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Long COVID and its treatment

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Among the more distinctive — and troubling — features of COVID-19 is the persistence of symptoms after individuals have recovered from the initial novel coronavirus infection. Formally called post-acute sequelae of SARS CoV-2, the condition has become more commonly known as “long COVID” or “long-haul COVID”; patients suffering from it are often called “long-haulers.” 

The Centers for Disease and Prevention uses the term “post-COVID conditions,” which refers to a variety of “new, returning, or ongoing health problems” (including some such as multisystem inflammatory syndrome in children not discussed in this article) that last four or more weeks after the onset of COVID-19.

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Regardless of which name is used, individuals with long COVID can experience a wide variety of symptoms. At least 20 have been identified. Some of the most common reported are shortness of breath, chest pain, elevated heart rate (palpitations), fatigue and continued loss of smell and “brain fog” (i.e., confusion and problems with concentration and memory). 

Others range from headaches and earaches (including hearing loss) to rashes and hair loss. In addition to lung damage, other organs (e.g., the heart and kidneys) can be affected by COVID-19 and long COVID.

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It is not yet known what causes long COVID, but current theories include residual damage to organs by the body’s immune system, persistence of some of the virus in the body and an exaggerated response by the body’s immune system to the virus. Diagnosing long COVID relies largely on a patient’s experience with COVID-19 (i.e., what symptoms they experienced while sick), physical and psychological tests that can identify known long COVID symptoms and, if necessary, diagnostic tests (e.g., x-rays and electrocardiograms).

Awareness that patients seemed to have persistent symptoms after they were thought to be over the initial infection came not long after the first COVID-19 cases were reported in late 2019. However, because of the newness of long COVID, there is no prognosis yet on the duration or severity of symptoms. Some long-haulers recover within weeks, while for others their conditions last for months. As we now enter the third year of the pandemic, researchers and health care workers will be able to gather more information on long COVID and its persistence.

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Jenny Queen, a physician’s assistant at Valley View Hospital’s Lung Center, told The Sopris Sun that those who were severely ill with COVID — in the hospital and often on ventilators — require “many weeks to recover, and they often have permanent lung damage.” 

However, she and the other Lung Center members, pulmonologist Dr. Suresh M. Khilhnani and physician’s assistants Eleanor Haring and Jaime Ball, were seeing that those with mild to moderate COVID cases (generally not needing much, if any, hospitalization) were also experiencing persistent symptoms. “This was in late winter, after the big spike in cases.”

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Early this year, Queen and her colleagues set up a long COVID clinic in the Lung Center, which Queen said was to be “interdisciplinary with primary-care physicians and specialists to try and coordinate treatment” for long COVID patients. 

She continued, “We thought it would be helpful for patients to have a safe place for care to treat what we can treat,” though conceding, “There are not a lot of treatment options.”

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The center runs the clinic once a month, but, Queen noted, “If a patient contacts the office, we will try to get them in to see us.” As for treatment, “We try to use steroids to decrease symptoms, but once the lungs are damaged, there’s not much we can do.” 

The clinic also offers a pulmonary rehabilitation program at the Lung Center involving physical exercises (e.g., strength and stamina training) and breathing techniques (such as yoga breathing).

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Queen cautioned that, “Recovery is very, very slow … there is no pill.” But, she added, “Time is a good healer, and the majority of patients typically feel better after about six months.” Not surprisingly, she noted that “We’re a little overwhelmed right now. We had a very busy 2021,” anticipating that 2022 would be as well. She went on to say, “We are lucky to have this level of expertise in this valley,” noting that Dr. Khilhnani is the only pulmonologist in the region. And, indeed, we are, from primary care for COVID patients at Valley View to post-illness rehabilitative programs, such as what the Lung Center offers. 

However, she reiterated — as do the great majority of healthcare workers — “I want to say that the best way to prevent COVID is to get vaccinated.”

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In July 2021, the U.S. Department of Health and Human Services designated long COVID as a disability under the Americans with Disabilities Act. 

Additional information can be found at www.bit.ly/CDCpost-COVID and www.bit.ly/LongCOVIDADA

Tags: #COVID-19 #Ken Pletcher #long covid #Valley View Hospital
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