This is the third part of a four-part series. Read Part 1 here, Part 2 here and Part 4 here.

Long COVID and reinfections

In the months after China’s first wave of mass infections with COVID-19 last winter, in which the vast majority of the population was infected, the term “Long COVID” gradually entered public consciousness as many discovered that they are still troubled by prolonged symptoms months after “recovery.” Long COVID researchers’ and advocates’ assessment of the pandemic as a “mass disabling event” has again been tragically confirmed by this experience.

Contrary to the claims of officials like Dr. Li Tongzeng that reports of Long COVID outside China are relatively rare and concentrated among “the vulnerable,” ample medical research has demonstrated that the virus can cause lasting damage to every organ system of the body, especially the cardiovascular, gastrointestinal, neurological, endocrine, respiratory, and genitourinary systems. Symptoms of long COVID, including extreme fatigue, difficulty breathing and shortness of breath, painful muscles, ageusia (loss of sense of taste) or anosmia (loss of sense of smell), and others have been reported by millions of patients globally.

As early as late March, online discussion about Long COVID started to expand across China, as people complained that they have been coughing for three months since their infection, were out of breath after doing basic house chores, and more.

On April 6, a Long COVID patient posted a widely shared thread on Douban, titled, “Please tell me who said COVID is just like a cold? My 20-year-old body is like a broken machine now.” It received a few hundred “likes” and more than 300 comments from people with similar experiences. The original poster said their symptoms include “shortness of breath and difficulty breathing.” They added:

My quality of sleep declined as well and I sweat a lot in the middle of the night. I felt pains in my chest and back. I used to sleep very well and never had to wake up in the night. Now I always wake up in the middle of the night with cold limbs and sweats…

I also experience fatigue. Both my physical strength and my appetite dropped a lot. I always came top in 800-meter races, but now I have to take a break after a 10-minute walk. Lifting something feels like it can almost kill me. Due to the lack of appetite, I recently only had two real meals in five days and almost passed out on the curb because of low blood sugar levels.

Lastly, I have palpitations from time to time, along with panic attacks.

The most popular comment under this thread said, “Same here, my immune system has been completely wrecked,” and received 900 “Likes.” Other replies shared what they have been suffering through:

• I now have lung nodules. I don’t know what to say because now I have to have surgery to remove some of the more serious ones.
• Same here…[before COVID] my heart rate was slow (around 45-50 BPM when at rest). After the infection, my heart rate can go up to 130 BPM after walking a few steps. I feel a really heavy burden on my heart.
• When I was in hospital a while ago, I saw several doctors keep coughing. They said it has been like this ever since they got infected.
• I get hives a lot more frequently after having COVID.
• I don’t have enough energy to do anything. I sweat very easily and cannot sleep well. I think I might die if I’m infected a few more times.
• After getting COVID, I could only sleep for 3 hours each night. Two or three months later, I can finally sleep for 5 hours straight. I’ve never known what it’s like to have a good night of sleep since having COVID.
• After jogging for just 300 meters at a very slow pace, it feels like someone is strangling my neck with a rope.

Over the past two months, the ongoing second wave of COVID-19 infections has reignited discussions about Long COVID. Social media has been flooded with posts by people sharing their symptoms, seeking help, and even all sorts of very confused folk remedies. Many comments about being infected a second time note that they have not even recovered from prolonged symptoms from their first infection.

One complained, “It’s been six months but I haven’t had one comfortable day.” Another said, “Today this symptom seems to go away, but another one comes tomorrow. [All sorts of symptoms] come back in different combinations all the time.”

One of the most widely discussed Long COVID symptoms is heart palpitations, especially high heart rate after even a slight movement. Some representative comments include:

• Whenever I stand up or am just walking slowly, my heart rate goes over 100 BPM, sometimes 140 BPM.
• I feel like having a heart attack just after walking a few steps…. [These symptoms] have been on and off for more than four months. Will this ever end?
• I’m gonna lose my mind. When I went to pick up a delivery the other day, I consciously chose to only take a few smaller packages and left the heavier ones there. But all of a sudden I felt shaky and hot. I was short of breath and my legs felt weak. I had to lie down on the road.
• I didn’t have any underlying conditions before, but my heart rate is still abnormal more than half a year after the infection… I’m a typical example of long COVID.

Many Long COVID patients have lost their ability to work as usual and are deeply concerned about where their livelihood will come from. One person shared that their migraine headaches after having COVID have been so severe that they had to resign but are not in a position to seek new employment, especially during a period when the youth unemployment rate is high and the job market is bleak. Another person similarly said they have been out of work for five months after being infected during the first COVID wave.

Fatigue and brain fog are other symptoms that have been widely reported. For example, one thread attracted more than 900 comments from people who are struggling to carry out daily activities, including the following:

• It feels like any memory can stay for no more than 5 seconds.
• Up until now, I still experience dizziness and fatigue. I can hardly walk any substantial distance. I’m very sensitive to temperature change. My heart always feels uncomfortable…. I’m only in my early thirties, but I’ve been on sick leave for months and still cannot return to work. [This comment was echoed by another 300 replies from people who are going through the same thing.]
• I’m an accountant as well and seem to be the only one with Long COVID at work. I used to be so proud of my brain power but now my brain is so slow. I used to be the most hardworking one but now I have no energy to do anything. No one can understand what I’m going through. I’ve taken all sorts of medical exams but nothing conclusive came out of them. I’m so tortured.
• I don’t have enough energy to go to work after being infected. As a single mom who’s not young, losing income makes me really anxious. Insurance payments, my children’s and my family’s living expenses—I don’t know what to do with all these.

It has been more widely understood since the onset of the second wave that the pandemic will not go away by itself. On June 13, the CDC from the city of Pingdingshan in Henan Province published an article based on a Nature commentary about the prospect of having a wave of COVID infections every six months. The article is bluntly titled, “It may become a norm that everyone will be infected 2-3 times a year.”

Once every six months might already be too optimistic, given how quickly the virus can mutate in a vast pool of available hosts. Already, reports about people having third infections are starting to emerge across social media, with some people reporting that they were infected last December, again in late April or early May, and now a third time in June.

Having witnessed or suffered from the not-so-rare cases of Long COVID, many express concerns and anger that Chinese society seems to have collectively entered a game of Russian Roulette, in which every six months one risks becoming debilitated by their next COVID infection. One person asked, “If we get reinfected over and over again like this, can we even survive to our retirement age of 65 years old?”

On top of a substantial section of the population suffering from Long COVID, the pandemic, especially the possibility of being reinfected multiple times a year, has brought heavy tolls to those who are pregnant, an impact hardly ever mentioned by any media outlets.

Outside of China, where the virus has been allowed to spread freely for more than three years, the increase in maternal mortality rates has demonstrated how pregnant and postpartum women have been put at higher risk from infections and/or insufficient medical resources for non-emergency treatment.

Women who try to plan their pregnancy are now uncertain whether there will ever be a good time to become pregnant. As one woman commented:

The social environment today is very unfriendly for those who are preparing for pregnancy. I was infected with COVID twice in just over half a year, plus catching a flu in between. There were only three months in between each infection. How could I ever feel comfortable getting pregnant?

A similar post said:

the central question is that you don’t know when you’ll be infected again. If you start preparing for pregnancy three months after you recover and if you are lucky enough to get pregnant right away, you may well get infected again when you are pregnant for three months. This vicious cycle will never end.

Another woman expressed the same frustration about the danger of constant reinfections in a thread on Xiaohongshu, stating:

I was infected for the first time on [May] 31, but I was already preparing to get pregnant before this. My husband has quit smoking. Both of us were trying hard to quit drinking, stop eating fast food and stop taking medications… now I have to wait for another few months to get pregnant. I wonder if it’s even good to bring a child into this world under these circumstances.

This thread was liked more than 800 times and received almost 600 replies sharing similar sentiments. A representative one which was liked more than 500 times said:

I really feel like it’s bad for the baby to give birth to it. My older kid is three-and-a-half years old and was infected right before she turned three. She got pneumonia from catching the H1N1 flu last month as well. Both times she had high fevers for 3-4 days…. she is probably going to be infected a second time now. I don’t even know if my daughter can survive to adulthood.

For women who are already pregnant, they face the risk of miscarriage or blighted ovum after being infected. One thread on social media talked about how all her maternal exams were normal at week six, but the fetal heartbeat stopped at week eight, soon after she was infected. Among the about 450 comments under this thread, most of them were from women who lost their children after being infected during pregnancy.

Even though factors contributing to complications during pregnancy can be complicated and not singular, pregnant women are indeed at a much higher risk of severe illness if they contract COVID-19, especially if they are not fully vaccinated.

To be continued