Among the many confusing aspects of the coronavirus are the range of possible symptoms, as well as their severity and duration. Some people develop mild illness and recover quickly, without lasting effects. But studies estimate that 10 to 30 percent of people report persistent or new medical problems months after their initial infection with the coronavirus — a group of symptoms known as long-CoV. People with mild or moderate illness, as well as those without any underlying medical conditions, can nonetheless have some long-term debilitating symptoms, including fatigue, shortness of breath, irregular heartbeat, headache, dizziness, depression, and problems with memory and concentration. .
Such persistent medical problems are so diverse that one patient-led research group study evaluated 203 symptoms that may fluctuate or even appear suddenly after people recover.
As Dr. Ziyad Al-Ali, Head of Research and Development at VA St. I have seen a patient with a long covid virus.”
How are doctors currently diagnosing COVID-19?
There is little consensus on the exact definition of prolonged Covid, also known by the medical term PASC, or the post-acute sequelae of Covid-19. While the World Health Organization says the long Covid period begins three months after the original outbreak or positive test result, the Centers for Disease Control and Prevention sets the timeline just one month later.
Dr Al-Ali, who has conducted several studies on long-term post-Covid issues, said some researchers and healthcare providers are using other time frames, making efforts to study and quantify the condition more difficult.
Dr Al-Ali said that when patients have persistent symptoms they go to their doctors, tests such as ECG, chest X-ray, CT scan and blood work do not always identify physiological problems. Researchers are working to identify certain biological factors, called biomarkers, that are associated with persistent Covid symptoms. These could include signs of inflammation or certain molecules produced by the immune system that can be measured by blood tests, for example.
Currently, clinicians must rely on their patients’ descriptions of symptoms and rule out alternative explanations or causes. Some post-Covid clinics have multidisciplinary teams of specialists evaluating patients for the best treatment options.
What causes Long Covid?
It’s unclear what exactly drives the long Covid virus, but research is beginning to provide some clues. Some experts believe that an immune response that overloads when you first become sick may lead to inflammation and damage throughout the body, eventually leading to prolonged Covid symptoms, says Dr. Michael Belloso, an infectious disease physician at the University of California, San Francisco. Francisco.
“We know that during severe Covid-19, some people have a really fast immune response and some people have a low immune response, and that response can determine the course of how well someone does,” he said.
Experts say another explanation could be that your immune system doesn’t shut down completely after the initial infection.
Who is at risk?
Research offers some hints about which patients may be at greater risk of developing long-term symptoms. In a study of 209 patients published in January, researchers found four factors that can be identified early in a person’s infection with the coronavirus that appear to be associated with an increased risk of persistent symptoms after two to three months.
One factor was the level of coronavirus RNA in the blood early in the infection, an indicator of viral load. Another reason was the presence of autoantibodies – antibodies that mistakenly attack tissues in the body as they do in conditions such as lupus and rheumatoid arthritis. The third factor was the reactivation of the Epstein-Barr virus, which can cause mononucleosis and infect most people, often when they are young and then hibernating.
The fourth factor was having type 2 diabetes, although experts say that in studies with larger numbers of patients, diabetes may be just one of many medical conditions that increase the risk of long-term Covid disease.
Studies from post-Covid clinics have also found other pre-existing medical conditions that may put people at risk for a prolonged period of Covid. In a report of the first 100 patients treated for neurological and cognitive symptoms at the post-Covid clinic at Northwestern Memorial Hospital in Chicago, 42 percent reported having previously had depression or anxiety, although these patients may simply be more comfortable looking for Neurological treatment, as the doctors said. Other pre-existing conditions include autoimmune disease and headache.
Studies also show that the long-term risk of developing Covid-19 peaks in middle age, said Dr. Belloso. The average age of patients in the Northwestern study was 43. An analysis of 78,252 private health insurance claims across the United States found that people between the ages of 36 and 64 made up about two-thirds of long-term Covid patients. (But this study did not include most Medicare recipients, so it includes relatively few older patients.)
Women may be disproportionately affected, with some studies finding that about 60 percent of patients are female. A similar pattern has been seen in other long-term conditions such as ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), which have many of the same symptoms as those of long-term COVID-19.
Because the pandemic has had a significant impact on the black and Latino communities in the United States, and because these groups have limited access to medical care, they may have a significant number of prolonged Covid cases as well, Dr. Peloso said.
Can vaccines protect against the long-term Covid disease?
The picture is still in focus, but several studies suggest that getting a Covid vaccine can reduce – but not eliminate – the risk of long-term symptoms.
The UK’s Health Security Agency carried out an analysis of eight studies that looked at vaccines and Covid long before mid-January. Six found that vaccinated people who then contracted the coronavirus were less likely to develop symptoms of long-term COVID-19 compared to unvaccinated patients. The remaining two studies found that vaccination does not appear to conclusively reduce the chances of developing long-term Covid disease.
In this analysis, one study, not peer-reviewed, of nearly 240,000 US patients found that those who received a single dose of the Covid vaccine before becoming infected were seven to ten times less likely than unvaccinated patients to report symptoms of the disease . Long Covid after 12 to 20 weeks. But another large study of electronic patient records at the US Veterans Health Administration, which has not yet been peer-reviewed, found that those who were vaccinated had only a 13 percent lower risk of developing symptoms after six months than unvaccinated patients. Dr. Al-Ali, one of the study’s authors, said the vaccinated patients mostly benefited by being less likely to have lung problems and difficulties with blood clotting.
“Reliance on vaccination as the only mitigation strategy is absolutely not sufficient,” said Dr. Al-Ali. “It’s like getting into a fight with a shield that’s only partially functioning.”
Seek medical attention
If you are concerned about any lingering symptoms after a confirmed or suspected coronavirus infection, don’t be afraid to seek help. Checking in with your primary care provider is a good first step. More doctors are becoming aware of your prolonged Covid symptoms and can recommend tests that may at least rule out other causes of your symptoms.
“Although we say the prolonged Covid period is when symptoms persist for a month or three after infection, there is no need to wait that long for help,” Dr. Al-Aly said. “People should really respect their symptoms.”
If you don’t get help from a primary care physician, you may want to seek out a post-Covid clinic, although Dr Al Ali acknowledged that it’s “easier said than done”. Post-Covid clinics can be difficult to access for those without proper medical insurance. And in some states, people may have to travel hundreds of miles to get to the nearest one. You can search for post-Covid clinics near you in the Survivor Corps database.
If you’re visiting a new provider, bring your medical records and make a list of all your symptoms, especially if you have cognitive problems and are likely to forget some health issues when your appointment comes.
Some protracted COVID issues can be managed with medications or current treatments for symptoms such as headaches or digestive issues. Physical therapy and “cognitive rehabilitation,” including techniques often used for patients who have experienced strokes or brain injuries, can also be beneficial over time. Some people benefit from customized physical and mental health rehabilitation services and breathing exercises, which can help them slowly restore strength and endurance when engaging in physical activities.
Other possible tools to combat the prolonged Covid-19 disease, including antiviral therapies, are just beginning to be studied. The National Institutes of Health is allocating more than $1 billion to a large research effort called the Recovery Initiative, but progress has been slow so far. Lawmakers are pushing for better funding for long-running Covid research and Medicare.
Many groups, such as Body Politic, the Long Covid Alliance, and Survivor Corps, offer emotional support, as well as resources for seeking treatment, disability benefits, and patient advocacy.
Dr. Peloso said people with prolonged Covid-19 may also want to consider joining a research trial. You may be able to find ongoing clinical studies at universities and academic centers near you, or register to be part of a recovery initiative.
“Participation in the research can be very powerful,” said Dr. Peluso.