If you follow the news, you are aware that some people who recover from a COVID-19 infection have persistent complaints for months after their apparent recovery. These can occur in almost every body system, but the most prominent tend to be fatigue, shortness of breath and “brain fog:” difficulty concentrating.
While an enormous amount has been written about post-acute Covid syndrome, popularly known as Long Covid, the medical profession still has more questions than answers. There are many challenges to understanding what is happening. For those who were sick enough to be hospitalized, the medium and long-term symptoms seen in Covid survivors are not that different than those seen in many patients who spent time in the ICU for any reason. In these people, “long Covid” may be a form of “post-ICU syndrome,” which has only recently been studied.
Another problem is that to date, we have no good measures to evaluate the long haulers’ complaints. There are no blood tests or X-rays that we can point and say that these explain the symptoms or that they “prove” you are truly sick. Just as with the chronic fatigue syndrome, when all the usual blood makers are normal, many doctors dismiss the complaints as being imagined.
Several recent studies have shed some light. Comparing people who have recovered from Covid with those who have recovered from other illnesses, there are more complaints of shortness of breath and of a variety of neurologic and psychologic symptoms. A large study of Chinese Covid survivors found them to have more decline in mental acuity, particularly among those who had severe acute Covid. Strengthening the idea that this was not psychological, a small study in Britain found both cognitive decline and shrinkage of the brain on MRI among people who had recovered from mostly mild cases of Covid but had persisting symptoms.
A very large study done by the VA showed that compared to people hospitalized for other reasons, Covid survivors had more blood clots, atrial fibrillation, strokes and heart failure. Most recently, a study of 10 patients who complained of shortness of breath but whose routine tests were all normal found, with more sophisticated tests, that their tissues did not take up oxygen normally, thus explaining why they had trouble exercising.
On the bright side, a British study found that only 9.5% of vaccinated individuals who had break though infection had Long Covid symptoms compared to 14.6% of unvaccinated individuals. Since vaccination also clearly reduces your chances of any symptomatic Covid, the value is even greater.
Finally, a very preliminary study in the U.S. found that enhanced external counterpulsation, a harmless but tedious treatment shown to improve circulation to the heart and brain, improved symptoms in most of the 50 patients studied.
Bottom line: 1. Get vaccinated. 2. If you have symptoms months after recovery from Covid, don’t let your doctor tell you “it is all in your head,” but ask to be referred to one of the specialized centers bringing a multi-disciplinary approach to treating Long Covid.
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