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Long-term recovery from COVID-19, also known as COVID “long-hauler” syndrome, remains challenging for clinicians and patients alike, with evidence on how best to treat the most common symptoms, mainly based on cross-sectional studies and anecdotal reports .
Until a clearer picture emerges from larger, future, and multicentre studies, experts shared what is known and what evidence remains elusive in a Feb. 12 media report 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 experience symptoms that last for 2 to 6 months or more.
Fatigue seems to be most common, followed by shortness of breath and other pulmonary complications, Allison Navis, MD, assistant professor in the department of Neuro-Infectious Diseases at Icahn School of Medicine at Mount Sinai in New York City, said during the briefing.
Dr. Allison Navis
Neurological symptoms, especially “brain fog” and numbness or tingling throughout the body, as well as mental health challenges, including post-traumatic stress disorder (PTSD), have also been reported anecdotally, she said.
Symptoms of post-COVID-19 syndrome can be similar to those during acute infection.
Symptomatic infection is most common
People who have experienced an asymptomatic SARS-CoV-2 infection rarely appear to progress to persistent post-COVID syndrome, said Kathleen Bell, MD, Kimberly Clark Distinguished Chair in Mobility Research at UT Southwestern Medical Center in Dallas.
Dr. Kathleen Bell
But “we certainly see people who have not been hospitalized who were acutely ill and managed it at home” present with post-COVID syndrome, said Bell, who is also a professor and chair of the Department of Physical Medicine and Rehabilitation. the UT Southwestern.
Navis agreed that, according to her, most people with long-term effects were treated with an acute infection at home or were hospitalized. “There were maybe one or two people who probably had an asymptomatic infection and came in with mild long-term COVID syndrome,” she said.
Hazards related to hospitalization
For some patients, hospitalization for COVID-19 in itself can lead to long-term recovery problems. For example, inpatients who spend much of the time in the prone position may be more likely to develop peripheral neuropathy, Bell said. The associated arm and leg weakness can be especially important in people with diabetes.
In addition, a long hospital stay can lead to adverse mental health consequences. “We have people in the hospital for three months, and in a large percentage we see psychological symptoms, including PTSD, anxiety and depression,” said Bell. These side effects are not unique to COVID-19, but have also been reported in other people who spend weeks or months in intensive care, she added.
Some people with mild mental health conditions may have made up for this well in advance of 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 peak of cases in March and April 2020, for example, “was a very scary time here in New York City,” Navis said.
“Some people were isolated in their apartments, hearing the sounds of ambulances and sirens, and concerned about their own health and survival,” she said, adding that it also caused anxiety, depression or PTSD in some.
Consensus and guidelines in the works
The World Health Organization released updated treatment guidelines for COVID-19 on Jan. 26, including for people with persistent symptoms.
The Centers for Disease Control and Prevention are working on guidelines for the diagnosis and treatment of people with post-COVID syndrome, “which is very exciting,” Bell said. The recommendations are expected to stem from an event about 3 or 4 weeks ago where the agency brought together experts to share their care models.
The National Institutes of Health is also interested in developing protocols, Navis said.
Many specialist teams and clinics have emerged to address the growing population of COVID-19 “long-haul vehicles”.
Interestingly, although many centers initially established their own protocols for treating 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 address specific symptoms.
Remaining questions
It is not known which proportion of people with COVID-19 will progress to post-COVID syndrome. “Most people would be expected to get better over weeks to months, and about 10% to 15% will have longer-term problems,” Bell said. Larger studies should help clarify the numbers.
While it is widely believed that more men than women develop and die COVID-19, it remains to be seen whether the risk of long-term effects differs between men and women. Navis reported in her experience a fairly equal distribution of cases by gender.
How vaccination could prevent or reduce post-COVID syndrome also remains an open question. The vaccines “are so new that it would be a crystal ball,” Bell said.
Bell predicted that it will take about 6 months for answers to these and other unknown things about post-COVID syndrome to emerge from larger, prospective studies.
Damian McNamara is a personnel journalist based in Miami. It covers a wide variety of medical specialties, including infectious diseases, gastroenterology and intensive care. Follow Damian on Twitter: @MedReporter.
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