Managing the long-term symptoms of COVID patients

They’re called “Long-COVID” or “long-haulers”—people who have ostensibly recovered from COVID-19 yet continue to experience health problems for months afterward.

Peter Brookmeyer, M.D.

“We are still trying to understand what it is,” says infectious disease specialist and HealthTrust Physician Advisor Peter Brookmeyer, M.D., of Colorado Springs, Colorado. “We know that people with viral illnesses often have symptoms that go on for months,” such as those who experience long-term fatigue after having mononucleosis. “What we don’t know is if this is the same phenomenon we’re seeing with COVID or if it is it something unique to COVID.”

The long-hauler phenomenon

What is clear is that something is definitely going on.

A survey of 3,762 people with suspected and confirmed COVID-19 from 56 countries (just 8.4% of whom were hospitalized) found that after six months, 77.7% still reported fatigue; 72.2% had worsening of symptoms after exertion; and 55.4% experienced cognitive dysfunction.

Other symptoms included shortness of breath and trouble sleeping. Most participants had not returned to work and most still reported disability at seven months. The three most debilitating symptoms were fatigue, breathing issues and cognitive dysfunction.

The phenomenon is so new that expert opinions vary as to its scope. The authors of the aforementioned survey define “long-COVID” as “a collection of symptoms that develop during or following a confirmed or suspected case of COVID-19, and which continue for more than 28 days.” British health officials, however, define it as symptoms lasting more than 12 weeks, while the Infectious Disease Society of America still has not provided a definition or even an agreed-upon name.

Diagnosis & treatment

Although he’s only seen a few of these patients so far, Dr. Brookmeyer warns, “There are going to be a lot of them.” But he cautions clinicians, “Don’t go in with an anchored bias that it’s post-COVID, or you’re going to miss something.” For instance, he’s had patients who assumed their symptoms were still COVID-related and didn’t seek help. Yet, they actually had unrelated and serious bacterial infections requiring hospitalization. “You need to do a careful history and physical to make sure the symptoms aren’t explained by an alternative diagnosis,” he says.

Dr. Brookmeyer explains that studies find people who were hospitalized with COVID have a higher chance of experiencing long-term symptoms.

According to the Journal of the American Medical Association, an Italian study of 143 COVID-positive patients found 83% of hospitalized patients had at least one symptom three months after discharge.

Once it’s clear the symptoms are related to the initial infection, Dr. Brookmeyer says, there’s not much a clinician can do beyond providing symptom management. For example, he recommends managing fatigue with good sleep hygiene and exercise. Symptoms like cough should be addressed with a thorough pulmonary work-up. An otolaryngologist should evaluate chronic anosmia, and mental health providers should address the anxiety, depression and post-traumatic stress syndrome that may exist, particularly among people who were hospitalized.

“It’s a tough disease,” he says. “We’re going to learn more in the next couple of months, and there’s probably not an easy answer. This is going to take time and work to recover from.”


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