This content is first seen at YaleMedicine website.
Disclaimer: The information provided in this site is correct at the time of publication. POMConnect assumes no responsibility or liability for any errors or omissions in the content of this site.
Yale University’s Long COVID program is designed to address persistent COVID-19 symptoms like fatigue, cognitive difficulties, and breathlessness in patients who have recovered from the virus.
Long COVID, characterized by enduring symptoms after COVID-19 recovery, remains an enigma to medical professionals and researchers. Its debilitating manifestations encompass chronic pain, brain fog, chest discomfort, and severe fatigue, with the potential to impact organs. Yet, imaging scans often fail to reveal the cause, and the reasons for its selective occurrence remain uncertain, even following mild COVID-19 infections.
Although some research insights have emerged, they remain insufficient for a comprehensive comprehension of Long COVID’s progression within the body, which is crucial for devising effective treatments.
Dr. Lindsay McAlpine, a neurologist and director of the Yale NeuroCovid Clinic, stresses the absence of a universal treatment, emphasizing the diverse ways individuals experience Long COVID. Accordingly, personalized care is central to the approach of the Yale New Haven Long COVID Multidisciplinary Care Center, directed by Dr. Lisa Sanders. This center, established in spring 2023, adopts a comprehensive strategy by evaluating patients and referring them to various specialists, including cardiologists, neurologists, pulmonologists, and rheumatologists. The center also provides physical therapy and social work services due to Long COVID’s potential impact on various aspects of patients’ lives.
Yale Medicine’s specialists in Long COVID address the current understanding of the condition and the approaches available for managing it.
1. How is Long COVID defined?
Long COVID, as defined by the World Health Organization (WHO), refers to the continuation or emergence of new symptoms three months after the initial SARS-CoV-2 infection. These symptoms persist for at least two months without any other explanation. The Centers for Disease Control and Prevention (CDC) adds that Long COVID encompasses a wide spectrum of enduring health issues that can endure for weeks, months, or even years. The condition can impact any bodily system, with severe cases affecting multiple systems including the heart, lungs, kidneys, skin, and brain.
It’s important to note that each individual’s experience varies. Long COVID isn’t exclusive to those who had severe initial COVID-19 cases; some developed it after mild infections, while others may exhibit symptoms without testing positive for COVID-19. Yale Medicine pulmonologist Dr. Denyse Lutchmansingh mentions that individuals falling in the latter category are often referred to as “presumed COVID” patients.
2. What are researchers learning about Long COVID?
Dr. Akiko Iwasaki, an immunobiologist at Yale School of Medicine, is at the forefront of multiple studies investigating the underlying mechanisms of Long COVID. Iwasaki emphasizes that Long COVID is not a singular disease but rather a complex condition.
On her laboratory’s website, she outlines four hypotheses that could potentially explain how Long COVID originates and progresses:
- Persistent virus or remnants from a prior COVID-19 infection trigger chronic inflammation and ongoing symptoms.
- The body’s B and T cells, responsible for immune responses, trigger inflammation through autoimmunity. The continuous presence of the stimulus complicates pinpointing its source.
- Latent viruses within an individual become reactivated. Everyone carries dormant viruses, which can awaken under specific circumstances.
- The body undergoes chronic changes following the initial inflammatory response to COVID-19, where inflammation in one tissue can affect others.
Iwasaki acknowledges that their research has shown indications of all these hypotheses. She suggests that these scenarios might even unfold sequentially, with persistent viruses leading to latent virus reactivation and subsequent inflammation. Different individuals might experience a combination of these factors in varying degrees.
3. Isn’t Long COVID on the decline?
Data from the ongoing Household Pulse Survey, conducted by the Census Bureau and National Center for Health Statistics in the U.S., indicates a potential decrease in the prevalence of Long COVID. The proportion of participants who had previously contracted COVID-19 and reported experiencing new or persistent COVID-19 symptoms declined from 19% in June 2022 to 11% in January 2023.
While the exact reason for this decline isn’t clear, Dr. Erica Spatz, a Yale Medicine cardiologist, who is involved in the CDC-funded INSPIRE study (Innovative Support For Patients with SARS-CoV-2 Infections Registry), suggests that the decrease might be due to higher vaccination rates and the emergence of milder variants of the virus.
However, the total number of people affected by Long COVID remains uncertain. A study estimates that around 65 million people globally have the condition, but experts believe this number is likely much higher. Many COVID-19 cases might not have been reported, especially with the widespread use of at-home rapid testing since 2022. Additionally, people who confused COVID-19 with other illnesses or did not seek medical advice might have contributed to underreporting.
Despite the potential decline, healthcare professionals are still diagnosing new cases of Long COVID and treating those who have experienced persistent symptoms since the early days of the pandemic. Dr. Denyse Lutchmansingh mentions that since 2020, Yale specialists have received over 1,000 referrals for patients dealing with lingering symptoms after COVID-19.
4. Who is getting Long COVID?
Long COVID can affect individuals of any age. Dr. McAlpine emphasizes that she has observed cases across all age groups, including younger individuals without prior health issues.
Those who experienced severe COVID-19 illness, especially requiring hospitalization or intensive care, are at a heightened risk of developing Long COVID, as stated by the CDC. Individuals with pre-existing chronic conditions like diabetes, those who had multisystem inflammatory syndrome (MIS) during or after COVID-19, or those who remain unvaccinated are also at an elevated risk.
A study published in Health Affairs in March 2023 involving 800,000 people introduced another potential predictor: individuals with Long COVID were more likely to be older and female on average.
5. Are new cases of Long COVID milder than older ones?
Determining the trajectory of Long COVID’s impact is challenging due to limited data. However, Yale Medicine doctors have noticed changes as milder subvariants of the Omicron variant replace earlier Alpha and Delta variants, as well as the original virus strain. Dr. Lutchmansingh notes that considering the year of infection is important, as patients’ experiences vary. Anecdotal evidence suggests that those infected in 2021 and 2022 recover faster compared to those infected in 2020.
While new patients still grapple with symptoms, the prevalence of full-time disability seems to have decreased since earlier pandemic stages. Dr. Lutchmansingh mentions a decline in the number of patients on full-time disability, a significant concern among those with Long COVID. Notably, Long COVID is officially recognized as a disability under the Americans with Disabilities Act (ADA) and the Affordable Care Act (ACA). In 2022, a report estimated that 2 to 4 million Americans were unable to work due to Long COVID.
6. Will I need to see a specialist for my Long COVID symptoms?
The treatment approach for Long COVID is symptom-dependent, given that there is currently no cure for the condition. A study published in 2021 surveyed over 3,700 people with Long COVID, identifying around 200 symptoms that were categorized into specialties for treatment, similar to non-COVID patients with similar symptoms.
The specialists involved in treating Long COVID include:
- Pulmonologists: These doctors address breathing difficulties and can prescribe treatments like inhalers or biologic treatments for asthma-like symptoms. Exercise, tailored to the patient’s needs, may also be beneficial.
- Neurologists: Neurological symptoms range from headaches and neuropathy to cognitive difficulties, such as memory recall issues and language impairment.
- Gastroenterologists: Patients may experience stomach distress, bloating, constipation, diarrhea, and vomiting. Studies have shown increased gastrointestinal symptoms in individuals who had COVID-19 compared to those who did not.
- Cardiologists: While cardiovascular symptoms are less common, they include myocarditis, thrombosis, acute stress to the heart, cardiomyopathy, arrhythmia, and conditions like postural orthostatic tachycardia syndrome (POTS).
Each specialist addresses the specific symptoms within their domain, aiming to alleviate the effects of Long COVID and improve the patient’s quality of life.
7. What about Long COVID symptoms that aren’t easy to categorize?
Symptoms of Long COVID often overlap across multiple categories, creating complexity in diagnosis and treatment. A challenging symptom is “post-exertional malaise (PEM),” described by Dr. McAlpine as an energy crash or worsening of symptoms like fatigue, brain fog, and muscle pain after even mild exercise. The severity of PEM varies, ranging from a temporary bed rest requirement to several days of incapacitation following minimal activity.
Physical issues like PEM can contribute to anxiety and depression, exacerbating mental health concerns. These experiences can be disorienting and lead to new mental health challenges. Treatments such as cognitive behavioral therapy (CBT) and medications can assist in managing mental health aspects.
Sleep disturbances are also significant among Long COVID patients. Dr. McAlpine highlights the importance of sleep and the connection between COVID-19 and sleep disruption. Sleep specialists have diagnosed patients with insomnia and sleep apnea, although pinpointing Long COVID as the sole cause can be challenging. Sleep deprivation and disturbances have widespread implications, affecting cognitive function, healing, and headaches.
8. With so many different symptoms, how can I be sure I have Long COVID?
Diagnosing Long COVID lacks a definitive laboratory test, and even advanced medical tests like blood tests, chest X-rays, and electrocardiograms might yield normal results despite serious symptoms.
Diagnosis involves clinicians taking a comprehensive approach by considering a patient’s health history, conducting a physical examination, and gathering details about their COVID-19 infection diagnosis. Notably, some Long COVID patients are unable to confirm their past infection due to a lack of proper testing records or unawareness of their COVID-19 status.
Exclusion of other conditions is a crucial aspect of diagnosis. Dr. Lutchmansingh underscores the role of internists in coordinating Long COVID patient care and ruling out other potential causes of symptoms.
9. Can Paxlovid help Long COVID patients?
The effectiveness of Paxlovid, the primary COVID-19 treatment, in treating Long COVID lacks sufficient evidence. However, a randomized clinical trial is being conducted by immunobiologist Akiko Iwasaki and cardiologist Harlan Krumholz to explore its potential benefits for specific Long COVID patients.
The trial is essential due to the lack of available therapies for Long COVID patients. Iwasaki emphasizes the importance of starting the trial to determine which patients may benefit from specific medications, even though the underlying disease mechanisms are not fully understood.
The researchers believe that Long COVID’s diverse pathologies among patients suggest that not everyone would respond the same way to treatments. Blood samples collected before, during, and after Paxlovid administration will allow for the classification of positive and negative responders.
This classification will enable the recruitment of participants for a larger trial aimed at understanding the positive response to Paxlovid. The goal is to identify the appropriate therapies for individuals, even if it benefits a smaller percentage. The trial is currently available to residents of Connecticut, New York, and Florida, with the potential for expansion to other states.
(Anyone wishing to participate in the clinical trial can email YalePaxStudy@yale.edu for more information.)
10. Can vaccines prevent or help treat Long COVID?
The role of vaccines in preventing Long COVID remains uncertain, and ongoing research is being conducted to determine their effectiveness. According to immunobiologist Akiko Iwasaki, the current consensus is that vaccination prior to infection results in about a 30% reduction in the risk of developing Long COVID. This figure pertains to the preventive aspect of vaccines.
In addition to reducing the risk of Long COVID, vaccines might also influence the severity of symptoms in those who do develop the condition. However, further research is necessary to fully understand the impact of vaccination on Long COVID symptom severity.
11. Can I recover from Long COVID?
Research indicates that a significant number of people do experience improvement in their Long COVID symptoms over time. A study from Israel, published in the British Medical Journal (BMJ) in January 2023, found that the majority of Long COVID cases in nearly 300,000 individuals with mild COVID-19 infections had resolved within a year of diagnosis. The study spanned from March 2020 to October 2021 and encompassed both vaccinated and unvaccinated participants, predating the emergence of the Omicron variant.
Dr. Lutchmansingh shares her observations from her pulmonary practice, noting that she has seen two groups of patients. One group has shown improvement in their condition, although they may not have fully returned to their pre-COVID-19 state. The other group continues to face difficulties, experiencing multiple symptoms including pulmonary issues, fatigue, and neurological problems. While patients in both groups may not have entirely forgotten their COVID-19 experience, they are generally not as debilitated as they were in the earlier stages of the pandemic.
12. COVID-19 is no longer considered a public health emergency. Does that mean Long COVID will go away?
Predicting the future course of Long COVID is challenging, as its evolution remains uncertain. The emergence of the Omicron variant appears to result in a decreased prevalence of Long COVID and potentially milder symptoms. However, according to Akiko Iwasaki, the trajectory of Long COVID is unpredictable, and while the public health emergency may have subsided, the behavior of the SARS-CoV-2 virus is still erratic. If a new variant arises that substantially evades immune responses, the consequences for Long COVID remain uncertain.
13. What about those who think Long COVID shouldn’t be taken seriously?
Yale Medicine doctors emphasize the validity of Long COVID as a genuine condition that warrants medical attention. Despite the absence of comprehensive scientific understanding, individuals suffering from Long COVID can benefit from medical care. Some individuals might struggle to accept the condition due to the lack of conclusive scientific evidence, leading to instances where patients report symptoms that clinical tests cannot fully validate. However, according to Dr. Lutchmansingh, it’s important to believe patients and acknowledge that Long COVID is a real and legitimate concern. The medical community is actively working on strategies and treatments to provide relief and support for those affected by this condition.
Link to the full News (Yale Medicine):
