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‘Long COVID’ needs to be addressed by multiple specialties
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‘Long COVID’ needs to be addressed by multiple specialties

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Long Haul COVID

Loren Bonner

Man burdened with COVID infection on his back.

More and more cases of “long COVID” are surfacing—but what does it mean, and how can clinicians respond? Patients who present with long COVID—also called long-haul COVID or postacute COVID-19—typically report symptoms of severe fatigue, headache, or brain fog 4 weeks or longer after the acute phase of SARS-CoV-2 infection. Some patients also experience respiratory issues, sleep difficulties, depression, and anxiety.

“There is still a lot we do not understand, and empathy toward patients experiencing long COVID is fundamental,” said Alfonso Hernandez-Romieu MD, MPH, LCDR, from the U.S. Public Health Service, during a January 28, 2021, CDC webinar on treating long COVID.

Long COVID can be hard to define because it can overlap with other COVID-19 illness, Hernandez said. For example, patients hospitalized with severe COVID-19 may develop a range of long-term consequences, especially if they’ve been in the ICU.

However, many patients who have experienced long COVID had mild COVID-19 illness and were never hospitalized, according to several reports.

Allison Navis, MD, a neurologist at Mt. Sinai hospital in New York City, said she was surprised to learn how many COVID-19 patients have been referred to neurology since the pandemic hit. “The majority of [those] patients had not been hospitalized,” she said.

Although Navis and her team have been seeing a broad range of neurological symptoms in patients, brain fog is one of the most common.

“There is no clear correlation with COVID-19 severity, age, or comorbidities,” said Navis, who presented her clinical experience during the CDC webinar.

Jennifer Possick, MD, a pulmonologist at Yale New Haven Hospital, said that most long COVID data has focused on patients who needed to be hospitalized because of COVID-19.

“But the limited number of studies with [patients] with more mild illness indicate their [long COVID symptoms] are indistinguishable from those with more severe COVID-19,” she said during the CDC webinar. “This has been our anecdotal experience as well.”

Long COVID research

In one of the most comprehensive studies to date on long COVID, researchers evaluated 1,733 patients who were first diagnosed with COVID-19 in Wuhan, China, between January and May 2020. Seventy-six percent of these patients had at least one symptom 6 months after symptom onset, according to the research, which was published this January in the Lancet.

The study revealed that the most common symptoms to persist were fatigue and muscle weakness (63%), followed by sleep difficulties (26%), and anxiety and depression (23%).Patients who were hospitalized with severe COVID-19 illness showed more impaired lung function and abnormalities in chest imaging 6 months after symptom onset.

According to an April 2021 study in JAMA conducted by researchers in Sweden, 1 in 10 health care workers still had at least one moderate to severe symptom that negatively affected their life 8 months after having mild COVID-19 illness.

The first phase of the study took place in the spring of 2020 with roughly 2,000 employees at Danderyd Hospital in Sweden. In January 2021, the research team took a closer look at the participants who had reported long-term symptoms after mild COVID-19 at least 8 months earlier. This group consisted of 323 health care workers who were compared with roughly 1,072 health care workers who did not have COVID-19 during the study period.

The most common reported long-term symptoms among participants who had mild COVID-19 were loss of smell and taste, fatigue, and respiratory issues.

Clinician experience

Possick, from Yale New Haven Hospital, said that most long COVID patients have multiple symptoms simultaneously after COVID-19. She added that in her experience, the dominant symptoms may shift over time as patients are followed longitudinally.

Treatment options for these symptoms are still in the exploratory phase, however. Navis from Mt. Sinai said her team addresses any abnormalities in the patient’s blood work, but they also treat other contributing factors such as sleep issues or mood disorders patients are experiencing.

“It’s important to address mental health, but also [not] attribute everything to it,” she said. “We do know depression, anxiety, and PTSD can affect cognition.”

Possick said that going forward, acknowledging and treating long COVID “will undoubtedly need to be addressed by multiple, different specialties.”



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