What to Know About Long-Haul COVID

What exactly is long COVID?

The length of time that a person infected with COVID-19 has symptoms can vary. But long COVID, or post-acute sequelae of COVID-19, as the National Institute of Health refers to it, can occur when people have prolonged symptoms that extend for weeks or months beyond their initial infection. As the pandemic surges on, more patients are starting to complain of lingering COVID symptoms, inspiring clinics to open up across the United States that are dedicated to treating this specific form of the virus. Vanderbilt University Medical Center just opened the Adult Post-Acute Covid Clinic and the Cleveland Clinic recently started the reCOVer Clinic for Patients with Long COVID Syndrome.

Dr. Sapna Kripalani, an assistant professor of medicine at Vanderbilt University Medical Center, says the technical definition of a COVID long-hauler is “anyone whose symptoms last beyond six to eight weeks from their infections.” (Kripalani, S., MD, personal interview, Aug. 16, 2021) And long COVID is not always associated with the severity of a patient’s initial COVID infection. “I've seen people who had very serious infections initially where they had a lot of respiratory symptoms and required hospitalization or mechanical ventilation have long haul COVID,” she explains. “But I've also seen people who were relatively asymptomatic, who quarantined for the typical expected course of the illness, about 10 to 14 days, and ended up with lingering symptoms.”

The data is still new on long COVID but Kripalani says reports are estimating that up to 30% of people can have prolonged symptoms including: prolonged fatigue, headaches, cognitive challenges and speech changes. And the CDC reports that additional symptoms, some of which may be new, can include but are not limited to:

• Cough
• Chest or stomach pain
• Diarrhea
• Sleep problems
• Fever
• Rash
• Mood changes
• Changes in taste or smell
• Heart palpitations
• Joint or muscle pain
• Dizziness

Can long COVID exacerbate existing conditions?

Kripalani says she and her colleagues have have seen a lot of chronic conditions, especially inflammatory ones, exacerbated by COVID and long-haul COVID. While doctors are still studying why this is, there is some suggestion that inflammation may be playing a big role. “What’s causing people to not fully recover may be because there's this chronic inflammatory state,” she says. “And so for people who otherwise already suffer from chronic inflammatory conditions, those may be increased, especially when we're talking about autoimmune conditions.”

Doctors are seeing skin conditions like eczema and psoriasis, which are related to an autoimmune and inflammatory process, flaring up due to long COVID. And there is an uptick in conditions like diabetes and heart disease. “I don't know that it's enough to say it’s because of long haul or if it's because of the COVID itself, or if it's because a patient’s health care was delayed because they were ill and were maybe not paying as close attention to their diet or their lifestyle,” Kripalani says. “There may be a multifactorial causation there.” Experts, she adds, are collecting data in real time and really learning about long haul COVID as they go along. And it’s too soon to detect if there will be more incidents of long COVID from the Delta variant versus the previous strain.

How is long COVID treated?

Kripalani says there are currently no FDA-approved medications specifically for this condition. Some people are finding relief by working with doctors at a dedicated long COVID facility, where multidisciplinary approaches are being used to combat their symptoms. At Vanderbilt’s new center, this includes physical therapy programs to help patients regain strength and improve endurance for physical activity, speech therapy and cognitive and behavioral rehabilitation programs. “We’ve had really good success and helping people slowly start to make steps forward in their recovery,” Kripalani explains.

The best medicine is prevention

If you’ve come down with a COVID infection, Kripalani says to wait at least six to eight weeks beyond your initial infection before worrying about long COVID, as that is how long people may have symptoms. Then, if it seems like your symptoms are not going away, find a doctor who specializes in long COVID and talk to them about a treatment plan. And getting vaccinated can really help to decrease your odds of contracting this post viral disease. “The message is just really for people to consider getting vaccinated if they haven't,” says Kripalani. “Right now, we think that's our really our best protection against not only COVID, but also long haul COVID symptoms.”

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