When COVID lingers

Long COVID involves a variety of new, recurring or ongoing symptoms experienced more than four weeks after people initially contract COVID-19.

In some, these symptoms last months or years, causing mild lethargy, chronic fatigue, depression and other conditions, as well as, for many, the inability to live as they previously did.

Research suggests that between one month and one year after first experiencing the symptoms of COVID-19, one in five people aged between 18 and 64 years has at least one medical condition that might be due to the COVID virus. Among those aged 65 and older, the proportion is one in four.

Associate Professor Anthony Byrne is a thoracic physician at St Vincent’s public and private hospitals in Sydney. Along with Professor Steven Faux, he leads the Long COVID Rehabilitation Clinic at St Vincent’s.

“We have a six- to 12-month waitlist at present,” Professor Byrne said of the clinic. “With increased staffing, we’re hopeful that this will reduce to three months later in the year.

“A specialist clinic like ours sees the most severely affected patients. Many are unable to work, months after the virus, and have already seen their GP, and often other specialists. Some have had visits to the emergency department with chest pain and breathlessness.

“Most patients will benefit from GP and allied health support, but some are still debilitated and are looking for answers. We don’t have all the answers but can investigate less common causes of their symptoms, which can lead to specific treatments for asthma, bacterial and fungal infections, blood clots, insomnia, sleep apnoea and chronic pain, etc.”

Risk factors 

• A severe illness that coincides with the onset of COVID-19, especially if this has required hospitalisation.
• Experiencing certain medical conditions before contracting the COVID-19 virus.
• Experiencing a condition that affects the organs and tissues (multisystem inflammatory syndrome) while sick with COVID-19 or later.

Long COVID is more common in adults than in children and teens.

Symptoms 

• Fatigue.
• Inability to sustain physical activity due to respiratory difficulties or lethargy.
• Fever.
• Lung (respiratory) symptoms, including difficulty breathing or shortness of breath and coughing.

Less common symptoms may include:

• Neurological or mental health conditions such as difficulty concentrating, headaches, sleep problems, pins-and-needles feeling, a loss of smell or taste.
• Joint or muscle aches.
• Heart symptoms or conditions, including chest pain and fast or pounding heartbeat.
• Digestive symptoms, including stomach ache or indigestion.
• Blood clots and vascular issues, including deep vein thrombosis.

Treatment/management 

If someone is experiencing one or more of the symptoms listed above, consulting with their primary healthcare provider is advised. A pharmacist can explain what a doctor or specialist practitioner will be likely to ask and what tests or investigations may be part of the consultation process, including:

• What exacerbates or causes symptoms to appear.
• How often these symptoms occur and for how long.
• How symptoms affect lifestyle and activities.

“We see patients from 16 to 90 years of age,” Professor Byrne said. “Most are 20 to 50 with a two-to-one female predominance. Most were not admitted to hospital for their initial infection. Many have missed weeks or months of work. Some have other comorbid diseases, but many were previously fit and well in high-paying, professional jobs. Stress at the time of acute infection is a strong predictor of long COVID and is also a factor in preventing recovery.

“Recovery from long COVID is variable, but for the five to 10 per cent that have long COVID at three months, most are still affected by 12 months. However, with comprehensive management, they’re much more functional and less disabled.”

References

• Mayo Clinic. COVID-19: Long-term effects.
• St Vincent’s Hospital. svhlunghealth.com.au/about-us/whats-new/new-post-acute-long-covid-clinic.
• Theconversation.com The mystery of ‘long COVID’: up to 1 in 3 people who catch the virus suffer for months. Here’s what we know so far.

This Health Series feature was originally published in the May issue of Retail Pharmacy magazine.