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February 4, 2022 – The long COVID continues to be a moving target – an ever-evolving and still surprising physician and patient who sometimes has inoperable long-term symptoms.
Little about the disorder seems predictable at this point. People may have prolonged COVID after asymptomatic, mild, or severe COVID-19, for example. And when a person gets a long COVID – also known as a long-distance COVID – the symptoms can vary greatly.
To address all the uncertainty, the New York State Department of Health has gathered experts in primary care, pediatrics, physical medicine, rehabilitation and pulmonology to answer some urgent questions.
New York in 2020 was the first epicenter of the pandemic in the United States, making it the center of a long epidemic by COVID, said Dr. Emily Lutherlo, director of the epidemiology department at the New York State Department of Health.
What do you do when you see a patient with prolonged COVID for the first time?
The first exam varies because there are so many different ways in which COVID has been presented for a long time, says Benjamin Abramoff, MD, a specialist in physical medicine and rehabilitation at Penn Medicine in Philadelphia.
Assessing their past and present care also helps guide their ongoing management, said Zigian Chen, MD, medical director of the COVID Care Center at Mount Sinai in New York City.
Can the vaccine help people with long-term COVID?
Anything we can do to prevent critically ill people or be hospitalized with COVID-19 is helpful in preventing prolonged COVID, says Abramoff, who is also director of the Long COVID Clinic at the University of Pennsylvania.
“So this is something I always discuss with patients. In some studies, patients sometimes feel better after the vaccine,” he said.
What therapies do you find useful for your patients?
Rehabilitation is a key part of recovering from long-term COVID, Abramoff said. “It’s very important to make this very patient-specific.”
“We have patients who work. “They already go to the gym in some cases, but they don’t feel like they have the same stamina,” he said. “And then we have patients who are so crippled by their fatigue that they can’t get out of bed.”
An exercise program can help people who have had COVID for a long time.
“There’s a big role to play in therapeutic services for the recovery of these patients,” said John Barata, Ph.D., of the Department of Physical Medicine and Rehabilitation at the University of North Carolina.
But the limited number of long-term COVID clinics may mean that some people cannot reach therapists trained for patients with long-term COVID symptoms. The training of public physiotherapists and occupational therapists is one of the solutions.
How long does it take people with long-term COVID to recover and return to 100% if they can?
Specific numbers are not actually available, says Barata.
“But I can’t tell you the general trend I see is that many patients are gradually improving their symptoms. Slow but steady improvement over time may be the body’s natural healing process, the result of medical interventions or both. ”
It can help reassure people with long-term COVID that they will not be released from care until they feel they have maximized their health, said Sharagim Kemp, DO, medical director of the COVID Recovery Program for Nuvance Health, a health care system. in New York and Connecticut.
It is essential to set realistic expectations for recovery and that not everyone will return to 100% of their functioning before COVID, she said.
“Once we are able to help them reset their expectations, there is an almost accelerated recovery because they are no longer putting that pressure on themselves,” Kemp said.
What are the most common symptoms you see with prolonged COVID?
It is useful to think of long COVID as a very broad term, says Abramoff.
According to what many others have observed, fatigue, cognitive dysfunction or “brain fog” and shortness of breath or difficulty breathing seem to be the most common symptoms, he said.
Some report vague symptoms, Kemp said.
People can go to the doctor even without realizing they have COVID. This is one of the important points here – to have a high index of suspicion for patients who come with many symptoms, “she said.
For this reason, patients may report symptoms that do not necessarily fit into any specialty, says Sarah J. Ryan is a doctor of internal medicine at Columbia University Medical Center Irving in New York. People say they are “just not themselves” or are tired after recovering from COVID-19.
Is there a link between severe cases of COVID and severe prolonged COVID?
“It’s not like that at all. I would say that more than 80% of the patients we see had a mild to moderate illness and were not hospitalized, “said Barata.
The long COVID is a little different for children and teenagers, says Ixi Ramirez, PhD, a pediatric pulmonologist. Most patients at the long COVID clinic at the University of Michigan were previously healthy, not children with asthma or other lung diseases, as might be expected. In fact, many of them are student athletes or have been COVID for a long time.
In this population, shortness of breath is most common, followed by chest pain and fatigue. Unfortunately, the symptoms are so severe for many children that their performance is limited, even if they can return to competitive play.
Are there any specific criteria you use to diagnose prolonged COVID? How to diagnose someone?
This is an ever-evolving issue, Kemp said. The generally accepted definition focuses on persistent or new symptoms 4 weeks or more after the initial illness of COVID-19, but there are exceptions.
Researchers are working on laboratory tests to confirm the diagnosis. But without a definitive blood biomarker, getting a diagnosis requires “some in-depth detective work,” Ryan said.
Do you bring mental health providers to help you with treatment?
“We’re actually focusing on mental health,” said the co-founder of the COVID Rehabilitation Clinic at his institution. Mount Sinai offers individual and group mental health services, for example.
“Personally, I’ve seen patients who I didn’t expect to have such severe changes in mental health,” with continued COVID.
Examples include major depression, acute psychosis, hallucinations and other problems “that are really unexpected after a viral illness”.
Stony Brook University Hospital in New York has a long COVID clinic staffed by a number of primary care physicians who take exams and refer patients to services. The bonus of offering psychological services to all patients after COVID is that doctors get a better idea of each person and a better understanding of what they are going through, says Abigail Chua, a pulmonologist at Stony Brook.
Some empathy is essential, Barata says. “It’s important to recognize that many of these patients present themselves with feelings of grief or loss for their previous lives.”
What does the future hold?
A simple test to diagnose long-term COVID, combined with effective treatment that helps people feel better within a week, would be ideal, Abramoff said.
“It simply came to our notice then. But you know, we’re just not in this moment.
And it would be helpful to start identifying subtypes of long-term COVID so that diagnosis and treatment can be more targeted, Abramoff said. Otherwise, “it will be a very challenging approach to try to treat all our patients with long-term COVID symptoms in the same way.”
Good clinical trials are also needed to deal with all the intricacies of long COVID.
A number of long COVID centers are collaborating on research to learn more, Chen said. Actions include creating a bank of tissue samples from people with long-term COVID so that researchers can continue to discover the condition.
One goal, Chen says, would be the ability to treat long-term COVID, not just its symptoms.
The long COVID primarily emphasizes the need to prevent COVID infection, Ramirez said. This will continue to be important, especially when some people reject the seriousness of COVID, comparing it to the common cold if they get it. This attitude rejects the large number of people who, unfortunately, continue to develop long-term, often debilitating symptoms.
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