Do you also have difficulty with COVID after recovering? Let's talk about Long COVID!

Have you also had COVID and thought that you would get better in a few days or two weeks, but you still feel very tired? Or do you feel like your head is not clear, and you have difficulty concentrating? Maybe the foods you used to enjoy taste strange now, maybe they taste metallic, or you can't smell anything at all? You may not even remember how long it's been since you last slept. These are some of the symptoms of Long COVID, which we are going to talk about today.

What is Long COVID?

Simply put, Long COVID is a set of symptoms that persist for three months or more after you have had COVID-19 and the initial symptoms have subsided. It doesn’t matter if you had mild or severe COVID-19, it can happen to anyone. These symptoms can sometimes be similar to those of autoimmune disorders, lung, heart, nervous system, or mental illnesses. Some symptoms may be mild, while others can be so severe that they make it difficult for you to do your daily activities. These symptoms may come and go, change, or get worse over time. You may feel like you never really got well after having COVID.

Long COVID is also known by other names, such as long-haul COVID, post-COVID syndrome, or post-acute sequelae of COVID-19. Many people equate this condition with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Because it has a wide range of symptoms and can be caused by a variety of things, there is no single treatment that works for everyone.

How common is Long COVID?

It is currently estimated that between 5% and 10% of people infected with COVID-19 may develop these post-COVID conditions. However, because the symptoms vary and the duration of their symptoms varies, it is difficult to say exactly how many people have them.

What are the symptoms of Long COVID?

Long COVID can cause a variety of symptoms. Some people may have more than one symptom, but most people do not have all of them at once. The two most common symptoms are fatigue, which is a feeling of weakness, and shortness of breath.

Other symptoms that may be seen are:

• Loss or alteration of the sense of smell or taste: Some people may not be able to smell or taste at all (anosmia). Others may experience changes in their previously experienced sense of taste, such as a metallic taste (dysgeusia). Imagine eating your favorite food and not being able to taste it at all.
• Difficulty concentrating - "brain fog": Difficulty thinking clearly and concentrating. It feels like your head is covered in fog. Sometimes it's hard to remember words.
• Chronic cough: Even after COVID is cured, a cough can persist for months.
• Headaches: Frequent, sometimes severe headaches.
• Difficulty sleeping or insomnia: You may have trouble falling asleep at night, or you may not be able to sleep properly even when you do fall asleep.
• Depression: A state of feeling hopeless, a state of being hopeless about everything.
• Anxiety: Constantly feeling afraid and uneasy.
• Chest pain: Sometimes the chest may hurt even when breathing.
• Heart palpitations: A feeling of racing or racing heart.
• Diarrhea: Bloating.

If you continue to have one or more of these symptoms after contracting COVID, it's important to be concerned.

What are the causes of Long COVID?

Experts are still unable to pinpoint a single cause for Long COVID. However, other coronaviruses have been known to cause long-term effects in the past, such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). So it's no surprise that COVID symptoms can last for a long time. There are several factors that can contribute to Long COVID:

• Tiny blood clots: These tiny blood clots may not cause a major event like a stroke, but they can interfere with the proper functioning of your lungs, brain, and other organs.
• Inflammation: Your immune system may be overactive and continue to cause inflammation in your organs and tissues, even after it has finished fighting off the COVID infection.
• Autoimmune disorders: For reasons we don't know exactly, after a COVID infection, your immune system may start attacking parts of your own body, much like an autoimmune disease.
• Viral persistence: The SARS‑CoV‑2 virus, which causes COVID‑19, can persist in your body even after you recover from the initial illness. Even if you test negative for COVID, and you are not likely to infect anyone else, the virus can continue to cause problems in your body.
• Reactivation of other viruses: Some viruses may be dormant in your body without you knowing it. These can sometimes reactivate and cause symptoms. Some evidence suggests that Covid can reactivate the Epstein-Barr virus (the virus that causes mono) and cause long-term symptoms.
• Long-term psychological effects of severe illness: If you have a severe case of COVID, especially if you are hospitalized, you may develop anxiety, depression, or other mental health conditions as a result.

Who is at higher risk of developing Long COVID?

You are at higher risk of developing Long COVID if:

• If you have not been vaccinated against Covid-19.
• If you have a severe case of COVID, especially if you have been hospitalized. But remember, even people who have normal COVID can get Long COVID.
• If you have developed Multisystem Inflammatory Disorder (MIS-C) during or after COVID-19.
• If you had other health problems before you developed COVID, for example, lung disease, obesity, diabetes mellitus, and high blood pressure.
• If you are a woman. (The exact reason for this is not yet clear, but studies have shown this.)

How do you know if you have Long COVID?

Doctors will decide if you have Long COVID by listening to your symptoms and your health history. They may also do some tests to further understand your symptoms and decide how to treat them. Depending on your symptoms, they may do the following tests:

• Blood tests: Check for things like inflammation in the body and organ function.
• Chest X-rays or other imaging tests: Pictures can be taken of the inside of your lungs, brain, or other organs to see if there are any changes that could be causing your symptoms.
• CT scans: If you have certain types of lung inflammation, it can affect the way your doctor treats you with certain medications. Your doctor may need to do a CT scan to look at this inflammation.
• Lung (pulmonary) function tests: These tests can help your doctor know how well your lungs are working.
• Electrocardiogram (EKG/ECG) or Echocardiogram (Echocardiogram - Echo): These tests help doctors find out if you have any problems with your heart.

What can be done to avoid Long COVID?

Unfortunately, there is no single cure for Long COVID. You and your doctor may need to try several different treatments to find what works for you. Depending on your symptoms, treatment options may include:

• Medication: Doctors can treat some symptoms and conditions, such as cough, headache, anxiety, and depression, with medication. If an underlying cause (e.g., blood clots) can be found for Long COVID, that cause may also be treated with medication.
• Stellate ganglion block or olfactory retraining: Doctors can use these treatments to try to get your sense of smell and taste back. A stellate ganglion block numbs some of the nerves in your neck that affect your sense of smell. Olfactory retraining uses familiar smells to remind your brain how things should smell.
• Physical therapy: Physical therapy includes exercises, massage, and other treatments that can help you reduce pain and improve mobility.
• Pulmonary rehabilitation: This is a special exercise and educational program that helps you breathe easier and learn how to manage breathing difficulties at home.
• Counseling: Counseling gives you someone to talk to to help you manage the emotional effects of a serious or long-term illness.

The most important thing is, you don't have to face this alone. It's very important to seek medical advice.

What can you expect if you have Long COVID?

Long COVID symptoms may come and go, or they may get better or worse over time. Many "long-haulers," or people who suffer from this condition, eventually recover. But how long it takes varies from person to person. You may need to do these things:

• See a primary care physician (PCP) and one or more specialists to manage your symptoms. If there is a Long COVID clinic in your area, they can refer you to a specialist who is best suited for your specific symptoms.
• Be patient and don't give up when trying to find the treatment that works for you.
• Give yourself more time than you normally would for your regular activities, and take frequent breaks throughout the day. Some people may need to take a long break from work or school to recover.

How long can symptoms like fatigue last after contracting COVID?

Many people feel tired and lethargic for a few weeks after contracting COVID. But for some, this fatigue and other symptoms can last for months or even longer. Many people with Long COVID start to get better between 12 and 18 months.

Can Long COVID be prevented?

There is no single way to prevent Long COVID. But there are several ways to reduce your risk. They are:

• Antiviral medications: One study suggests that taking the antiviral drug Nirmatrelvir (brand name: Paxlovid®) within five days of testing positive for COVID may reduce the risk of long-term COVID. This study only looked at people who were at high risk for severe COVID. Keep in mind, doctors usually only prescribe antiviral medications within five days of your symptoms starting.
• Vaccination: Those who have not been vaccinated against COVID are at higher risk of developing Long COVID if infected.
• Avoiding infection: If you don't have COVID, you can't get Long COVID. You can reduce your risk of getting COVID by practicing good handwashing habits and wearing a mask that covers your mouth properly (e.g., a multi-layer mask like an N95 or KN95) when you're around other people. Avoid others if you or others are sick, or if someone has been exposed to COVID.

When should you seek medical advice?

See a doctor if you have any of these:

• Severe Covid symptoms.
• Even if your initial symptoms are good, symptoms that last a long time.
• Any symptoms that interfere with your daily life.

Tell your doctor about your symptoms and how they are affecting your life. Tell them when you were diagnosed with COVID and when your current symptoms started.

In what situations do you need to go to the Emergency Treatment Unit (ETU) ?

If your symptoms suddenly get worse, or if you have severe symptoms like these, go to the emergency room immediately:

• High fever (over 103 degrees Fahrenheit or over 40 degrees Celsius).
• Difficulty breathing.
• Severe or unrelenting pain in the chest or abdomen (belly).
• Frequent dizziness.
• Confusion.
• Severe muscle pain or weakness.
• Inability to wake up or stay awake.
• Seizures.
• Blue color of the skin, lips, or fingernails (Cyanosis - this can be a sign of low oxygen levels in your blood or tissues).

What questions should you ask your doctor?

It may be helpful for you to ask these questions when you see a doctor:

• What treatment options do I have?
• Do you know what is causing my symptoms?
• Do people with symptoms like mine usually recover?
• How should I take my medicine?
• When should I see you again?
• What symptoms require going to the emergency room?

The most important thing we need to keep in mind (Take-Home Message)

Sometimes, medical knowledge can be a little behind what patients have been experiencing for a long time. Fortunately, we have come a long way in understanding some of the long-term symptoms of COVID. Many doctors now work with different teams dedicated to understanding and treating your symptoms.

This is still a learning process - try a few things to find the treatment that works best for you, and you may make mistakes. If you can't speak up for yourself, get help from someone who can. They can help you find doctors, support groups, and counseling. Tell your family, friends, and your workplace or school that you may need more time to do certain things, or that you may need more rest. Allowing yourself to be kind to yourself while you heal can be the first step to recovery. Be patient and follow your doctor's advice. You are not alone!

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