While there is no general definition for the condition, there are clues to the causes of this constellation of symptoms and possible treatments.
Among the many confusing aspects of the coronavirus are the variety of possible symptoms, as well as their severity and duration. Some people develop mild illness and recover quickly, with no lasting effects; however, studies estimate that 10 to 30 percent of people develop new or persistent medical problems months after initial coronavirus infection.
This constellation of symptoms is known as persistent or prolonged covid . People with mild or moderate illness, as well as those with no underlying medical conditions, may nevertheless experience some long-term debilitating symptoms, such as fatigue, shortness of breath, erratic heartbeat, headaches, dizziness, depression, as well as memory and concentration problems.
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These persistent medical problems are so varied that a study by a patient-led research group evaluated 203 symptoms that can fluctuate or even appear out of the blue after people seem to have recovered.
As noted by Ziyad Al-Aly, a physician and chief of research and development for the St. Louis Veterans Affairs Health Care System and a public health clinical researcher at Washington University in St. Louis, “if you’ve cared for a patient with persistent covid, you have cared for a patient with persistent covid”.
How do doctors diagnose persistent covid today?
There is little consensus on the exact definition of this disease, also known by the medical term PASC, or post-acute sequelae of COVID-19. Although the World Health Organization says that persistent covid begins three months after the original disease outbreak or positive test result, the Centers for Disease Control and Prevention (CDC) of The United States sets the time frame just after a month.
Other timeframes are used by some researchers and health care providers, making it difficult to study and quantify the disease, said Al-Aly, who has conducted many studies on the problems of persistent Covid.
When patients with persistent symptoms go to their doctors, tests such as EKGs, chest X-rays, CT scans and blood tests don’t always identify physiological problems, Al-Aly said. Researchers are working to identify certain biological factors, called biomarkers, that are linked to persistent symptoms of covid. These could include symptoms of inflammation or certain molecules produced by the immune system, which could be measured by blood tests, for example.
For now, doctors rely on their patients’ descriptions of symptoms and rule out alternative explanations or causes. Some post-Covid clinics have multidisciplinary teams of specialists who evaluate patients to determine the best treatment options.
What are your causes?
It’s not clear what exactly causes persistent covid, but research has begun to offer clues. Some experts theorize that an immune response that kicks into high gear when you first get sick can lead to inflammation and damage throughout your body, leading to persistent Covid symptoms, said Michael Peluso, an infectious disease physician at the University of California at San Francisco.
“We know that during the acute phase of COVID-19, some people have a very heightened immune response and others have a reduced immune response, and that response can determine the trajectory of the person’s evolution,” he said.
According to experts, another explanation could be that the immune system never fully shuts down after the initial infection.
Who is at risk?
Research offers some clues about which patients might face a higher risk of long-term symptoms. In a study of 209 patients published in January, researchers found four factors that could be identified early in a person’s coronavirus infection and appeared to be associated with a higher risk of experiencing prolonged symptoms two to three months later.
One of the factors was the level of coronavirus RNA in the blood early in the infection, an indicator of viral load. Another was the presence of autoantibodies, that is, antibodies that mistakenly attack the body’s tissues, as occurs in diseases such as lupus and rheumatoid arthritis. A third factor was the reactivation of the Epstein-Barr virus, which can cause mononucleosis and infects most people, often when they are young, and then goes dormant.
The fourth factor was having type 2 diabetes, although experts say that in studies with larger numbers of patients, diabetes could be just one of several medical conditions that increase the risk of persistent covid.
Post-Covid clinic studies also found other pre-existing conditions that may put people at risk for this disease. In a report on the first 100 patients treated for neurological and cognitive symptoms at a post-Covid clinic at Northwestern Memorial Hospital in Chicago, 42 percent said they had previously suffered from depression or anxiety, although it could be that these patients simply felt more comfortable seeking neurological treatment, doctors said. Other pre-existing conditions included autoimmune diseases and headaches.
Studies also suggest that the risk of developing persistent Covid peaks in middle age, Peluso said. The average age of patients in the Northwestern study was 43 years. An analysis of 78,252 private health insurance claims across the United States found that people ages 36 to 64 made up about two-thirds of long-term Covid patients (but that study didn’t include most Medicare beneficiaries, so that there were relatively few elderly patients).
Women may be disproportionately affected, with some studies revealing that around 60 percent of patients are women. A similar pattern has emerged in other long-standing illnesses, such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), which features several symptoms similar to those of persistent covid.
Because the pandemic has had a significant effect on the black and Latino communities in the United States, and because these groups have more limited access to health care, they may also have a high number of persistent Covid cases, Peluso said.
Do vaccines offer protection against persistent covid?
The picture is still taking shape, but several studies suggest that getting vaccinated against covid can reduce—but not eliminate—the risk of long-term symptoms.
The UK Health Security Agency analyzed eight studies that had evaluated vaccines and persistent covid before mid-January. Six found that people who were vaccinated, and who later contracted coronavirus, were less likely than unvaccinated patients to develop symptoms of persistent covid. The remaining two studies found that vaccination did not appear to definitively reduce the chances of developing persistent covid.
In that analysis, an unreviewed study of some 240,000 U.S. patients found that those who had received even one dose of the Covid vaccine before becoming infected were seven to 10 times less likely than unvaccinated patients to develop persistent covid symptoms 12 to 20 weeks later. Yet another large study of electronic patient records from the U.S. Veterans Health Administration, which also has not been peer-reviewed, found that those who were vaccinated had only a 13 percent lower risk than unvaccinated patients. symptoms six months later. The vaccinated patients mainly benefited from being less likely to develop lung problems and blood clotting difficulties, said Al-Aly, one of the study’s authors.
"It is absolutely inappropriate to rely on vaccination as the sole mitigation strategy," Al-Aly said. "It’s like going into battle with a shield that’s only partially working."
seek medical attention
If you are worried about any persistent symptoms after confirming or suspecting a coronavirus infection, don’t be afraid to ask for help. Consulting your GP is a good first step. More and more doctors are aware of the symptoms of persistent covid and can recommend tests that at least rule out other causes of your symptoms.
"Although let’s say persistent covid occurs when symptoms last one to three months after infection, you don’t have to wait that long to get help," Al-Aly said. "People should attend to their symptoms."
If you don’t get help from a primary care doctor, you can seek out a post-Covid clinic, although Al-Aly acknowledged that "it’s easier said than done." In the United States, access to post-Covid clinics can be difficult for those without adequate health insurance. And, in some states, you have to travel hundreds of miles to get to the nearest store. In the United States, you can search for post-covid clinics near you in the Survivor Corps database.
Bring your medical history with you if you are going to see a new provider and make a list of all your symptoms, especially if you have cognitive issues and are likely to forget about some health issues at the time of the appointment.
Some persistent covid issues can be fixed with medications or existing treatments for symptoms like headaches or gastrointestinal issues. Physical therapy and "cognitive rehabilitation," including strategies often used for patients who have had strokes or brain injuries, may also be helpful over time. Some people benefit from tailored physical and mental rehabilitation services and breathing exercises, which can help them gradually regain strength and endurance for physical activities.
Other possible tools against persistent covid, such as antiviral treatments, are only beginning to be studied. The National Institutes of Health is devoting more than a billion dollars to a major research effort called the Recover Initiative, but progress has been slow so far. Lawmakers are pushing for improved funding for prolonged COVID research and care.
Several groups, such as Body Politic, the Long Covid Alliance, and Survivor Corps, offer emotional support as well as resources for seeking treatment, disability benefits, and patient advocacy.
People with persistent Covid may also consider joining a research trial, Peluso said. You can find ongoing clinical trials at nearby universities and academic centers or sign up to be part of the Recover Initiative.
“Participating in research can be very stimulating,” Peluso concluded.