Long-term COVID-19 study opens door to further exploration of post-viral diseases

For decades, scientists have studied why some people experience long-term illness with even minor infections. Now, as millions of people suffer from similar phenomena after contracting COVID-19, new funding and research efforts are beginning to unravel some of the mysteries that could help explain long flu, long colds, and long COVID.

Dr. Todd Ellerin, chief of infectious diseases at South Shore Health, said about 8 million people have long-term COVID-19 complications, including increased heart rate, brain fog and chronic breathing that lasts for months after the initial infection. short.

However, postviral illness is not a new phenomenon. COVID-19 has raised awareness of many other infectious diseases associated with post-viral illness, including infectious mononucleosis and Lyme disease.

“Regardless of the virus, a person may continue to experience symptoms weeks or even months after the acute phase of the initial infection,” said infectious disease epidemiologist Dr. Syra Madad.

These symptoms are severe enough to impact a person’s quality of life, whether they are leaving the house for work, going out to social events or simply being able to carry out daily activities.

Chronic fatigue syndrome is another post-viral disease that has been prevalent long before the COVID-19 era. It is defined as debilitating fatigue that lasts for at least six months, excluding other causes of fatigue.

“The first thing that’s important is to really recognize that this disease is real,” said Dr. William Schaffner, professor of medicine in the department of infectious diseases at Vanderbilt University. Historically, patients with chronic fatigue syndrome have been viewed with great suspicion—even by doctors.

Many of these syndromes manifest as “invisible” illnesses, Ellering said. “There’s a disconnect between the results and what patients are complaining about. When we do blood tests or imaging or X-rays, everything comes back normal. We don’t know the exact cause of these syndromes, we don’t know what exactly we’re dealing with, and that’s confusing People are depressed.”

“Imagine lying in bed for 18 hours a day,” Ellering continued. “That’s what we’re talking about. It’s hard to look into a patient’s eyes and know that you don’t know how to solve their problem.”

Despite decades of setbacks, new research funding set aside for long-term COVID-19 patients offers hope for the future and could help guide treatments.

Even in cases of uncertainty, it’s important to name a diagnosis, Ellering believes.

“If you don’t give it a name, how are you going to define it, and if you can’t define it, how are you going to study it?” Ellering asked.

Researchers at the Perelman School of Medicine at the University of Pennsylvania recently discovered that long-term COVID-19 patients have different levels of chemicals in their bodies compared to those who have recovered, most notably serotonin levels.

“Serotonin levels are reduced, and that’s a correlation. It doesn’t mean that’s the answer, but maybe if we replace their serotonin, maybe they’ll do better,” Ellering said.

In the meantime, effective treatments can help patients feel better. This may include lung exercises, cardio exercises, pain management, physical therapy and mental health treatment.

The emergence and severity of long-term COVID-19 has spurred not only scientific research but also the establishment of many clinics across the United States, including one at the University of Pittsburgh Medical Center. Patients are eligible to visit the clinic if they are at least 8 weeks away from their first COVID-19 diagnosis. About 60% of patients are self-referred. Long COVID experts work with consultants in pulmonary/sleep medicine, cardiology, neurology and physical medicine, as well as rehabilitation, physical and occupational therapy and mental health treatment.

Schaffner said treatment is primarily “supportive” and focuses on symptoms. For pain, physical therapy can help patients cope and respond quickly. For brain fog, patients receive a variety of mental exercises and short-term memory training to help them focus and stay on task.

For patients with unexplained exercise limitations, Dr. Michael Risbano, assistant professor of medicine in the Department of Pulmonary and Critical Care Medicine at the University of Pittsburgh Medical Center, can perform advanced cardiopulmonary exercise testing (ACPET), a minimally invasive procedure performed on the heart. Catheterization lab. This test could help identify different causes and treatments for exercise limitations in long-term COVID-19 patients and could help them return to baseline levels of physical function.

Experts say that as with many post-viral diseases, it’s important to first reduce your risk by getting timely vaccinations.

“I don’t think people take this seriously enough. Not only do these vaccines work for the acute phase of infection, but even in the long term, it reduces your chances of having some of the long-term chronic problems,” Madad said.

COVID-19 and influenza vaccines are now available and are recommended for the upcoming winter respiratory virus season. The RSV vaccine is also given to older adults, infants, and some pregnant women.

In the meantime, Madad said it’s important for doctors to stay up-to-date on the best ways to treat patients with post-viral illnesses.

“There are patients who become very frail as a result,” Ellering said. “We’re talking about millions of people around the world.”

As doctors continue to search for effective treatments, Schaffner said, “It’s important for physicians to recognize the disease, have empathy for the patient, and let them know that you as a physician will be with them.” , taking care of them as best as they can. That gives patients comfort. They can pretty much hang on.”

Krupa V. Patel, MD, is a resident physician in the Department of Anesthesiology at the University of Pittsburgh Medical Center and a member of the ABC News Medical Team.