Long-term Covid symptoms and treatment: what we know so far

Among the many confounding aspects of the coronavirus is the spectrum 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 10-30% of people report persistent or new medical problems months after their first coronavirus infections – a constellation of symptoms known as long Covid. People who suffer from mild to moderate illness, as well as those who have no underlying medical conditions, can still experience debilitating long-term symptoms, including fatigue, shortness of breath, erratic heartbeat, headaches, dizziness, depression, and memory and memory problems. concentration.

These persistent medical problems are so varied that a study by a patient-led research group assessed 203 symptoms that can fluctuate or even appear out of the blue after people seem to recover.

As Dr. Ziyad Al-Aly, head of research and development at the VA St. Louis Healthcare System and clinical epidemiologist at Washington University in St. Louis, said, “If you saw a patient with a long Covid, you’ve seen a patient with long Covid.

There is little consensus on the exact definition of long Covid, also known by the medical term PASC, or post-acute sequelae of Covid-19. While the World Health Organization says the long Covid begins three months after the first episode of illness or a positive test result, the Centers for Disease Control and Prevention pegs the timeline at just over a month.

Some researchers and healthcare providers use other timeframes, making efforts to study and quantify the condition more difficult, said Dr. Al-Aly, who has conducted numerous studies of long-term post-Covid issues.

When patients with persistent symptoms see their doctor, tests such as electrocardiograms, chest X-rays, CT scans and blood tests don’t always identify physiological issues, Dr. Al-Aly said. Researchers are working to identify certain biological factors, called biomarkers, that correlate with persistent Covid symptoms. These could include signs of inflammation or certain molecules produced by the immune system that could be measured by blood tests, for example.

For now, doctors must rely on their patients’ descriptions of symptoms and rule out other explanations or causes. Some post-Covid clinics have multidisciplinary teams of specialists who assess patients to determine the best treatment options.

It’s unclear exactly what has been driving Covid for so long, but research has begun to offer some clues. Some experts speculate that an immune response that ramps up when you first get sick can lead to inflammation and damage throughout the body, possibly leading to long-lasting Covid symptoms, Dr Michael Peluso said, infectious disease physician at the University of California, San Francois.

“We know that during the acute phase of Covid-19 some people have a really accelerated immune response and some people have a reduced immune response, and that response can determine the trajectory of a person’s performance,” he said. he declares.

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

The research offers some clues about which patients might face a higher 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 appeared to be correlated with an increased risk of having symptoms that persisted for two to three months. later.

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

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

Studies in post-Covid clinics have also found other pre-existing medical conditions that can put people at long risk of Covid. In a report of the first 100 patients treated for neurological and cognitive symptoms at a post-Covid clinic at Northwestern Memorial Hospital in Chicago, 42% said they had ever suffered from depression or anxiety, although these patients may simply be more comfortable seeking neurological treatment, doctors said. . Other pre-existing conditions included autoimmune diseases and headaches.

Studies also suggest that the risk of developing long Covid peaks in middle age, Dr Peluso said. The average age of patients in the Northwestern study was 43 years. An analysis of 78,252 private health insurance claims across the United States found that people between the ages of 36 and 64 accounted for around two-thirds of long Covid patients. (But this study did not include most Medicare beneficiaries, so it involved relatively few elderly patients.)

Women may be disproportionately affected, with some studies showing around 60% of patients are female. A similar pattern has emerged in other long-term conditions like ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome), which has several symptoms similar to long Covid.

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

The picture is still in focus, but several studies suggest that getting a Covid vaccine can reduce – but not eliminate – the risk of longer-term symptoms.

The UK’s Health Security Agency conducted an analysis of eight studies that had looked at vaccines and long Covid before mid-January. Six found that vaccinated people who were later infected with the coronavirus were less likely than unvaccinated patients to develop symptoms of long Covid. The remaining two studies found that vaccination did not appear to conclusively reduce the risks of developing long Covid.

In this analysis, a non-peer-reviewed study of around 240,000 US patients found that those who received even one dose of a Covid vaccine before their infections were seven. 10 times less likely than unvaccinated patients to report symptoms of long Covid 12 to 20 weeks later. But another large study of electronic patient records from the U.S. Veterans Health Administration, which has yet to be peer-reviewed, found that vaccinated people were only 13% less likely than unvaccinated patients. vaccinated to show symptoms six months later. Vaccinated patients mainly benefited from the fact that they were less likely to develop lung problems and blood clotting difficulties, said Dr Al-Aly, one of the study’s authors.

“Relying on vaccination as the only mitigation strategy is totally inadequate,” said Dr Al-Aly. “It’s like going into battle with a shield that only works partially.”

If you’re concerned about 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 and more doctors are becoming aware of the long symptoms of Covid and may recommend tests that could at least rule out other causes of your symptoms.

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

If you’re not getting help from a primary care doctor, you may want to seek out a post-Covid clinic, although Dr Al-Aly acknowledged that “that’s easier said than done. “. Accessing post-Covid clinics can be difficult for those without adequate 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 on the Survivor Corps database.

Bring your medical records if you are visiting a new provider and make a list of all your symptoms, especially if you are having cognitive issues and are likely to overlook certain health issues when your appointment arrives.

Some long Covid issues can be managed with existing medications or treatments for symptoms such as headaches or gastrointestinal issues. Physical therapy and “cognitive rehabilitation,” including approaches often used for patients who have suffered strokes or brain injuries, may also be helpful over time. Some people benefit from physical and mental rehabilitation services and adapted breathing exercises, which can help them slowly regain their strength and endurance for physical activities.

Other possible tools against the long Covid, including antiviral treatments, are only beginning to be studied. The National Institutes of Health is spending more than $1 billion on a major research effort called the Recover Initiative, but progress has been slow so far. Lawmakers are pushing for better funding for Covid research and long-term medical care.

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

People who have had Covid for a long time can also consider joining a research trial, Dr Peluso said. You may be able to find ongoing clinical studies at universities and academic centers near you, or register to be part of the Recover initiative.

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

About Antoine L. Cassell

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