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Long-term recovery from COVID-19, also known as long-hauler COVID syndrome, continues to challenge both clinicians and patients, with evidence on how to better manage the most common symptoms based primarily on cross-sectional studies and anecdotal reports. .
Until a clearer picture emerges of broader, prospective, multicenter studies, experts shared what is known and what evidence remains difficult in a Feb. 12 briefing sponsored by the Infectious Diseases Society of America.
To be considered post-COVID-19 syndrome, symptoms must persist for at least 4 weeks after acute SARS-CoV-2 infection. However, many patients present with symptoms for 2 to 6 months or more.
Fatigue appears to be the most common, followed by dyspnea and other lung complications, according to Allison Navis, a doctor and adjunct professor in the Division of Neuroinfectious Diseases at Mount Sinai Icahn School of Medicine in New York City.
Dr. Allison Navis
Neurological symptoms, in particular “brain fog” and numbness or tingling throughout the body, as well as mental health problems, including post-traumatic stress disorder (PTSD), have also been reported anecdotally.
The symptoms of post-COVID-19 syndrome may be similar to those experienced during acute infection.
Symptomatic infection precedes most cases
People who experienced an asymptomatic SARS-CoV-2 infection rarely appear to progress to persistent post-COVID syndrome, said Kathleen Bell, MD, Distinguished President Kimberly Clark in mobility research at UT Southwestern Medical Center in Dallas.
Dra. Kathleen Bell
However, “we are certainly seeing people who were not hospitalized who were acutely ill and managed it at home” with post-COVID syndrome, said Bell, who is also a professor and chair of the Department of Physical Medicine and Rehabilitation. UT Southwestern.
Navis agreed that, in his experience, most people with long-term effects controlled the acute infection at home or were hospitalized. “There were perhaps one or two people who probably had an asymptomatic infection and had a mild long COVID syndrome,” he said.
Risks related to hospitalization
For some patients, being hospitalized for COVID-19 on its own can lead to long-term recovery problems. For example, hospitalized patients who spend a high proportion of time in a prone position may be more likely to have peripheral neuropathy, Bell said. Weakness associated with arms and legs can be particularly significant in people with diabetes.
In addition, a long-term hospital stay can trigger adverse mental health outcomes. “We have people in the hospital for 3 months and a large percentage see mental health symptoms, including PTSD, anxiety and depression,” Bell said. These adverse effects are not unique to COVID-19, but are also reported in other people who spend weeks or months in critical care, he added.
Some people with mild mental health problems may have been compensating long before their experience with COVID-19, but the stress of acute infection and hospitalization exacerbates their condition, Bell explained.
A local outbreak can also increase the risk of mental health problems. The rise in cases in March and April 2020, for example, “was a very frightening time here in New York City,” Navis said.
“Some people were isolated in their apartments, heard the sound of ambulances and sirens, and were worried about their own health and survival,” he said, adding that it also caused anxiety, depression or PTSD.
Consensus and guidelines in works
On January 26, the World Health Organization published updated treatment guidelines for COVID-19, including people with persistent symptoms.
The Centers for Disease Control and Prevention is working on guidelines for the diagnosis and management of people with post-COVID syndrome, “which is very exciting,” Bell said. The recommendations are expected to emerge from an event about 3 or 4 weeks ago at which the agency brought together experts to share their models of care.
The National Institutes of Health is also interested in developing protocols, Navis said.
Many specialized teams and clinics have sprung up to cater to the growing population of COVID-19 “long haulers”.
Interestingly, while many centers initially drafted their own protocols to treat this patient population, “we’re starting to look alike,” Bell said.
The COVID-19 recovery clinics at Bell and Navis institutions focus on multidisciplinary collaboration, including general medical care and specialists such as pulmonologists, cardiologists, and psychiatrists, as well as rehabilitation specialists, to treat specific symptoms.
Remaining questions
It is unknown what proportion of people with COVID-19 will progress to post-COVID syndrome. “The expectation would be that most people are likely to improve between weeks and months, and about 10% to 15% will have problems longer,” Bell said. Extensive studies should help clarify the figures.
Although it is generally accepted that more men than women develop COVID-19 and die, it remains to be seen whether the risk of long-term effects differs between men and women. Navis reported a fairly equal distribution of cases by gender in his experience.
How vaccination can prevent or mitigate post-COVID syndrome also remains an open question. The vaccines “are so new, it would be a crystal ball question,” Bell said.
Bell predicted that it would take about 6 months to get answers to these and other unknowns about post-COVID syndrome from larger prospective studies.
Damian McNamara is a Miami-based journalist. It covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.
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