Health Matters…Long COVID – What we have learned

“There is no ill wind that doesn’t blow some good.” This old adage describes what we have learned over the past year about COVID-19 and its post-infection cousin, long COVID.

            First, the bad news – of which we should take notice very carefully. In the last 28 days in April, over 1,000,000 cases of COVID-19 were newly diagnosed in the United States. In this same 28-day period, over 13,000 people died from their COVID-19 infections. While not as bad as two years ago in the last weeks of January, 2021 when 5 million cases were being reported each week and over 16 thousand people were dying – every week, COVID-19 has not gone away.

             A new “normal” has emerged. COVID-19 is probably here to stay. In fact, COVID-19 isn’t all that new. The full name of this disease is Severe Acute Respiratory Syndrome Coronavirus-2 first discovered and described in 2019 – thus, the name SARS-CoV-2 or COVID-19. It is named SARS-CoV-2 because there is a SARS-CoV-1 which caused the Severe Acute Respiratory Syndrome (SARS) outbreak around the world in 2002-2004. So why didn’t someone tell us that the second iteration of this virus was coming?

            Actually, they did. In 2016, the World Health Organization (WHO) researchers noted that SARS-CoV and several other viruses were highly suspected of creating an epidemic in the near future, spurring virologists around the world to increase their vigilance for, seek treatments for, and try to build vaccines against these viruses. Which is why the vaccine response to COVID-19 happened so quickly, averting a much larger disaster in the US and around the world. Had the vaccines not been quickly activated and produced, the pandemic could have killed 5-10 times as many people in the US alone instead of the 1 million people who died in the two-year period 2020-2021.

            But now we are faced with a new entity – long COVID.  Or is it new?

            Long COVID began to be recognized as a possible follow-up to the acute COVID-19 infection when a number of people didn’t recover as quickly from their infections as the majority of cases. They continued to have symptoms 3-6 months later, or developed renewed symptoms after seemingly shaking off the acute infection. Researchers at the National Health Service of the UK noted these trends as early as the mid-months of 2020. But front-line clinicians tended to ignore these early reports as people who had not quite recovered like others.

            As the pandemic dragged on, more and more people – 30% of younger patients and over 50% of older patients – who had been hospitalized and severely ill were developing these symptoms – persistent fatigue, cough, muscle weakness, low-grade fever, brain fog, and headaches. These symptoms either persisted for longer than 2-3 months after the initial infection OR appeared a few weeks to 1-2 months after the initial infection was over. The statistics said that this “new” disease entity occurred more often in those who were more severely ill, in those who were not vaccinated, or in those who had other debilitating illnesses – heart or lung disease (It is a SARS virus), other severe illnesses (diabetes, kidney, liver, GI dysfunction), older and/or obese populations (weaker immune systems), depression/anxiety/PTSD mental dysfunction.

            Now comes the good news – actually, in three parts. First, the medical community and more slowly, those who finance medical care finally recognized long COVID as a real entity. Second, medical healthcare systems around the country set up over 200 clinics to specifically address this entity and began being paid for the care required. While there is no specific treatment for this problem, the clinics have established effective, supportive treatment plans for the various kinds of long COVID conditions.

            The third piece of good news is the recognition by the medical community that this condition looks like/acts like other post-infectious syndromes – post-polio syndrome, post-ebola syndrome, post-treatment Lyme disease (a bacterium, not a virus) – and looks like chronic fatigue syndrome and/or fibromyalgia. Because so many of these diseases are relatively rare or occur without a good connection to a specific cause, good long-term studies have not been able to specifically identify a cause, a prevention, or a treatment. Now, with the pandemic of COVID-19 and the subsequent long COVID (30-50%), literally hundreds of thousands of people around the world have developed a post-infection response, the studying of which might lead to a better understanding of the post-infectious condition and might identify the cause of the mysterious chronic fatigue syndrome and fibromyalgia.

            In the meantime, how do we avoid being part of the long COVID clinic line-ups getting longer with each passing day? Good hygiene (wash your hands and face), properly wear an effective mask (N95 or NK95) when in risky situations, and get vaccinated as current guidelines recommend (which change as COVID continues to evolve). Like the other post-infection syndromes (polio, ebola, and others) which have no treatment or cure, long COVID is to be avoided, if at all possible, by avoiding COVID-19. Be wary of nay-sayers who downplay ignoring recommended precautions. Be smart; potential prevention is worth the inconvenience.

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