can cause abnormal heart rhythms or impair the ability of the heart to pump blood.

Although SARS-CoV-2, the coronavirus that causes COVID-19, is a respiratory virus, it can also damage the heart and other organs.

Many studies have found this kind of damage in patients hospitalized with COVID-19.

But new research shows that people who had only a mild SARS-CoV-2 infection and were never hospitalized can show signs of heart damage months after their initial infection.

In addition, doctors around the country are reporting that a growing number of patients who had a mild or moderate form of COVID-19 are now seeking treatment for lingering symptoms like cough, shortness of breath, and fatigue, as well as headache, poor concentration, and weakness.

Dr. Zijian Chen, an endocrinologist and medical director of Mount Sinai’s Center for Post-COVID Care in New York City, says many patients are showing up at the center with symptoms like this — sometimes weeks or months after their initial illness.

And they don’t all fall into groups at higher risk of a severe form of COVID-19, such as older adults and those with underlying health conditions.

“We’re looking at younger people who were perfectly healthy prior to getting infected with coronavirus — no medical problems, not taking any medications,” said Chen. “And now, in spite of not being in the hospital for COVID-19, they’re having trouble resuming their everyday life.”

Effects of COVID-19 linger for weeks or longer

The World Health Organization estimated in March that about 80 percent of SARS-CoV-2 infections are mild or asymptomatic, while the rest are severe and often require hospitalization.

But for some people, mild or asymptomatic doesn’t mean smooth sailing.

The results of a survey released last week by the Centers for Disease Control and Prevention (CDC) show that people who were never hospitalized for COVID-19 can experience “prolonged illness and persistent symptoms,” even if they are young and have no underlying medical conditions.

Of the 292 people surveyed, around one-third still had symptoms up to 3 weeks after they tested positive for the novel coronavirus. This included around one-quarter of 18- to 34-year-olds.

People with underlying medical conditions were more likely to report ongoing symptoms, but almost one-fifth of younger adults with no chronic medical condition had not fully recovered weeks after the initial infection.

Compare this to seasonal influenza, where one study found that over 90 percent of people who had the flu and weren’t hospitalized had fully recovered within 2 weeks of having a positive test result.

Another study, published this week in the medical journal JAMA Cardiology, found that the vast majority of people with a mild form of COVID-19 are also showing signs of heart damage, sometimes months later.

About two-thirds of the people in the study had recovered at home, with mild to moderate illness.

Overall, 78 percent of people had abnormal cardiac MRI results, a sign of structural changes to the heart. Sixty percent had ongoing inflammation in the heart.

The authors of the study wrote that even people with no preexisting heart problems and mild illness showed signs of inflammation as well as structural changes to the heart.

Long-term effects on the heart are unknown

Dr. Jeffrey Goldberger, a cardiologist with the University of Miami Health System, says that although we don’t know much yet about the long-term effects of COVID-19 on the heart, there’s no question that the novel coronavirus can affect this organ.

“Approximately 30 percent of hospitalized patients have evidence of damage to their heart cells,” he said, with elevated levels of troponin, an enzyme that is also released when you have a heart attack.

Viruses can damage the heart in several ways: by infecting the cells directly, by causing blood clots in the small vessels of the heart, or through an overactive immune response of the body to the virus.

In some cases, these effects can be severe.

“We know from other viral infections of the heart that some patients go on to get heart failure,” said Goldberger. “But some patients recover completely.”

It’s not clear what this means for the long-term heart health of people who had mild or moderate SARS-CoV-2 infections.

But Goldberger says with so many of these cases accumulating in the United States, doctors will be able to evaluate people who had COVID-19 for these kinds of problems.

“I would imagine there is going to be a range of effects on the heart in people who survive COVID-19,” said Goldberger. “Hopefully most people will have no long-term effects at all, but some fraction are likely to have some involvement of the heart.”

Goldberger and his colleagues have called for ongoing tracking of patients with COVID-19 and clinical trials to see if some patients develop “post-COVID-19 cardiac syndrome.”

Ongoing fatigue after SARS-CoV-2 infection

While most viral infections can cause fatigue, for some people who’ve had COVID-19, it’s severe enough that they struggle to do everyday tasks like take a shower, make meals, or even get out of bed.

National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci noted earlier this month that some of the long-term symptoms after COVID-19 resembled myalgic encephalomyelitis, originally known as chronic fatigue syndrome.

This debilitating condition is poorly understood, but has been linked by some studies to viral infections. Many people with this condition report severe fatigue that often worsens after exercise or mental exertion.

Treating patients with lingering symptoms of SARS-CoV-2 infection is not always easy, because there is not a clear cause.

Chen says treatment often involves a team of specialists and starts with medications known to relieve the symptoms that people have.

However, “What we’re seeing is that some of these patients, despite medications, don’t get better,” he said. “So we’re also looking at new treatment modalities.”

This includes things like physical rehabilitation to help them regain their functioning, or treating a patient’s anxiety or depression to see if that helps.

Chen cautions that with novel coronavirus cases continuing to surge in the United States, the virus still poses a danger to people of all ages, including those without underlying health problems.

“Even if you don’t die from coronavirus infection, that may not be the end,” he said. “You could continue to have illness, sometimes bad enough that it can change your life.”

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