The downslope of the Covid crisis is proving to be its own bumpy ride — and there’s no telling yet how long it will last. We’ve learned a tremendous amount about the disease itself, but in terms of grasping the impact of lingering post-Covid Syndrome, or Long Covid as it’s often called, we’re just getting started.
As hospital admissions from Covid decline, clinics dealing with post-Covid effects are being flooded with demand and questions around treatment are proliferating. Addressing the problem will require more resources at a time when health-care systems are tapped out. That’s hard in the UK, where hospital executives say they will have to cut back services if the Treasury can’t find more funds than what Chancellor Rishi Sunak put in last week’s budget.
So far, research into Long Covid has suffered from various limitations, such as small sample sizes or truncated follow-up periods. Even so, the emerging picture is stark.
Britain’s Office for National Statistics estimates that 23.6% of females with Covid-19 and 20.7% of males continued to experience symptoms five weeks after they tested positive for the virus. Nearly 10% had symptoms 12 weeks later.
More than 117 million people around the world have been infected with Covid-19. If at least one in 10 experience symptoms that persist for weeks or months after the virus has left their body, that’s a lot of disability, however temporary. The reported symptoms list is too long to publish here but includes fatigue, breathlessness, brain fog, muscle aches, stomach illness and heart palpitations. Long Covid doesn’t care if you’re young or super fit or just had a mild case of the virus.
At University College London Hospital, the clinic for post-Covid treatment is a multidisciplinary team involving respiratory, cardiology and neurology specialists, as well as occupational therapists and psychologists. It is struggling to keep up with demand, says Melissa Heightman, a respiratory physician and clinical lead. Only about one-third of their non-hospitalized patients with post-Covid illnesses have recovered fully, she says. “I think we’re at the worst moment, because we are facing the second wave needing follow up. The referrals at the clinics are twice the number we can cope with.”
The problem isn’t only the number of patients struggling with Long Covid; it’s also that there is still much we don’t know about how to treat the condition that is complex and can affect different systems of the body.
Doctors treating post-Covid patients find sharing experiences invaluable. Steroids, antihistamines and Vitamin D have been shown to help reduce symptoms in some cases. Some patients are put on beta-blockers to control their elevated heart rate; a common treatment for gout has helped improve chest pain in some patients. Rest seems a universal protocol, whereas exercise can lead to a relapse. Researchers and patients (sometimes one and the same) exchange experiences, hope and exasperation on Facebook groups, Twitter and other social media.
Needless to say, there’s plenty of unscientific advice going around too. When Gwyneth Paltrow, founder of the lifestyle brand Goop, suffered “long-tail fatigue and brain fog” after her bout with Covid-19, she was recommended a program of “intuitive fasting,” which includes fasting until 11 a.m. every day and eating a keto and plant-based diet, by leading “functional medicine practitioner” Will Cole, who isn’t a medical doctor.
Paltrow was so happy with the results that she wrote about it in her blog, but the details (including regular use of an infrared sauna) set off alarm bells in the medical community. “We wish her well, but some of the solutions she’s recommending are really not the solutions we’d recommend in the NHS,” said Stephen Powis, medical director of the National Health Service in England.
Still, this points to many unanswered questions. What causes post-Covid fatigue? The NHS’s Covid Recovery website informs sufferers that it could be a continued response to the virus, or it could just be the “effect of a serious illness.” What makes this fatigue last a long time? The official word is, “in some people, different things.” Who’s to say special diet regimes might not help on the margins?
There is some encouraging evidence that vaccines have helped people with their post-Covid symptoms, along with some serious theories on why that might be the case. Perhaps this potential benefit will help reduce vaccine hesitancy, especially among ethnic minorities and younger people.
And given emerging evidence that children can also suffer longer-term effects of the virus, there’s a case for vaccinating them too if current trials establish they are safe and effective for those under 18.
The good news is that Long Covid sufferers are getting attention — there are some 70 Long Covid clinics around the UK, and, according to NBC News, more than 80 post-Covid clinics in the US. This is a feat if you consider how relatively new Covid is. It took more than 80 years to determine a diagnosis for what’s known as Chronic Fatigue Syndrome or ME/CFS. Today it affects an estimated 2.5 million Americans and shares symptoms with Long Covid.
The costs of ignoring illness are high. ME/CFS sufferers have greater health care needs, are more likely to be unemployed, often require care from family members and are more likely to attempt suicide. Research into ME/CFS remains paltry, but sufferers are hoping that the interest in Covid’s after-effects will help shed new light on their own plight. Maybe they will get answers too. The US National Institutes of Health has just announced funding worth $1.15 billion for investigations into Long Covid, which it has named Post-Acute Sequelae of Sars-CoV-2 or PASC.
For now, though, many suffering from Long Covid will have to continue to rely on support groups and their own reserves of patience. “Patients are expecting an awful lot from a health service that is pretty much defeated,” says Heightman. “We are so tired. And we don’t have enough of the right skillset in the right place. This is the moment to try to sort this out.”
Bloomberg
