Understand Long Covid
MEDICAL AND MENTAL HEALTH UPDATE
Lisa is a nurse in her mid-50s. She’s also a patient of mine who had COVID-19 last spring (and has given me permission to share her story).
She’s still not well.
Back in May 2020, she and I discussed her COVID-19 saga with Ari Shapiro on NPR's All Things Considered.
Today, Lisa is one of the many people I’m seeing with a long “tail” of COVID symptoms. Coronavirus has been cleared from her body for 8 months, yet its lingering effects are still part of her daily life. She continues to have fatigue, brain fog, and muscle aches. We have ruled out all other potential causes for these symptoms through extensive testing.
One of the challenges for Lisa—and for so many other patients like her—is that we don’t yet understand the mechanism of these ongoing symptoms. In other words, if the virus is gone, why would she still feel sick? Why do so many people diagnosed with COVID-19 have prolonged fevers, fatigue, chronic cough, brain fog, hot flushes, and joint aches?
Indeed, this long “tail” of symptoms is turning out not to be an exception but a more common part of the clinical course.
In medicine, we know that other viruses can wreak havoc on our organ systems well after the virus leaves our body. The Epstein-Barr or “mono” virus, for example, can cause liver damage, spleen enlargement, and long-standing fatigue. Other common viruses like the flu, parvovirus, or cytomegalovirus, can even trigger our immune system to overreact and attack our own organs, mistaking them for foreign foes, well after the virus has come and gone. Like the wreckage from a hurricane, damage from some viruses can take months for our bodies to “clean up”—and sometimes requires specific treatment to quiet a trigger-happy immune response.
Coronavirus has joined the club of viruses whose effects extend beyond the short window of acute infection. A robust study published this month in the Lancet showed that 76% of hospitalized patients reported at least one symptom 6 months after symptom onset, and the proportion was higher in women. The most common symptoms were fatigue or muscle weakness and sleep difficulties. Additionally, 23% of patients reported anxiety or depression at follow-up. A Swiss study showed that 32% of patients with mild disease—most of whom did not require hospitalization—reported at least one lasting symptom (like fatigue or loss of taste or smell) over a month after diagnosis. A German study that included many patients who recovered at home found that 78 percent had heart abnormalities after two or three months. A team from the Centers for Disease Control and Prevention found that a third of 270 nonhospitalized patients hadn’t returned to their usual state of health after two weeks. (For comparison, roughly 90 percent of people who get the flu recover within that time frame.)
Yet another study showed that one in five patients with COVID-19 develops mental health symptoms like anxiety and depression within 90 days of diagnosis. As if the isolation, stress, and vulnerability of the pandemic isn’t enough!
Determining the mechanism(s) for these lasting symptoms will help direct treatment, but in the meantime we are supporting patients as best we know how. Sadly, many people with lingering symptoms will be accused of malingering.
So how am I treating Lisa?
First, with validation. As above, far too many patients with non-specific symptoms are dismissed by the medical profession. Healthcare practitioners need to understand the robust data on patients with vexing and real symptoms three months after the initial diagnosis of COVID-19.
Second, we are treating her symptoms: Ibuprofen for muscle aches and fever, physical therapy for muscle weakness, melatonin for insomnia, and a dash of hope that therapies for COVID long-haulers—like Leronlimab monoclonal antibody to quiet the immune response to coronavirus—will pan out.
And last, for ALL of us, it’s critical to understand the goals of COVID-19 vaccination. It’s not only to prevent death. It’s not simply to avoid a transient “bug.” It’s also to prevent the lasting suffering that so many people with COVID-19 experience.
If you don’t get COVID, you definitely won’t get “long” COVID.
Will my patient Lisa get the coronavirus vaccine? Yes! Because it’s possible to get reinfected. New research from the UK shows that most people with COVID-19 develop immune protection that lasts at least 5 months. (It probably lasts even longer—we just haven’t had enough time to know for sure). However, the risk of getting COVID a second time is too high not to get vaccinated.
For MORE INFO on vaccines and variants, check out my Instagram Q & A video from last night! You can find it in “stories” and under “highlights.” I hope it’s helpful.
I will see you later this week. Until then, be well.