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Persistent illness after COVID-19 'recoveries' baffling Japan doctors

A hand showing symptoms of eczema, belonging to a university student who has experienced persistent symptoms of illness even after testing negative for the new coronavirus, is seen when he was hospitalized in May, in this picture provided by the patient.
A hand with persistent symptoms of eczema, belonging to the same university student, is seen while he has been convalescing at his parents' home, in this picture provided by the patient.

Although more information on the characteristics and symptoms of the new coronavirus has become available compared to the data that existed early on in the outbreak, there are still many things we don't understand about the infectious disease.

Among the most pressing unknowns is whether infected people who eventually test negative do experience a steady recovery. One man aged 21 was infected in early April and tested negative in early May, but he has reported still being affected by symptoms including tiredness, headaches, eczema to his hands and feet, and an impaired sense of smell, among other issues.

Although aftereffects that could arise from COVID-19 are yet to be confirmed, some academic associations and doctors have already started sounding the alarm on the issue. To find out more, the Mainichi Shimbun spoke with experts and with the man still suffering the aftereffects of infection.

"Even after I was discharged from hospital I felt fatigued and had to take time out from university. I want people to know that there are many people who are testing negative for the virus who continue to have symptoms," he told the Mainichi. A student at a university in Chiba Prefecture, just east of Tokyo, he had moved to a nearby residence alone to commute to school. But doctors advised him he will require help to lead his daily life for the foreseeable future, and he was forced to return to his parents' home.

He first developed COVID-19 symptoms on April 1. His temperature was close to 38 degrees Celsius, and by the next day it had risen to 38.5C, and on April 3 it had gone past 40C. On April 4, he spent around eight hours on the phone until he finally could speak to someone at his local public health center, but because it was a Saturday he was advised to call again on Monday.

Because he had started to experience worsening symptoms, including diarrhea, vomiting and bloody coughing, he went to be examined by a nearby physician on April 6. He was then able to receive a polymerase chain reaction (PCR) test, and he was informed the following day that he had tested positive for the novel coronavirus.

The man was told by the local health center that he would be admitted to a hospital in the next three to four days, but in the end, he says, he didn't get admitted until April 29 -- 22 days after he found out he had the virus.

Over the 22-day period in which he was resting at home, the man was too sick to eat properly. Instead, his diet consisted primarily of jellies and other liquid food products. On around April 12, he reported becoming able to eat small amounts of food, and that when he tried to eat gyoza dumplings it was "just like I was eating clay." It was then that he realized his sense of taste and smell were also being affected by the virus.

Concerned about his condition, the man called the health center on April 29 to ask when he would be able to receive treatment from the hospital. It was then that the decision was made for him to be hospitalized from that night.

A hospital doctor diagnosed him with pneumonia based on the results of a CT scan. At that point he had a fever of around 38C, and he says that while he was in the hospital he started to develop eczema on his hands and feet. Because two subsequent PCR tests on May 7 and 8 came back negative, he was discharged on May 9. But even though he was allowed to leave, his suffering didn't end.

The day he left hospital, the man was still recording a fever of 37.5C, and he reports staying at about the same temperature for days after being discharged. His sluggishness, headaches and loss of sense of smell all persisted, and he couldn't go out to shop, meaning that at one point he apparently didn't eat for three days in a row. There were also days where his fever returned to about the 38C level, and on May 14 he was back in the hospital for more checks. A blood test showed he was suffering from dehydration, and he was hospitalized again. The man said a doctor told him, "It's a viral disease, so it can be protracted."

Although he left hospital again on May 20, because his doctor told him that he wouldn't be able to lead a life without the assistance of his family, he decided to return to his parents' home. By then, his weight had dropped by 11 kilograms compared to before he contracted the infection. He also told the Mainichi Shimbun he decided to take time away from school, saying, "Online lectures at university started in mid-May, but in my condition, even if I was able to take the classes, there was no way I would be able to study for exams."

Since returning to his parents' home he has continually developed fevers of about 37C, and his symptoms of tiredness, headaches and eczema persist. "I'm still far from healthy," he says. He added that he had been to a hospital near the house numerous times, but had only been prescribed painkillers, and the cause remains unknown.

He said, "Even going out shopping was hard. I'm still not able to go back into society, and I'm afraid because I don't know what the cause of these constant symptoms is."

Discussing possible causes of the man's persistent condition, Yasushi Taniguchi, head of the Taiyujicho Taniguchi Clinic in the western Japan city of Osaka's Kita Ward, said, "The most likely cause I can think of is a blood clot."

It has become clear from papers released up to now that it is possible to develop blood clots across the body upon infection with the new coronavirus. Taniguchi explained, "Although we still don't understand its exact mechanism, we do know that the virus infiltrates the lungs and enters the bloodstream to then reach and bond with the ACE2 receptors of organ cells. The blood clots may be connected to the inflammation of vascular endothelial cells caused by the virus entering those cells where ACE2 receptors exist."

He went on, "The blood clots caused by the new coronavirus can affect various tissues, and cause inflammation of vascular endothelial cells, which affects the entire body. Additionally, in severe cases the virus can cause problems in the immune system, known as a cytokine storm syndrome, in which multiple organs are damaged. It means that if symptoms get serious, the virus takes on a completely different form to just a simple cold."

Ken Jinnouchi, director of a medical corporation that operates clinics in the capital, reported to the Mainichi that his clinics received around 180 patients between April and May complaining of constant minor fevers at around 37C, pain in their chests, and feelings of lethargy. Among them, five were COVID-19 patients who had gone on to later test negative.

Jinnouchi also said that about 75% of the patients reported experiencing symptoms for a month or more, and that because blood tests and other diagnostic measures administered at hospitals haven't registered irregularities, there have been some instances in which doctors have opted to label the illnesses as caused by the patients' psychological states.

He explained, "Many patients have been hurt by their doctors determining the causes to be mental issues. I want to warn people that individuals in medical care are simplistically deciding to explain the persisting symptoms as something caused by the patients' mental conditions."

The Japanese Society on Thrombosis and Homeostasis has pointed out that through coronavirus infection, inflammation of blood vessels could lead to the development of blood clots. It reported that rates of thrombosis are particularly high among people with serious COVID-19 cases and that it is one of the factors leading to the worsening of full-body symptoms.

The Ministry of Health, Labor and Welfare's publically released guidebook on new coronavirus health care also includes passages on measures related to thrombosis. Although the guidebook doesn't include a section on aftereffects of infection, a person in charge at the ministry's Tuberculosis and Infectious Diseases Control Division said, "We will continue to collect information, and if it becomes necessary we will publish additional information in the guidebook."

(Japanese original by Reiko Noguchi, Osaka Regional News Department)

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