Lange Covid symptoms and treatment: what we know so far

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Lange Covid symptoms and treatment: what we know so far

Among the many confusing aspects of the coronavirus is the range of possible symptoms, as well as their severity and duration. Some people develop mild illness and recover quickly with no lasting effects. But studies estimate that 10 to 30 percent of people report ongoing or new medical problems months after their first coronavirus infection — a constellation of symptoms known as Long Covid. People with mild or moderate medical conditions, as well as those with no underlying medical conditions, can still experience some debilitating long-term symptoms, including fatigue, shortness of breath, irregular heart rate, headache, dizziness, depression, and problems with memory and concentration.

Such ongoing medical problems are so diverse that a study by a patient-led research group looked at 203 symptoms that may fluctuate or even appear out of the blue after people appear to have recovered.

like dr Ziyad Al-Aly, director of research and development for the VA St. Louis Healthcare System and clinical epidemiologist at Washington University in St. Louis, said: “If you’ve seen a long-Covid patient, I’ve seen a long-Covid patient .”

There is little consensus on the precise definition of Long Covid, also known by the medical term PASC, or post-acute sequelae of Covid-19. While the World Health Organization says long Covid starts three months after the initial attack of illness or positive test result, the Centers for Disease Control and Prevention puts the timeline at just under a month.

Some researchers and healthcare providers use different time frames, complicating efforts to study and quantify the condition, said Dr. Al-Aly, who has conducted many studies on long-term post-Covid issues.

When patients with persistent symptoms go to their doctors, tests like electrocardiograms, chest X-rays, CT scans, and blood tests can’t always detect physiological problems, Dr. Al-Aly. Researchers are working to pinpoint certain biological factors, called biomarkers, that correlate with ongoing Covid symptoms. These can be signs of inflammation or certain molecules produced by the immune system, which can be measured by blood tests, for example.

Doctors must initially rely on their patients’ symptom descriptions and rule out alternative explanations or causes. Some post-Covid clinics have multidisciplinary teams of specialists examining patients to find out the best treatment options.

It’s unclear what exactly is driving Long Covid, but research has begun to offer some clues. Some experts theorize that an immune response that goes into overdrive when you first get sick can lead to inflammation and damage throughout the body that eventually leads to long-lasting Covid symptoms, said Dr. Michael Peluso, an infectious disease physician at the University of California, San Francisco.

“We know that some people have a really heightened immune response and some people have a reduced immune response during acute Covid-19, and that response can dictate the course of how well someone is doing,” he said.

Another explanation, experts say, could be that your immune system never completely shuts down after the initial infection.

Research offers some clues as to which patients are at greater risk of long-term symptoms. In a study of 209 patients published in January, researchers found four factors that could be identified early in a person’s coronavirus infection and that appeared to correlate with an increased risk of having persistent symptoms two to three months later.

One factor was the level of coronavirus RNA in the blood at the onset of infection, an indicator of viral load. Another reason was the presence of autoantibodies — antibodies that mistakenly attack tissues in the body, as occurs in conditions like lupus and rheumatoid arthritis. A third factor was the reactivation of the Epstein-Barr virus, which can cause mononucleosis and often infects most people at a young age and then usually becomes dormant.

The fourth factor was type 2 diabetes, although experts say diabetes may be just one of several conditions that increase the risk of a long covid in studies involving larger numbers of patients.

Studies from post-Covid clinics have also found other pre-existing conditions that can put people at long-term Covid risk. In a report of the first 100 patients treated for neurological and cognitive symptoms at a post-Covid clinic at Chicago’s Northwestern Memorial Hospital, 42 percent said they had previously suffered from depression or anxiety, although such patients may have themselves simply feel more comfortable when they seek neurological treatment, doctors said. Other pre-existing conditions were autoimmune diseases and headaches.

Studies also suggest that the risk of developing long-term Covid peaks in middle age, said Dr. peluso The median age of patients in the Northwestern study was 43. An analysis of 78,252 private health insurance claims in the United States found that people between the ages of 36 and 64 made up about two-thirds of long Covid patients. (But this study did not include most Medicare beneficiaries, so relatively few older patients were affected.)

Women can be disproportionately affected, with some studies showing that about 60 percent of sufferers are female. A similar pattern has emerged in other long-term conditions such as ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), which has multiple symptoms similar to long-Covid.

Because the pandemic has had a significant impact on Black and Hispanic communities in the United States, and because these groups have more limited access to medical care, they may also have high numbers of long-term Covid cases, Dr. peluso

The image still comes into focus, but several studies suggest that taking a Covid vaccine may reduce, but not eliminate, the risk of longer-term symptoms.

The UK Health Security Agency conducted an analysis of eight studies looking at vaccines and long Covid before mid-January. Six found that vaccinated people who then contracted the coronavirus were less likely to develop symptoms of long-Covid than unvaccinated patients. The remaining two studies found that vaccination did not appear to definitively reduce the likelihood of long-term Covid illness.

In that analysis, a non-peer-reviewed study of about 240,000 US patients found that those who had received even one dose of a Covid vaccine before becoming infected were seven to 10 times less likely than unvaccinated patients to report symptoms of a long time Covid 12 to 20 weeks later. But another large study of electronic medical records at the US Veterans Health Administration, which has also not yet been peer-reviewed, found that vaccinated patients were only 13 percent less likely to develop symptoms six months later than unvaccinated patients. Vaccinated patients benefited the most by being less likely to develop lung problems and blood clotting disorders, said Dr. Al-Aly, one of the authors of the study.

“Reliance on vaccination as the sole mitigation strategy is grossly inadequate,” said Dr. Al-Aly. “It’s like fighting with a shield that only partially works.”

If you’re concerned about persistent symptoms after a confirmed or suspected coronavirus infection, don’t be afraid to ask for help. Checking in with your GP is a good first step. More and more doctors are becoming aware of long Covid symptoms and may recommend tests that could at least rule out other causes of your symptoms.

“Although we say long is Covid, if the symptoms last a month or three months after infection, you don’t have to wait that long to get help,” said Dr. Al-Aly. “People should really honor their symptoms.”

If you’re not getting help from a GP, you might want to see a post-Covid clinic, although Dr. Al-Aly admitted that “it’s easier said than done”. Accessing post-Covid clinics can be difficult for those without proper health insurance. And in some states, people may have to travel hundreds of miles to get to the next one. You can look up post-Covid clinics near you in the Survivor Corps database.

Bring your medical records with you when you see a new provider and make a list of all your symptoms, especially if you have cognitive issues and are likely to forget some health concerns when your appointment comes.

Some long-standing Covid problems can be managed with existing medications or treatments for symptoms such as headaches or gastrointestinal issues. Physical therapy and “cognitive rehab,” including approaches commonly used in patients with stroke or brain injury, may also be helpful over time. Some people benefit from tailored physical and mental health rehabilitation services and breathing exercises, which can help them slowly regain strength and endurance for physical activity.

Other potential remedies for long Covid, including antiviral treatments, are just beginning to be explored. The National Institutes of Health is committing more than $1 billion to a major research effort called the Recover Initiative, but progress has been slow so far. Lawmakers are pushing for better funding of long-running Covid research and medical supplies.

Several groups such as Body Politic, Long Covid Alliance and Survivor Corps provide emotional support as well as resources for finding treatment, disability benefits and patient advocacy.

People with long Covid may also want to consider participating in a research study, said Dr. peluso You may find further clinical trials at universities and academic centers near you, or sign up to be part of the Recover initiative.

“Participating in research can be very empowering,” said Dr. peluso

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