As the COVID pandemic continues, “long-haul COVID” and “long COVID” have entered our lexicon as the constellation of symptoms that present in the wake of COVID infection. Long-haul COVID is gaining attention as more patients navigate a healthcare system not fully prepared to care for the consequences of a novel virus.
In medicine, we try to follow guidelines and practice evidence-based medicine. The “evidence” in evidence-based means data and studies published in peer-reviewed journals that support guidelines or recommendations. Today, there is no “playbook” for long-haul COVID. Accordingly, the National Institutes of Health (NIH) have granted 1.15 billion dollars in funding over the next four years for researchers to study long-haul COVID and its treatments. In the interim, the medical community continues to see more patients with sequelae and symptoms related to COVID19 infections.
By now, most physicians have seen patients with suspected long COVID and have some in-person experience. There is not one clinical picture that fits all patients with long COVID. Symptoms of long-haul COVID may include headaches, shortness of breath, cough, muscle aches, fatigue, post-exertional malaise, and cognitive dysfunction. In some cases, few objective findings are present with respect to reports of long-haul COVID. From a personal standpoint, I have seen several patients with persistent difficulty concentrating and brain fog months after infection. Several, including an athlete with no prior history of asthma, have also had persistent shortness of breath. Patients with persistent respiratory symptoms may or may not have abnormal chest imaging.
Long-haul COVID impacts up to 25% of patients ages 35-49; it is less likely to impact the young and old. Overall, about 13% of patients who have had COVID still experience at least one symptom 12 weeks after infection. Women are more likely to experience long-haul COVID than men. It is currently impossible to predict who, on an individual basis, will experience long-haul COVID as it does not seem to be based on the severity of disease during the acute phase of the virus. Researchers are investigating various biomarkers to determine whether there is a genetic predisposition for long-haul COVID.
How can we prevent or treat long-haul COVID? There is early data out of the UK, though not yet peer-reviewed, showing that 57% of people with long-haul COVID felt better after receiving an approved COVID vaccine. The mechanism for why long haulers feel better is not clear, but there are several theories, including the potential benefit of eradicating the last existing virus particles. If COVID remains a part of our way of life, understanding long-haul COVID will be an important aspect of care for all specialties.
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