February 4, 2022 — Long COVID remains a moving target — constantly evolving and still surprising doctors and patients who have sometimes debilitating long-term symptoms.
Little about the condition seems predictable at this point. People can have COVID-19 for a long time after, for example, asymptomatic, mild or severe COVID-19. And when a person gets long-haul COVID — also known as long-haul COVID — symptoms can vary widely.
To clear up any uncertainty, the New York State Department of Health gathered experts from primary care, pediatrics, physical medicine, rehabilitation and pulmonology to answer some pressing questions.
New York was the first epicenter of the pandemic in the United States in 2020, making it also the center of the long COVID epidemic, says Emily Lutterloh, MD, director of the Division of Epidemiology at the New York State Department of Health.
What do you do when you see a patient with long-term COVID for the first time?
The first exam varies because there are so many different ways COVID presents itself, says Benjamin Abramoff, MD, a physical medicine and rehabilitation specialist at Penn Medicine in Philadelphia.
Assessing their past and current care also helps guide their ongoing management, says Zijian Chen, MD, medical director of the Center for Post-COVID Care at Mount Sinai Health System in New York City.
Can vaccination help people with long-term COVID?
Anything we can do to prevent people from becoming seriously ill or hospitalized with COVID-19 will help prevent long-term COVID-19, says Abramoff, who is also director of the long-term COVID-19 clinic at the University from Pennsylvania.
“So that’s something I always discuss with patients. In some studies, patients sometimes feel better after the vaccine,” he says.
What kinds of therapies do you find helpful for your patients?
Rehabilitation is an important part of recovery from long-term COVID, Abramoff says. “It’s very important to make this very patient-specific.”
“We have patients who are working. They already go to the gym in some cases, but they don’t feel like they have the same stamina,” he says. “And then we have patients who are so lame from 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 is a big role for therapy services in the recovery of these patients,” says John Baratta, MD, of the Department of Physical Medicine and Rehabilitation at the University of North Carolina.
But the limited number of long COVID clinics may mean some people are unable to see therapists trained in the needs of patients with persistent COVID symptoms. Training community physiotherapists and occupational therapists is one solution.
How long will it take for people with long-term COVID-19 to recover and, if possible, be back to 100%?
Specific numbers aren’t really available, says Baratta.
“But I can’t tell you that the general trend I see is that many patients have a gradual improvement in symptoms. The slow but steady improvement over time may be the body’s natural healing process, a result of medical interventions, or both .”
It can help reassure people with long-term COVID that they won’t be discharged from care until they feel they’ve maximized their health, says Sharagim Kemp, DO, medical director of the COVID Recovery Program for Nuvance Health, a health system in New York and Connecticut.
It is essential to set realistic recovery expectations and that not everyone will return to 100% of their pre-COVID functioning, she says.
“Once we can help them adjust their expectations, there’s almost an accelerated recovery because they don’t put that pressure on themselves anymore,” Kemp says.
What are the most common symptoms you see with long-term COVID?
It’s helpful for a long time to think of COVID as a very broad umbrella term, Abramoff says.
Echoing 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 says.
Some reported vague symptoms, Kemp says.
People can go to the doctor “not even realizing they had COVID. That’s one of the important points here — having a high index of suspicion for patients coming in with multiple symptoms,” she says.
For this reason, patients may report symptoms that don’t necessarily fit into a specialty, says Sarah J. Ryan, MD, an internal medicine physician at Columbia University Irving Medical Center in New York City. People say they are “just not themselves” or that they are tired after their recovery from COVID-19.
Is there a link between severe COVID cases and severe long-term COVID?
“It’s not like that at all. I’d say over 80% of the patients we see had mild to moderate disease and they weren’t hospitalized,” Baratta says.
Lung COVID is a little different in kids and teens, says Ixsy Ramirez, MD, pediatric pulmonologist. Most of the patients in the long COVID clinic at the University of Michigan were previously healthy, and not children with asthma or other lung conditions as would be expected. Many are even student athletes, or have had COVID for a long time.
In this population, shortness of breath is most common, followed by chest pain and fatigue. Unfortunately, for many children, the symptoms are so severe that their performance is limited, even when they can play competitively again.
Are there defined criteria you use to diagnose long-term COVID? How do you diagnose someone?
That is an ever-changing question, says Kemp. The generally accepted definition focuses on persistent or new symptoms 4 weeks or more after the original COVID-19 illness, but there are exceptions.
Researchers are working on lab tests to confirm the diagnosis. But without a definitive blood biomarker, making the diagnosis requires “some thorough detective work,” Ryan says.
Do you engage care providers to help you with the treatment?
“We’re actually quite focused on mental health,” says co-founder of his facility’s COVID recovery clinic. For example, Mount Sinai offers one-on-one and group family care.
“Personally, I’ve seen patients I didn’t expect to have such severe mental health changes” with long-term COVID.
Examples include severe depression, cases of acute psychosis, hallucinations, and other problems ‘that are really unexpected after a viral illness’.
Stony Brook University Hospital in New York City has a long COVID clinic staffed by multiple primary care physicians who conduct exams and refer patients to services. A bonus of providing psychological services to all post-COVID patients is that doctors get a more complete picture of each person and a better understanding of what they’re going through, says Abigail Chua, a pulmonologist at Stony Brook.
Some empathy is essential, says Baratta. “It’s important to recognize that many of these patients present with a sense of grief or loss for their past lives.”
What will the future bring?
A simple test to diagnose COVID long-term, combined with effective treatment that helps people feel better within a week, would be ideal, Abramoff says.
“That would be nice. But you know, we’re just not at that point.”
And it would be helpful to identify subtypes of long-term COVID so that diagnosis and treatment can be more targeted, Abramoff says. Anders: “It’s going to be a very challenging approach to try to treat all of our patients with long-term COVID symptoms in the same way.”
Good clinical trials are also needed to address all the subtleties of long-term COVID.
A number of long-term COVID centers are collaborating on research to find out more, Chen says. Actions include establishing a bank of tissue samples from people with long-term COVID so that researchers can continue to identify the condition.
One goal, Chen says, would be the ability to treat long-term COVID rather than just its symptoms.
Lung COVID emphasizes the need to prevent people from getting COVID in the first place, Ramirez says. This will continue to be important, especially as some people dismiss the seriousness of COVID and compare it to a cold when they get it. That attitude rejects the large number of people who unfortunately develop long-lasting, often debilitating symptoms.
This post Long COVID symptoms, management and where we are going
was original published at “https://www.webmd.com/lung/news/20220204/long-covid-q-and-a?src=RSS_PUBLIC”