Out Of The Fire, Into The Frying Pan: Long Covid

by Dr. Dennis Bautista

For the last three years, COVID-19 has continued to spread among our community, resulting in more than 330,000 cases and 1,641 deaths in the State of Hawaii. According to the Hawaii Department of Health (DOH), there are still an average of about 200+ new cases daily, but the actual number could be much greater because a lot of cases are not reported to the DOH.

The combined efforts of the global community has resulted in new policies, infrastructure, and therapeutics that have reduced the severity and deaths from COVID infection.

But a new, and mysterious health problem has emerged: Long COVID. It has also been referred to by several other names, including “post-COVID conditions,” “chronic COVID-19”, and “postacute sequelae of SARS-CoV-2 infection (PASC).”

What is Long COVID?
So far there has been no widely accepted definition, but Centers for Disease Control and Prevention, as well as the World Health Organization, describe Long COVID as:

“Broad range of symptoms (physical and mental) and symptom clusters that develop during or after COVID-19, continue for more than two months, have an impact on the patient’s life, and are not explained by an alternative diagnosis.”

What are the symptoms of Long COVID?
As mentioned above, Long COVID patients can suffer from a variety of physical and mental issues.

The most common persistent physical symptoms include: Fatigue, Shortness of breath, Chest pain, and Cough.

Less common symptoms include lack of smell, joint pains, nasal congestion, taste abnormalities, poor appetite, dizziness, muscle pain, insomnia, hoarseness, hair loss, and diarrhea. Psychological or cognitive symptoms include new or worsened problems with memory, concentration, anxiety, depression, and post-traumatic symptoms.

These symptoms often lead to a patient’s disability, keeping them from going back to work, or even doing their activities of daily living.

How long do these symptoms last?
The length of time patients continue to suffer from these symptoms greatly vary, from just a couple of weeks to several months. That being said, there seems to be a tendency for patients who are unvaccinated, older, had more severe disease, and had multiple co-morbidities to have a more prolonged course.

What can we do for patients who have Long COVID?
Most patients who have mild illness are expected to have resolution of symptoms over a few weeks, even without intervention. Most patients get better.
For those who continue to have symptoms, a primary care doctor can help do further investigation, and make sure that they are not dealing with an alternative condition. A primary care doctor can also help alleviate the patient’s symptoms by optimizing a patient’s medical therapy.

At times, there may be a need for the patient to go to a specialized center. Here in Hawaii, the Queen’s Medical Center has a “Post COVID Recovery and Care Clinic,” which requires a referral from a PCP.

What can be done to prevent Long COVID?
At this time, the most effective prevention is not getting a COVID infection in the first place. This means continuing to take precautions like social distancing and masking when appropriate.

There is also no over-stressing the importance of COVID vaccinations. There will be a new version of the vaccines (“bivalent booster”) that has been approved by the FDA, and these are aimed at the more current COVID variants.

These vaccines have been proven to help prevent COVID infection and hospitalizations. Remember, patients who were hospitalized for COVID were more likely to get long COVID.

The work continues
Researchers and clinicians continue to study COVID and its long-term effects on patients. In time, there would hopefully be more information on the exact mechanisms behind this condition which may in turn lead to finding more effective treatment.

While waiting for all these, we hope the members of the community continue to protect themselves and each other, and to continue to work with their doctors and the local health authorities.

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