Long symptoms and Covid treatment: what we know so far

Among the many confounding aspects of the coronavirus is the specter of the possible symptoms, as well as their severity and duration. Some people develop mild illness and recover quickly, with no lasting effects. But the studies estimate it 10 to 30 percent of people report persistent or new medical problems months after their initial coronavirus infections, a constellation of symptoms known as long Covid. People suffering from mild or moderate illnesses, as well as those without any underlying medical conditions, however, you may experience some long-term debilitating symptomsincluding fatigue, shortness of breath, irregular heartbeat, headache, dizziness, depression, and problems with memory and concentration.

Such persistent medical problems are so varied that one study was evaluated by a patient-led research team 203 symptoms which can fluctuate or even appear out of the blue after people seem to have recovered.

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

There is little consensus on the exact definition of long Covid, also known by the medical term PASC, or post-acute after-effects of Covid-19. While the World Health Organization says Covid starts long three months After the onset of the disease or the positive test result, the Centers for Disease Control and Prevention fixes the timeline immediately after a month.

Some researchers and healthcare professionals use other times, making efforts to study and quantify the condition more difficult, said Dr. Al-Aly, who led many Education on long-term post-Covid issues.

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

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

It’s unclear what exactly drives the 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, resulting in long-lasting Covid symptoms, said Dr. Michael Peluso, an infectious disease physician at the University of California, San Francisco.

“We know that during acute Covid-19, some people have a really stimulated immune response and some people have a reduced immune response, and that response can determine the trajectory of how well someone does,” he said.

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

The research offers some hints on which patients might face a higher risk of long-term symptoms. in a Study on 209 patients published in JanuaryThe researchers found four factors that could be identified early in a person’s coronavirus infection that appeared to be related to an increased risk of having ongoing symptoms two to three months later.

One factor was the coronavirus RNA level in the blood at the onset of infection, an indicator of viral load. Another was the presence of autoantibodies, antibodies that mistakenly attack the body’s tissues as they do in conditions like lupus and rheumatoid arthritis. A third factor has been the reactivation of the Epstein-Barr virus, which can cause mononucleosis and infect most people, often when they are young, and then usually goes dormant.

The fourth factor was having type 2 diabetes, although experts say that in studies involving more patients, diabetes may be just one of several medical conditions that increase the risk of Covid for a long time.

Studies from post-Covid clinics have also found other pre-existing medical conditions that could put people at risk for Covid for a long time. In a report on the first 100 patients treated for neurological and cognitive symptoms in a post-Covid clinic at Northwestern Memorial Hospital in Chicago, 42% reported previously having depression or anxiety, although such 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 spikes in middle age, said Dr. Peluso said. The mean age of the patients in the Northwestern study was 43. An analysis of 78,252 private health insurance claims In the United States, it was found that people between the ages of 36 and 64 made up about two-thirds of long-term Covid patients. (But that study didn’t include the majority of Medicare beneficiaries, so it involved relatively few older patients.)

Women can be disproportionately affected, with some studies finding that around 60% of patients are women. A similar pattern has emerged in other long-term conditions such as ME / CFS (myalgic encephalomyelitis / chronic fatigue syndrome), which exhibits several symptoms similar to those of long Covid.

Why the pandemic has had a significant impact on Black and Latino communities in the United Statesand those groups have more limited access to medical care, they may even have a high number of long-term Covid cases, Dr. Peluso said.

The image is still in focus, but different the studies suggest that getting a Covid vaccine can reduce, but not eliminate, the risk of long-term symptoms.

The UK Health Safety Agency has conducted a analyses of eight studies that looked at vaccines and the long Covid before mid-January. Six found that vaccinated people who were then infected with the coronavirus were less likely than unvaccinated patients to develop Covid symptoms for a long time. The remaining two studies found that vaccination did not seem to permanently reduce the chances of developing a long Covid.

In that analysis, one study, which has not been peer-reviewed, found out of approximately 240,000 U.S. patients that those who had received even a single dose of a Covid vaccine prior to their infections were seven to 10 times less likely than unvaccinated patients to report symptoms. Covid 12 to 20 long weeks later. But another one large studio of electronic patient records at the US Veterans Health Administration, also not yet peer-reviewed, found that those who had been vaccinated only had a 13% lower risk than unvaccinated patients of having symptoms six months later. . Vaccinated patients mainly benefited from a lower likelihood of developing lung problems and blood clotting difficulties, said Dr. Al-Aly, one of the authors of the study.

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

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 and more doctors are becoming aware of Covid’s long symptoms and may recommend tests that could at least rule out other causes of your symptoms.

“Even if 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,” said Dr. Al-Aly said. “People should really honor their symptoms.”

If you’re not getting help from a primary care physician, you may want to seek out a post-Covid clinic, although Dr. Al-Aly acknowledged that “that’s easier said than done.” Access to 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 look up post-Covid clinics near you in 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 experiencing cognitive problems and are likely to forget some health issues when your appointment comes.

Some long-lasting Covid problems can be managed with existing medications or treatments for symptoms such as headaches or gastrointestinal problems. physical therapy ecognitive rehabilitation”, Including approaches often used for patients who have suffered strokes or brain injuries, may also be helpful over time. Some people benefit from tailor-made physical and mental rehabilitation services and breathing exercises, which can help them slowly regain strength and stamina for physical activities.

Other possible tools against long Covid, including antiviral treatments, are just beginning to be studied. The National Institutes of Health is dedicating more than $ 1 billion to a major research effort called tea Recovery initiative, but progress so far has been slow. Lawmakers are pushing for better funding for a long time research on Covid and medical treatment.

Different groups, like Body politics, LongCovid alliance Other Body of survivorsprovide emotional support, as well as resources for seeking care, disability benefits, and patient support.

People with a long Covid may also want to consider joining a research study, Dr. Peluso said. You may be able to find continuing 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 said.