Long COVID May Linger in Patients for Months or Years
May 1, 2023 7 minutes read
By Melinda Young
EXECUTIVE SUMMARY
New research shows a severe, long-term effect from COVID-19 infection on many patients who survived hospitalization.
- The results of one study showed 90% of patients who survived hospitalization in the first wave of COVID-19 experienced symptoms of long COVID.
- Long COVID symptoms include fatigue, shortness of breath, brain fog, and more.
- COVID-19’s long-term effects also include life stressors, such as financial issues, domestic violence, and food insecurity.
The COVID-19 pandemic may be waning, but its effects continue as many patients experience long-term symptoms, including fatigue, brain fog, and other problems. Healthcare providers across the continuum may see these patients for months — and possibly for years.
New research highlights the effects of long COVID, particularly on patients who were hospitalized. One new study revealed a group of patients who had been hospitalized with COVID-19 experienced significant life stressors, including new disability, within 12 months after discharge.1
“Of our cohort of people who survived hospitalization from COVID, 90% still had symptoms or tested abnormal on one of the metrics we tested these folks on a year after hospitalization,” says Jennifer A. Frontera, MD, a professor of neurology at the NYU Neurology COVID-19 Study Team. “These included cognitive testing; questions about if they were able to do their normal activities; [and] questions about fatigue, sleep, anxiety, and depression. Most of the people — if they were hospitalized — had some long-lasting symptoms.”
Long COVID is an evolving disease that occurs four to 12 weeks after acute COVID, says Arvind Trindade, MD, FASGE, FACG, regional director of endoscopy at Northwell Health (Central Region) and director of endoscopy at Long Island Jewish Medical Center in New Hyde Park, NY. “There is no specific treatment for long COVID. It’s more symptom relief, depending on what the symptom is.” For some patients with long COVID, the symptoms will resolve within a few months. For others, it can last six months or longer after acute infection.
Because there is no cure for long COVID, the best tactic is vaccination, which offers some protection from the illness. “Those who receive at least two vaccine doses have half the risk of continued symptoms of long COVID,” adds Trindade, program director of advanced endoscopy and an associate professor of medicine at Hofstra/Northwell. “Vaccination is the best measure to prevent long COVID.”
One in Eight Patients
Long COVID affects one in eight patients with COVID-19, noted Michael Gottlieb, MD, RDMS, co-principal investigator for the INSPIRE site at Rush University Medical Center. Gottlieb spoke about long COVID symptoms on Feb. 15 during a media briefing held by the Infectious Diseases Society of America.2
Long COVID can affect people who experienced mild symptoms, as well as those who were hospitalized with life-threatening COVID-19 illness.
“It has a life-impacting effect for one in eight people,” Gottlieb said. “We need to study this further and account for this impact.”
For example, people with long COVID may experience severe fatigue. They also report other troubling symptoms, such as shortness of breath. “Some have lost taste and smell that is persistent,” Gottlieb said.
Gastrointestinal Effects
Another study revealed many patients with COVID-19 reported an altered heart rate and blood pressure regulation during exercise. The authors of a third study found that many people who recovered from COVID-19 reported cough, fever, and/or headache for at least a month after receiving monoclonal antibody treatment.3,4
Other debilitating symptoms of long COVID relate to gastrointestinal problems, including abdominal pain, nausea, vomiting, irritable bowel symptoms, and anorexia/weight loss.5
“Loss of taste can overlap with gastrointestinal issues,” Trindade says. “Weight loss and anorexia can happen, which may require oral supplementation and nutrition and counseling.” Some people may experience post-COVID cholangiopathy, in which a liver marker is elevated, he adds.
Researchers and physicians still do not know the cause of gastrointestinal symptoms related to long COVID. “The exact mechanism is poorly understood, and researchers are trying to figure it out,” Trindade notes.
One theory is the virus causes inflammation of the GI tract, which leads to the symptoms. “The biggest things that patients are frustrated with that we are hearing is the fatigue and weight loss,” Trindade explains. “They lack energy and are really tired, and they say, ‘No matter what I eat, I’m losing weight.’”
Patients with GI symptoms from long COVID should receive nutritional counseling and oral supplementation, such as protein supplements. “They need to establish care with a nutritionist and dietary counselor,” Trindade adds.
Lingering symptoms can affect people’s working and leisure lives. Patients with mild fatigue still may work but limit their leisure activities. But patients with severe fatigue may be unable to work, engage in leisure activities, or even handle day-to-day chores.
“If you’re suffering from severe fatigue, you realize you’re not alone,” Gottlieb stressed. “If there are 16 people, at least one other person has gone through this. ... We need more attention to understanding long COVID. The people who are experiencing this need to understand long COVID better.”
The good news is the odds of acquiring long COVID have changed as COVID-19 rates decline. Gottlieb and co-investigators studied long COVID from the early pandemic through the middle and later periods and found vaccination against COVID-19 provided a protective effect.
“We pulled back layers of data and saw both groups [unvaccinated and vaccinated] were affected, but those with vaccination had a protective effect,” Gottlieb explained. “The rate of long COVID is going down because of things we’ve done; getting vaccinated reduces that risk.”
Researchers are continuing to study long COVID to better define symptom duration. “We see a difference in people, going in both directions,” Gottlieb explained. “Some have minimal symptoms in three months, and then their symptoms become more severe at six months. Others who have severe symptoms in three months will have it resolve later.”
Psychosocial Symptoms
The experience of the pandemic also can cause psychosocial symptoms. “For example, life stressors like financial insecurity, food insecurity, domestic violence, and a spectrum of life stressors seem to be bigger predictors of how people recover than any other factor,” Frontera explains. “Life stressors predict symptoms some people have regardless of whether they have COVID or not.”
Providers should think holistically about their patients, particularly those with a previous COVID-19 infection. “Think about what they’re like as a person, and what kind of social stressors this person might be under,” Frontera says. “Think about utilizing multidisciplinary practices like social work and case management.”
A variety of local, state, and federal resources could alleviate some of the stressors people face, such as social isolation and food insecurity. Case managers can help patients find solutions to some of these stressors.
Social stressors affect more people, but those who were hospitalized with severe COVID-19 illness may experience long-term effects related to low oxygen or persistent lung disease. These can be debilitating.
Some researchers have focused on cognition and neuropsychology with COVID-19 patients. They found patients who were hospitalized and died from COVID-19 showed neuropathological changes in their brain sections — especially evidence of amyloid deposits and other hallmark findings that mirror Alzheimer’s disease and dementia.
“We compared people who died of COVID to people who died from hypoxia who have the same changes,” Frontera adds. “We know hypoxia, which is severely low oxygen, can lead to a buildup of this type of pathology in the brain.”
Frontera and colleagues also are studying COVID survivors and performing cognitive testing to see if they find any of the same kind of pathology.
Patients with long COVID report a variety of problems, including headaches, brain fog, pulmonary symptoms, and mood disorders.
“When we asked people about their symptoms and whether their symptoms impacted their ability to work, 45% said they can’t work because of their symptoms, and 55% said they couldn’t do household activities,” Frontera says.
An even higher percentage of respondents said they could not participate in leisure activities, which suggests those who were working were doing so out of necessity — not because they were comfortable continuing to work.
“The symptoms have to be really bad if you’re not working at all because people have to make a living,” Frontera notes. “People work to the extent they can, and the first thing they give up is leisure.”
Patients who were hospitalized with COVID-19 suffered the most. “These affect people’s ability to do their normal activities,” Frontera says. “Those with severe COVID are different from folks who were never hospitalized.”
Their mental health challenges are particularly important. These symptoms can exacerbate their problems. Frontera and colleagues suggested treatment for mood disorders and mental health issues can help patients with their overall health as well.
“We need to make sure we address mental health as part of the therapeutic approach,” Frontera says. “One hundred percent said they had improved after therapies, including some mental health treatment, whether it was a medication, cognitive behavioral therapy, or talk therapy.”
Physical therapy, occupational therapy, and other interventions also helped, but each study participant received some psychological intervention.
“The group that had headaches and brain fog also got headache medicine and physical therapy,” Frontera says. “Sometimes, people with a lot of symptoms need some kind of direction and some sort of practitioner to take their symptoms seriously because whatever they’re experiencing is real for them.”
REFERENCES
- Frontera JA, Sabadia S, Yang D, et al. Life stressors significantly impact long-term outcomes and post-acute symptoms 12-months after COVID-19 hospitalization. J Neurol Sci 2022;443:120487.
- Infectious Diseases Society of America. 3 years later, what’s known about long COVID? Feb. 15, 2023.
- Chan J, Senior H, Homitz J, et al. Individuals with a previous symptomatic COVID-19 infection have altered heart rate and blood pressure variability during acute exercise. Front Physiol 2023;14:1052369.
- Vawter NL, Godino JG, Lewis SV, et al. COVID-19 monoclonal antibody treatment impact on symptoms and post-COVID conditions among high-risk patients at a Federally Qualified Health Center. BMC Infect Dis 2023;23:105.
- Rizvi A, Ziv Y, Crawford JM, Trindade AJ. Gastrointestinal and hepatobiliary symptoms and disorders with long (chronic) COVID infection. Gastroeterol Clin North Am 2023;52:139-156.
The COVID-19 pandemic may be waning, but its effects continue as many patients experience long-term symptoms, including fatigue, brain fog, and other problems. Healthcare providers across the continuum may see these patients for months — and possibly for years.
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