Siliconeer | Long-Term COVID: The Next Pandemic?

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Long COVID has potentially affected up to 23 million Americans, and left 1 million people permanently unable to work, according to a recent report from the U.S. Government Accountability Office. A study released earlier last month in the scientific journal Nature concludes that nearly half of patients who suffered from symptomatic Covid have not recovered several months later.

(Above, l-r): Dr. Nisha Viswanathan, Director of UCLA’s Long COVID Program. Viswanathan is a primary care physician and assistant professor at the David Geffen School of Medicine at UCLA; Dr. Jose Luis Perez, Chief Medical Officer, South Central Family Health Center; and Michelle Burroughs, MPH, Director of Community Engagement and Outreach for the UC Riverside. (EMS)

At a briefing jointly hosted by Ethnic Media Services and California Department of Public Health ‘Vaccinate All 58’ campaign, Oct. 26, speakers – Dr. Nisha Viswanathan, Director of UCLA’s Long COVID Program. Viswanathan is a primary care physician and assistant professor at the David Geffen School of Medicine at UCLA; Dr. Jose Luis Perez, Chief Medical Officer, South Central Family Health Center; and Michelle Burroughs, MPH, Director of Community Engagement and Outreach for the UC Riverside – addressed the role of vaccines in mitigating long COVID; symptoms of long COVID; managing long COVID symptoms; disparities in the delivery of care to vulnerable populations. They explored answers to questions like – Could proper treatment in the first stages of infection possibly prevent long COVID? Is lack of access to antiviral medications contributing to the high number of lower-income people suffering from long COVID? Are certain communities more vulnerable? Are genetics and underlying conditions involved?

Dr. Jose Luis Perez gave us overview of long COVID and the role of vaccines.

“There is no clear definition, what we know is that patients that suffer from long COVID have a wide range of ongoing health problems after being infected with COVID 19, which is a stepping-stone into this area for most patients.

“There are no tests thus it is difficult for healthcare providers to recognize especially when you see the symptomatology associated with it. It can be one of a thousand things for primary care providers, you must have had a COVID infection either by a positive test; by symptoms or exposure; or by an examination by healthcare providers.

“Symptoms can last for weeks, months, and sometimes longer, more often in patients with severe COVID disease, but there have been cases of patients with mild moderate symptoms that can also experience long COVID.

“Patients with long COVID can experience a combination of symptoms – the number one in all the categories are the most common – tiredness or fatigue. Every time you engage in physical or mental activity, you just don’t feel yourself, and you feel sick.

“Some folks experience a fever on and off in their lungs, and their heart, respiratory and cardiovascular system, experience shortness of breath.

“Folks that were physically active prior to the COVID infection –  runners, people who hit the gym on a regular basis, can no longer do that and get very winded, get palpitations very frequently, and cannot do the physical trainings that they used to do.

“It’s even worse for those who were not as fit. People who already had issues with their physical fitness, find themselves having even a harder time doing minimal physical accessions. “People with long COVID complain of foggy brain, difficulty thinking or concentrating. Headaches, sleep disturbances, dizziness, changes malar taste, are some of the cardinal symptoms for COVID infection, and it may extend into the post-COVID infection period, into the long COVID time.

“Long COVID patients are anxious and depressed. There’s something going on in the brain that makes it more possible for people to feel depressed as the interaction between immune system and neurotransmitters in the brain are unclear.

“Diarrhea, stomach pain, are less common. Other symptoms such as joint and muscle pain, rashes, and for women of reproductive age, they can have changes in their menstrual cycle. The symptoms are very hard to explain and can be due to other health conditions which makes it very hard to identify.

“The medical and the research community don’t know much about what is the pathophysiology that occurs in long COVID. Is it blood clots; is it an abnormality in the immune system? We just don’t know. But there’s quite a lot of research happening and we’re hoping to have some answers in the future.

“People uh who got severe COVID disease are a particularly at risk of developing long COVID, especially those hospitalized, and those needing ICU care.

“People with underlying conditions like diabetes, hypertension, asthma, obesity are at major risk for having severe COVID, and are at a higher risk of developing long COVID.

“Those who experience multi-system inflammatory syndrome, more of an issue in the pediatric population, although the adult population did get it.

“There are all kinds of theories – the virus itself mimics some of the cells in the body, so the body mistakenly attacks the organs like liver, kidneys, stomach, the most common autoimmune process that people recognize is rheumatoid arthritis and lupus.

“Overcrowding, multiple family members, multiple generations sharing the same space, are at higher risk of acquiring the virus. Under or uninsured, lack of access to health care, distrust of the health care system, delayed second treatment all allow for worsening of the infection. “More severe infections mean higher risk of developing a long haul COVID. Language barrier, immigration status, deleting access to care, homelessness, environmental factors, older neighborhood, increasing traffic, doing chemicals, lead to respiratory illnesses.

“The important thing here is to treat it holistically. It is very important to continue training the healthcare providers in the identification on long COVID.

“At this time, the most important things to remember – prevent the infection in the first place. The three W’s – Watch your distance; Wash your hands; Wear a mask,” said Dr Perez.

Dr Nisha Visvanathan, director of the long COVID program at UCLA, spoke about her program from UCLA, “We created the program here about 18 months ago to help our patients having persistent symptoms after their COVID infection, to determine two things – one, is this truly long COVID or are we dealing with a different clinical problem; or is this a new medical issue that has nothing to do with COVID.

“It is difficult for primary care doctors to have the time to spend an hour with their patients talking about all of their symptoms, often when we get referrals from primary care doctors, they haven’t been able to do that comprehensive deep dive and we often find that there may be other issues going on.

“We try to focus on a symptom-based strategy. Some of our patients have numerous symptoms – fatigue, shortness of breath, brain fog, and some will just have isolated symptoms like loss of taste and smell, and we are trying to use the knowledge we already have about other medical conditions to help our patients with their current symptoms.

“There have been some studies done this year on the role of COVID vaccination and if it truly is protective against lung COVID. There have been various studies, the conclusions of which have varied anywhere from 15 to 50 in terms of the vaccine’s effectiveness in preventing long COVID. I think more research has to be done here and ultimately truly the best answer is ‘if you don’t get COVID at all, obviously that is the best way to prevent getting long COVID.’

“There has been a study done on could vaccination be something that could help our patients with symptoms of long COVID.

“The role of Paxlovid in treating long COVID – there was some early success with this in terms of patients who were saying that when they took Paxlovid, they were feeling better in terms of their symptoms.

“Pfizer decided not to pursue this as a long-term study. They wanted to limit the drug to the use of acute COVID and they don’t believe that there’s the data use on an ongoing way. At this point we do not recommend it as a treatment for our patients with long COVID.

“I’ve seen a lot of luck with using many of our antidepressants and managing the brain fog especially because we now know that with long COVID it can really change the hormones in your brain and this can lead to depression, anxiety, PTSD, as well as concentration issues which are some things that our patients notice quite often.

“I’ve found that often involving an effort towards their mental health, both in terms of medications as well as involving a therapist, these have been successful strategies. In addition, we also do talk about using other types of more multi-disciplinary treatments for patient symptoms.

“One area of success has been the anti-inflammatory diet, a diet that’s primarily more plant-based, involves eating less red meat, focuses more on whole grains, nuts, and avoiding sugar and alcohol has also been shown to have some improvements for many of our patients.

“When we’re struggling with making sure you have an insurance that is accepted by the various doctors we may refer you to, when you may not have enough money to be able to purchase a lot of fruits and vegetables, and all the various things that are required to kind of keep that healthy diet, or when we’re talking about trying to get in a more normal weight or controlling your other medical issues such as your diabetes, and your cholesterol, in the process of also managing your long COVID, for many of our patients this has been difficult.

“One of the big strategies we’ve really focused on is when our patients have debilitating fatigue and shortness of breath, or brain fog, it may be really difficult to work and when we suggest taking any time off of work to focus on their recovery, patients who have less financial means then ask me ‘how am I supposed to pay my rent? ‘how am I to take care of my family?’ especially when people may have young children at home, and I think that delivering long COVID care has actually made not only myself but many of us realize the challenges of treating our patients with chronic illnesses especially now because we’re dealing with a chronic illness that is affecting a far younger population than we’re traditionally used to.

“Primary care doctors are used to treating complex medical issues – heart failure, diabetes, things that may require frequent check-ins, but this tends to be for an older patient population and fortunately in this country, because our older patient population has access to Medicare they may be able to they may be able to actually get resources to cover a lot of their medical care versus our younger patient population may not have that same access to the resources that is provided by Medicare.

“It’s going to take a lot of effort from both health care systems, governments, individuals to try to help us continue to create awareness so that more can be done in terms of not only research to determine what helps, but how do we get things that help to the people who need them. I think that long COVID has opened our eyes to the challenges of doing this type of care,” said Dr Viswanathan.

Michelle Burroughs from UC Riverside discussed overall disparities in accessing healthcare amid the pandemic, why a significant percentage of black people remain unvaccinated and support services for long haulers including disability insurance.