One of the most puzzling and pernicious aspects of COVID-19 is the variation in effects and outcomes of the disease. For some, it’s deadly. For the majority, it’s not. Yet for as many as one in three infected people – even those who reported only mild symptoms when diagnosed – at least one symptom persists for two months or more. These are the pandemic’s “long-haulers.”
Fatigue is the most common complaint among long-haulers, says Dr. Farrin Manian, an infectious disease physician and chairman of the department of medicine at Mercy St. Louis. Other symptoms include “brain fog,” body aches, memory or sleep problems, shortness of breath, rapid heart rate, dizziness, headache, chest discomfort, cough, poor sense of smell, anxiety or depression, and difficulty concentrating.
Although physicians are seeing many cases of this “long-hauler syndrome” or “long COVID,” the causes are unclear. “There are several possibilities, including an overactive immune response that doesn’t shut off even after the virus has been eliminated from the body, low-grade infection due to the persistence of the virus after the acute infection has passed or abnormalities of the brain and nervous system as a result of the original infection,” Manian says. “It’s possible that not all patients have the same cause even though at this time they are all lumped together as a ‘long COVID.’”
Until doctors learn more about the mechanisms causing the persistence of symptoms, treatment is targeted at managing and alleviating the symptoms. Patients are often advised to improve sleep hygiene and physical conditioning, reduce stress and eat a healthy diet. All of that, combined with time, currently seems to be the best bet for gradual recovery.
Manian notes that although these patients seem to recover from the acute illness and that their labs and X-rays look fine, there is clearly a continuing problem. “This condition, not unlike chronic fatigue syndrome or fibromyalgia, can be quite debilitating and can make it difficult for even previously healthy young or middle-age persons to get their life back and function normally long after the acute infection is gone,” he says.
An increasing number of medical centers are establishing “post-COVID clinics,” and long-haulers can enroll in studies to help scientists figure out what drives this condition. “In my view, we really need to figure out how much of these symptoms are due to overactive immune response, persistent low-grade infection that is not easy to find on routine tests or injury to the nervous system or body that will just take time to heal,” Manian says. “There is intense scientific interest in this condition around the world, so I am optimistic.”
As scientists and physicians work to find answers, Manian encourages everyone to get vaccinated. “You can’t get this condition unless you get COVID-19,” he points out.
“Not only do the vaccines reduce the likelihood of serious disease, but they also reduce the risk of mild to moderate disease, which can also be associated with ‘long COVID,’” he adds. “It makes no sense to expose yourself to the risk of getting COVID-19, even if it’s mild, and then have to deal with debilitating symptoms that go on for weeks or months.”
Mercy Hospital St. Louis, 621 S. New Ballas Road, St. Louis, 314-251-6000, mercy.net