Among the many confusing aspects of the coronavirus is the range of possible symptoms, as well as their severity and duration. Some people develop a 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 coronavirus infections – a constellation of symptoms known as long-term covid. People who experience mild or moderate illness, as well as those without any underlying medical conditions, may still experience some debilitating long-term symptoms, including fatigue, shortness of breath, irregular heartbeat, headache, dizziness, depression, and memory and concentration problems.
Such long-term medical problems are so diverse that a study by a patient-led study evaluated 203 symptoms that may vary or even appear suddenly after people seem to have recovered.
As Dr. Ziad Al-Ali, head of research and development at the VA St. Louis Health System and clinical epidemiologist at the University of Washington in St. Louis, said, “If you’ve seen a patient with prolonged Covid, you’ve seen a patient with prolonged Covid.
How Doctors Are Currently Diagnosing Long Covid
There is little consensus on the exact definition of long Covid, also known by the medical term PASC, or the post-acute effects of Covid-19. While the World Health Organization says the long-term Covid begins three months after the initial onset of illness or a positive test result, the Centers for Disease Control and Prevention set the timeline in just one month.
Some researchers and health care providers are using other time frames, making research and quantifying the situation more difficult, said Dr. Al-Ali, who has conducted many studies on long-term problems after Covid.
When patients who experience persistent symptoms go to their doctors, tests such as electrocardiograms, chest x-rays, computed tomography and blood tests do not always identify physiological problems, Dr. Al-Ali said. Researchers are working to identify certain biological factors, called biomarkers, that correlate with persistent Covid symptoms. These may include signs of inflammation or certain molecules produced by the immune system that can be measured, for example, by blood tests.
For now, physicians should rely on describing their patients’ symptoms and rule out alternative explanations or causes. Some post-Covid clinics have multidisciplinary teams of specialists who evaluate patients to find the best treatment options.
What Causes Long Covid?
It’s not clear what exactly the long Covid is doing, but research has begun to suggest some clues. Some experts theorize that the immune response, which is amplified when you first become ill, can lead to inflammation and damage throughout the body, which eventually leads to long-term symptoms of Covid, said Dr. Michael Peluso, a physician. Infectious Diseases at the University of California, San Francisco.
“We know that during acute Covid-19, some people have a really strong immune response, and some people have a reduced immune response, and that response can determine the trajectory of how well someone is doing,” he said.
Another explanation, experts say, may be that your immune system is never completely shut down after the initial infection.
Who is at risk?
Research suggests some clues as to which patients may be at greater risk for long-term symptoms. In a study of 209 patients published in January, researchers found four factors that can be identified at the onset of human coronavirus infection that appear to correlate with an increased risk of continued symptoms two to three months later.
One factor was the level of coronaviral RNA in the blood at the beginning of the infection, an indicator of viral load. Another is the presence of autoantibodies – antibodies that mistakenly attack the tissues in the body, as they do in conditions such as lupus and rheumatoid arthritis. A third factor is the reactivation of the Epstein-Barr virus, which can cause mononucleosis and infect most people, often when they are young, and then usually becomes latent.
The fourth factor is 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 long-term Covid.
Updated
May 20, 2022, 8:45 p.m. ET
Studies from post-Covid clinics have also found other pre-existing medical conditions that could put people at risk for long-term Covid. In a report on the first 100 patients treated for neurological and cognitive symptoms at a post-Covid clinic at Northwestern Memorial Hospital in Chicago, 42 percent said they had previously had depression or anxiety, although such patients may simply be more comfortable looking. neurological treatment, doctors said. Other pre-existing conditions include autoimmune diseases and headaches.
Studies also show that the risk of developing long-term Covid peaks in middle age, said Dr. Peluso. The average age of patients in the Northwestern study is 43. An analysis of 78,252 private health insurance claims in the United States found that people between the ages of 36 and 64 make up about two-thirds of long-term Covid patients. (But this study does not include most Medicare recipients, so it does include relatively few older patients.)
Women may be disproportionately affected, with some studies finding that about 60 percent of patients are women. A similar pattern has emerged in other long-term conditions such as ME / CFS (myalgic encephalomyelitis / chronic fatigue syndrome), which has several symptoms similar to those of prolonged Covid.
Because the pandemic has had a significant impact on blacks and Latin American communities in the United States, and these groups have more limited access to health care, they may also have a large number of long-term cases of Covid, Dr. Peluso said.
Can vaccines protect against long-term Covid?
The picture is still in focus, but several studies have shown that getting a vaccine against Covid can 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 the long Covid before mid-January. Six found that vaccinated people who subsequently became infected with the coronavirus were less likely than unvaccinated patients to develop symptoms of prolonged Covid. The other two studies found that vaccination did not appear to permanently reduce the chances of developing long-term Covid.
In this analysis, a non-peer-reviewed study of approximately 240,000 patients in the United States found that those who received even one dose of Covid vaccine before their infections were seven to 10 times less likely than unvaccinated patients to reported symptoms of long Covid 12 to 20 weeks later. But another large study of electronic patient records in the U.S. Veterans Health Administration, also untested by partners, found that those who were vaccinated had only a 13 percent lower risk of not vaccinating patients having symptoms for six months. later. Vaccinated patients have benefited most from the fact that they are less likely to develop lung problems and blood clotting problems, said Dr. Al-Ali, one of the study’s authors.
“Relying on vaccination as the only mitigation strategy is completely inadequate,” said Dr Al-Ali. “It’s like fighting a shield that only partially works.”
Seek medical help
If you are concerned about any prolonged symptoms after a confirmed or suspected coronavirus infection, do not be afraid to ask for help. Checking with your primary care provider is a good first step. More and more doctors are realizing the long symptoms of Covid and may recommend tests that can at least rule out other causes of your symptoms.
“Although we say Covid is long when symptoms persist for a month or three months after infection, you don’t have to wait that long to get help,” said Dr. Al-Ali. “People really need to respect their symptoms.”
If you are not receiving help from a primary care physician, you may want to seek a clinic after Covid, although Dr. Al-Ali acknowledged that “this is easier said than done.” Access to clinics after Covid can be difficult for those without adequate health insurance. And in some states, people may have to travel hundreds of miles to get to the nearest one. You can search for clinics after Covid 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 problems when you meet.
Some long-term Covid problems can be managed with existing medications or treatments for symptoms such as headaches or gastrointestinal problems. Physical therapy and “cognitive rehabilitation”, including approaches often used for patients who have experienced a stroke or brain injury, may also be helpful over time. Some people take advantage of personalized physical and mental health rehabilitation and breathing exercises that can help them slowly build strength and endurance for physical activity.
Other possible remedies against long-term Covid, including antiviral treatments, are just beginning to be studied. The National Institutes of Health is allocating more than $ 1 billion to a major research effort called the Recovery Initiative, but progress has been slow so far. Lawmakers are pushing for better funding for Covid’s long-term research and care.
Several groups, such as Body Politic, Long Covid Alliance, and Survivor Corps, provide emotional support as well as resources for seeking treatment, disability benefits, and patient advocacy.
People with long-term Covid may also want to consider joining a research experience, Dr. Peluso said. You may be able to find ongoing clinical trials at universities and academic centers near you, or register to become part of the Recovery Initiative.
“Participating in research can be very empowering,” said Dr. Peluso.
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