The EconomistAugust 22nd 2020 651T
he symptoms began in March, says
Laura, a British woman in her mid-20s.
At first covid-19 felt like a bad case of flu: a
dry cough, fever, shortness of breath, loss
of smell, “horrendous nausea” and general
fatigue. After three weeks of rest, things
started to improve. Five months later, she
has still not recovered. Sometimes her
symptoms ease for a week or two, but they
inevitably return. “When it’s bad I can’t
even go on work calls, because if I talk too
much I can’t breathe.”
In March, as covid-19 cases began their
exponential rise in country after country,
doctors focused on saving patients’ lives.
Speedy sharing of knowledge, clinical
trials and hands-on experience have made
the illness less deadly. In Britain about half
the patients treated in intensive-care units
(icus) in the weeks to the middle of April
died. By the end of June mortality was be-
low 30%. Reductions were seen across all
age groups, which means the fall cannot
have been caused by fewer frail old people
arriving in hospital (see chart 1). In places
where the epidemic has subsided, calmer
wards have meant better care. But im-
proved knowledge about treatment proba-
bly accounts for much of the improvement.
Doctors have learned a lot. They have
stopped rushing covid-19 patients onto
ventilators, which can cause lung damage.
Oxygen supplied through small prongs in
the nostrils is much less invasive and often
does the job. In British icus the share of co-
vid-19 patients on ventilation fell from
90% in the early days to 30% in June. Treat-
ment protocols have improved further
with the addition of dexamethasone, an
immune-dampening drug that increases
survival rates in patients who need oxygen.
Now, though, doctors and scientists are
shifting their focus to those who survive
the infection—including the subset of peo-
ple like Laura, who have never been ill
enough to be hospitalised, but who have
also never recovered sufficiently to return
to normal life.In most people, covid-19 is a brief, mild
illness. Between a third and a half of those
infected do not notice any symptoms. In
those who do become unwell symptoms
usually clear within two to three weeks
with just home rest. In Europe only around
3-4% of those who become infected are ad-
mitted to hospital.
Yet at the same time it is becoming clear
that some small but significant proportion
of those infected have symptoms that per-
sist for months. Prolonged recovery is not
unusual for patients hospitalised for pneu-
monia, a frequent complication of co-
vid-19. It is also common for people who
have been admitted to an icu, who are by
definition seriously ill. But many clini-Covid and chronic illness
Lingering fog
Most people recover quickly from covid-19. The mystery is why some do not
Gettingbetterallthetime
SurvivalratesofICUpatientswithcovid-19
Britain,byage,%Source:CentreforEvidence-BasedMedicine116-39 40-49 50-59 60-69 70-79 80+100
80
60
40
20
0To April 17th 2020 May 15th–June 26thScience & technology