Multidisciplinary teams are best equipped to combat long-term COVID-19 ailments, healthcare providers said.
COVID-19 can cause organs to swell and damage tissues, triggering lingering symptoms like shortness of breath, fatigue and loss of smell. A team of UK-based researchers estimated that around 10% of COVID-19 patients are “long-haulers,” but other studies found that up to three-quarters of COVID-19 patients experience at least one long-term effect.
One patient told the UK researchers that it had taken eight weeks to start feeling close to his normal self, enduring “fatigue to the point of having to sleep in the day, inability to exercise, shortness of breath both motionless and when exerting, small waves of anxiety, considerable depression, continued loss of smell—symptoms that I have no medical history with.”
Although providers are still grappling with why the immune response to COVID-19 persists for some patients, it could lead to permanent lung scarring, blood clots, heart failure and psychological disorders, said Dr. Joshua Lee, a pulmonologist at Newark Beth Israel Medical Center. Long-term symptoms can impact all COVID-19 patients, even if the case was relatively mild, he noted.
“Because the post-COVID syndrome affects the entire body, that’s the approach we have to take when we take care of these patients,” Lee said during a webinar late Tuesday, adding that physical therapy, nutrition supplements and pulmonary rehabilitation can help patients regain strength and lung function. “It’s not just about seeing a pulmonologist or a cardiologist, it’s more about having the whole team together to take care of your body and the symptoms you are experiencing. The collaborative approach should be the standard of care.”
It’s hard to pin down how prevalent post-COVID syndrome is, providers said, noting several studies with varying estimates. About a third of 488 COVID-19 patients had lingering symptoms 60 days after they were released from Michigan hospitals, the most common being shortness of breath, coughing and loss of smell. Nearly 19% had new or worsening symptoms, according to an observational study published in the Annals of Internal Medicine.
“It’s not uncommon that a patient with mild symptoms might develop a progressive lung injury and the recurrence of weakness and fatigue that can lead to lung failure,” said Dr. Jesus Gomez-Abraham, the associate surgical director of lung transplantation at Newark.
Of the 1,648 COVID-19 patients admitted to those hospitals, 398 died during hospitalization—an additional 84 died within 60 days after discharge, the Michigan study found. That translated to a 29.2% mortality rate.
“About a third of patients who are hospitalized for COVID-19 have evidence in their blood tests of injury to their hearts,” said Dr. Peter Libby, a cardiologist at Brigham and Women’s Hospital who was not affiliated with the study. Libby recently published a paper in the European Heart Journal linking COVID-19 complications to altered endothelium functioning.
There are more than 60,000 members of long-haul COVID support groups on Facebook, an informal search revealed. One member recently posted that they didn’t have the worst symptoms when they had the virus, but they cycled between acute and mild long-term symptoms over the past year.
“I got better. I hiked with my dog about 2 miles per day. And now I am worse. Terribly fatigued every day, hardly an appetite and dry cough on and off all day. I have been in bed mostly all week and a friend has taken my dog for this week as I was too weak,” they wrote.
Since so much is unknown about COVID, it is important for patients to follow up with their primary-care doctor and specialized clinics like Newark, which has pulmonary hypertension and rehabilitation specialists, cardiologists, physical therapists and nutritionists on site, said Dr. Christina Migliore, medical director of quality at Newark.
“We have seen patients in clinic who have had mild COVID symptoms and they’ve kept progressing and feel more and more short of breath as time has gone on, despite being COVID negative,” she said. “The lingering effects are just something we don’t know.”