April 4, 2023 – Lisa McCorkell had a gentle bout of COVID-19 in March 2020. Young and healthy, she assumed she would recuperate quickly. But as her fatigue, shortness of breath and mental fog persevered, she realized she almost definitely had Long COVID.
“We as patients basically coined the term back then,” she says. Her first GP was sympathetic but unsure methods to treat her. After switching insurance, she ended up with a second GP who didn't take her symptoms seriously. “They dismissed my symptoms and told me they were all just imaginary. I didn't seek treatment for a while after that.”
McCorkell's symptoms improved after her first COVID vaccination in spring 2021. She also finally found a recent primary care doctor she trusted. However, as one in every of the founders of the Patient-Led Research Collaborative, a research group studying long COVID, she says many doctors still don't know the standard symptoms of the disease or methods to treat it.
“There is still a lack of education about what long COVID is and what symptoms accompany it,” she said.Many of the symptoms seen in Long COVID are symptoms of other chronic diseases, akin to myalgic encephalomyelitis / chronic fatigue syndrome, which are often ignored. And even when doctors consider patients and send them for tests, lots of the routine blood and imaging tests are normal.”
The term “Long COVID” emerged in May 2020. And although the disease was recognized inside months of the pandemic starting, doctors were unsure methods to test for or treat it.
Although knowledge has expanded since then, GPs are still in a difficult position. They are sometimes the primary doctors patients turn to once they have symptoms of Long COVID. But because there are not any standardised diagnostic tests, treatment guidelines, standard recommendations for care and the disease may cause a wide selection of symptoms, doctors may not know what to search for or methods to help patients.
“There is no clear algorithm to detect long COVID – there are no clear blood tests or biomarkers or specific things to look for on a physical exam,” said Dr. Lawrence Purpura, an infectious disease specialist and director of the Long COVID Clinic at Columbia University Medical Center in New York City. “It's a complicated disease that can affect any organ system in the body.”
However, recent research has produced a checklist of things that doctors should consider when a patient seeks treatment for a condition akin to Long COVID. These include:
- The primary systems and organs affected by the disease
- The commonest symptoms
- Useful therapeutic options for symptom management that help individuals with Long COVID
- The best healthy lifestyle decisions doctors can recommend to their patients
Here's a more in-depth have a look at each of those points, based on research and interviews with experts, patients and doctors.
Important systems and organs are affected
At least 10% of individuals infected with COVID-19 subsequently develop Long COVID, in accordance with a recent study on which McCorkell worked. But greater than three years after the pandemic began, much concerning the disease continues to be a mystery.
COVID is a singular virus because it could spread widely in a patient's body. A study published in December 2022 within the journal Nature, Autopsies of 44 individuals who died from COVID found that the virus can spread throughout the body and, in a single case, persist for as much as 230 days after symptoms appear. started.
“We know there are dozens of symptoms across multiple organ systems,” McCorkell said. “That makes it harder for a general practitioner to see the connections and link them to COVID.”
An article published last December in Natural medicine proposed a technique for diagnosis. The symptoms were divided into 4 groups:
- Heart and kidney problems akin to heart palpitations, chest pain and kidney damage
- Sleep and anxiety problems akin to insomnia, waking up in the midst of the night and anxiety
- In the musculoskeletal system and nervous system: musculoskeletal pain, osteoarthritis and problems with mental abilities
- In the digestive and respiratory system: difficulty respiratory, asthma, stomach pain, nausea and vomiting
There were specific patterns inside these groups, too. People in the primary group were more more likely to be older, male, produce other medical conditions, and have been infected throughout the first wave of the COVID pandemic. People within the second group were over 60% female and more more likely to have pre-existing allergies or asthma. The third group was also about 60% female, and lots of of them already had autoimmune diseases akin to rheumatoid arthritis. Members of the fourth group—also 60% female—were the least likely of all groups to have one other medical condition.
“These research findings are helpful because they give doctors a better sense of under what circumstances a patient is more susceptible to long-COVID illness and what specific symptoms to look for,” says Dr. Steven Flanagan, a physical medicine and rehabilitation specialist at NYU Langone Medical Center who also focuses on treating patients with long-COVID.
But “the challenge for healthcare providers is that not everyone falls clearly into one of these categories,” he stressed.
Checklist of symptoms
Although Long COVID might be confusing, doctors say there are several symptoms that keep cropping up and that primary care physicians should look out for, as they could indicate Long COVID. These include:
Post-exertional malaise (PEM). That's different than simply feeling drained. “That term is often confused with exhaustion, but it's something completely different,” says Dr. David Putrino, director of rehabilitation innovation at Mount Sinai Health System in New York City. He says he sees that in about 90% of patients who come to his Long COVID clinic.
PEM is the worsening of symptoms following physical or mental exertion. This normally occurs a day or two after the activity, but can last for days and sometimes weeks.
“It's very different from fatigue, which is just general tiredness, and exercise intolerance, where someone complains about not being able to do their usual workout on the treadmill,” he noted. “People with PEM can grind through and do what they need to do, and then the symptoms appear between 12 and 72 hours later.”
Dysautonomia. This is a blanket term that describes a dysfunction of the autonomic nervous system, which regulates body functions you possibly can't control, akin to your blood pressure, heart rate, and respiratory. This may cause symptoms like heart palpitations, in addition to orthostatic intolerance, which implies you possibly can't stand for long periods of time without feeling faint or dizzy.
“In my practice, about 80% of patients meet the criteria for dysautonomia,” said Putrino. Other studies have found that it’s present in about two-thirds of long-COVID patients.
A comparatively easy method that primary care physicians can use to diagnose dysautonomia is the lean table test. This is used to find out whether the patient has postural orthostatic tachycardia syndrome (POTS), one of the common types of dysautonomia. In this test, the patient lies flat on a table. While the pinnacle of the table is raised to an almost upright position, heart rate and blood pressure are measured. Signs of POTS include an abnormal heart rate when standing and worsening of symptoms.
Exercise intolerance. A review published within the journal in 2022 JAMA network opened analyzed 38 studies on Long COVID and exercise and located that patients with the condition had way more problems with physical activity. Physical performance declined to levels that might be expected a couple of decade later in life. According to study authors.
“This is particularly important because it cannot be explained by loss of fitness alone,” Purpura said. “Sometimes these patients are encouraged to exercise more to alleviate symptoms, but in these cases, the encouragement to push through can create post-exercise malaise that sets patients back and delays recovery.”
While Long COVID may cause dozens of symptoms, an article co-authored by McCorkell focused on a number of the commonest:
- Chest pain
- Heart palpitations
- Cough
- shortness of breath
- stomach pain
- Nausea
- Problems with mental abilities
- fatigue
- sleep disorders
- Memory loss
- Ringing within the ears (tinnitus)
- Erectile dysfunction
- Irregular menstruation
- Worsening of premenstrual syndrome
While most primary care physicians are conversant in a few of these Long COVID symptoms, they will not be aware of others.
“COVID itself appears to cause hormonal changes that can lead to erectile and menstrual problems,” Putrino explained. “But these may not be detected at a visit if the patient complains of other signs of long COVID.”
It isn’t only vital what symptoms there are, but additionally once they occur, he added.
“Typically, these symptoms start either with the first COVID infection or sometime within 3 months of the acute COVID infection. That's why it's important for people with COVID to be alert to anything unusual that occurs within a month or two of becoming ill.”
Can Long COVID be prevented?
You can reduce your risk by taking preventive measures akin to wearing a mask, keeping your distance from others in crowded indoor settings, and getting vaccinated. According to a 2022 study published in , receiving at the very least one dose of a COVID vaccine before testing positive for COVID lowers your risk of Long COVID by about 35%. Antimicrobial therapy and health epidemiologyUnvaccinated individuals who recovered from COVID after which received a vaccine reduced their very own long-COVID risk by 27%.
In addition, a study was published in February in JAMA Internal Medicine found that girls infected with COVID were less more likely to develop Long COVID and/or have fewer debilitating symptoms in the event that they maintained a healthy lifestyle that included:
- Healthy weight (a BMI between 18.5 and 24.7)
- Never smoker
- Moderate alcohol consumption
- A high-quality weight-reduction plan
- Seven to nine hours of sleep per night
- At least 150 minutes of physical activity per week
However, McCorkell identified that she herself maintained a healthy lifestyle before infection but still contracted Long COVID, suggesting that these approaches don’t work for everybody.
“I think one reason my symptoms went unaddressed by GPs for so long is because they looked at me and saw that I was young and healthy, and so dismissed my reports as my imagination,” she explained. “But we now know that anyone can get Long COVID, regardless of age, health status or severity of illness. That's why it's so important that GPs can recognise symptoms.”