This article by Robert Glatter, MD was originally published by Forbes on February 20, 2021.
As people with long Covid come to grips with ongoing symptoms such as fatigue, chest pain, difficulty breathing and brain fog, the ongoing question has been when—and if— such symptoms may potentially end.
With prior research indicating that lingering symptoms may last at least several months among those who were never hospitalized, new data from a research letter published in JAMA indicates that up to a third of predominately outpatients continue to have symptoms, some lasting up to 9 months.
While the study from researchers at the University of Washington was small, it adds to the ongoing body of literature detailing the chronicity of the disease in growing numbers of people. For their study, researchers conducted a follow-up questionnaire of 177 patients between 3 and 9 months after onset of Covid-19, with an average age of 48 years (age range,18-94 years).
Of the 177 mostly outpatients (90% never admitted to the hospital), researchers found that the most common chronic symptoms were fatigue (24/177 patients) and loss of smell or taste (24/177 patients). Four patients (2.3%) also reported brain fog, among 23 patients (13%) reporting other symptoms.
Among patients surveyed, hypertension was the most common underlying chronic condition. Overall, 49 of 150 outpatients (32%), and 5 of 16 hospitalized patients (31%) reported at least 1 persistent symptom. The study found that of 31 patients with hypertension or diabetes, 11 (35%) experienced ongoing symptoms.
“This small study shows that in certain individuals a long tail of symptoms post Covid-19 can occur.” said Amesh Adalja, MD, an Infectious Disease physician and Senior Scholar at Johns Hopkins Center for Health Security. “The key is untangling the cause, the risk factors, and determining whether all these patients are alike or represent different disease processes.”
“For example, loss of taste and smell is different in kind than an ADL (activities of daily life)-limiting symptom,” offered Adalja.
Figuring out if there is a common immunologic defect among all patients who develop long Covid is one of the greatest challenges researchers have been attempting to unravel, as Adalja suggests.
Covid-19 research points to the role of post viral inflammation from SARS-CoV-2, leading researchers to compare Covid-19 to other chronic diseases such as ME/CFS (myalgic encephalomyelitis) seen in patients with chronic post viral fatigue and weakness after developing Epstein-Barr virus, Ebola, Ross River virus, various enteroviruses, as well as West Nile Virus and Borrelia burgdoferi (Lyme disease).
Dr. Anthony Fauci, Director of the National Institute for Allergy and Infectious Disease (NIAID) said in a Medscape interview with Dr. Eric Topol that long Covid patients may develop “ a post-viral syndrome that’s very strikingly similar to ME/ CFS.” But confirming this is an ongoing challenge.
That said, we do know that patients present with symptoms indicating loss of fine regulation of the autonomic nervous system—a system which controls involuntary functions such as heart rate, breathing, blood pressure, sweating and body temperature. One example of such dysfunction is manifested as POTS (postural orthostatic tachycardia syndrome) syndrome, in which post viral inflammation is believed to upset the ability of blood vessels and nerves to respond to changes in volume or blood pressure, leading to inappropriately elevated heart rates, low blood pressure and fainting. POTS can lead to significant impairment in daily functioning, and is one of the most serious conditions associated with Long Covid.
The heart failure drug, ivabradine, (Corlanor), may potentially help to ameliorate elevated heart rates and other associated symptoms associated with POTS, according to results of new study recently published in the Journal of the American College of Cardiology. The study found that the drug significantly lowered standing heart rates compared with placebo, blunting the typical surge in heart rate associated with standing in patients with POTS. Ivabradine’s utility may derive from its ability to reduce heart rate selectively, while not lowering blood pressure.
While there are many subtypes of POTS syndrome, it’s possible this drug may potentially help treat Long Covid patients with this disorder. Current approaches include midodrine, a drug which increases blood pressure but often has debilitating side effects (skin tingling, abdominal pain, urinary problems, dry mouth, dizziness, drowsiness, chills and “goosebumps”) and fludrocortisone which may lead to weight gain and fluid retention. While beta blockers may also be used, they can lower blood pressure, increasing risk for depression and fatigue.
