Since March of 2020 Covid-19 has affected over 16 million people in the US and over 70 million globally. What many people may not know is that some individuals who have had Covid-19 and have recovered are still experiencing symptoms of the disease weeks and months after their initial infection. These individuals are being called the “long haulers” or patients having post-Covid-19 Syndrome or Long Covid-19. According to the CDC and the Mayo Clinic, some patients have symptoms such as, fatigue, difficulty concentrating and thinking often referred to as “ brain fog”, shortness of breath, chest pain, and joint pain that lasts for weeks and maybe months.
When do the “long-hauler” symptoms start and who is affected?
The long-lasting symptoms of Covid-19 can affect almost any patient who has been sick. It is often thought that this can only happen to the severely ill elderly patient who required ICU care. According to a CDC summary article, which was published in the Morbidity and Mortality Weekly Review looking at data from March through June of 2020, younger outpatients who had a milder illness also reported experiencing long-lasting Covid-19 symptoms, such as confusion, dizziness, and cognitive impairment. The data showed that 35% of patients over 18 who were contacted regarding their symptoms reported not feeling “their normal selves” weeks after their illness.
The psychiatric and neurological symptoms, which include dizziness, headache, and numbness in the limbs have been reported to start when patients were still hospitalized. According to Dr. Robert Stevens, a neurologist at Johns Hopkins University, 40%-50% of Covid-19 patients who are hospitalized begin to have neurological and psychiatric symptoms. What is even more concerning is that 1 in 3 patients will have symptoms, such as dizziness, headache, and loss of taste and smell long after they leave the facility.
In addition to the lungs, the brain, and the nervous system, Covid-19 has also affected other organs in the body, such as the heart and kidneys. Some patients may have long-lasting cardiac symptoms such as chest pain and heart palpitations. Dr. Samer Kottiech, a cardiologist in New York City estimates that 90% of his patients who come in after the Covid-19 infection experience prolonged symptoms. The renal effects of Covid-19 have included renal failure requiring hemodialysis.
One of the most insidious long-term effects of Covid-19 and the most misunderstood is the overwhelming fatigue that patients may experience long after their initial illness. Many people have reported crippling exhaustion where they cannot work or carry on normal activities of daily living, such as caring for their children and doing housework.
Some articles about the “long haulers” have put a face to the issue to make it more relatable and to show real people who’s lives are turned upside down by Covid-19.
A December 1, 2020 article in the Wall Street Journal in the Health and Wellness section, highlighted a 46-year-old female who previously was healthy and walked 4-5 miles a day. Since having Covid-19 she gets dizzy when she stands and is also experiencing severe chest pain. This patient has been diagnosed with an autoimmune disorder that can occur after a viral infection, such as Covid-19 called postural orthostatic tachycardia syndrome, POTS. This syndrome is managed with medication, physical therapy, and supportive care. Total recovery from POTS varies and in most cases, patients live with life-long limitations. Another case described was a 40-year old woman who was an engineer. Prior to Covid-19 she was energetic, caring for two children, and had a career. Following her illness, she reported difficulty in taking care of her children and had significant memory loss.
How are “long haulers” managed and treated?
At this time, long haulers are treated based on the symptoms they present with, for example for cardiac symptoms of chest pain, and palpitations patients are seen by a cardiologist and treated accordingly. Some patients may require cardiac medications such as beta blockers and anticoagulants.
Patients with neurological symptoms, such as memory loss or cognitive issues are attending programs for cognitive rehabilitation. According to the studies so far, what is being seen are short-term cognitive issues to date, the long-term effects are still not known. At this time the experts are saying we will have a population of people with some level of disability from Covid-19 and the goal would be to reverse that impact with proper rehabilitation programs. Currently, hospital systems throughout the U.S. are developing interdisciplinary programs to manage post-Covid patients. These programs are composed of a variety of disciplines that include services such as neurology, cardiology, psychiatry, and social services. Early recognition of cognitive decline is so important. Family members know the patients best and if they recognize changes in the person’s mental status and it concerns them, don’t ignore it. Early evaluation and treatment interventions are important.
References:
https://www.statnews.com/2020/08/12/after-covid19-mental-neurological-effects-smolder
https://www.thelancet.com/action/showPdf?pii=S2215-0366%2820%2930307-2