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The Medical Minute: When you’re in it for the long haul with COVID-19

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Almost a year after fighting a severe case of COVID-19, Tamika Washington lives with lingering effects that leave her gasping for breath, chronically fatigued and anxious about her future.

“I’ve seen some small improvement recently, but I do wonder what my quality of life will be like in 10 or 20 years if I am this young and already have all these problems,” said the 42-year-old Hummelstown resident, who was hospitalized for two weeks at Penn State Health Milton S. Hershey Medical Center last May with high fever and respiratory failure due to the virus.

At one point, Washington called her father and gave him all her financial information because she didn’t think she would live. A registered nurse and mother of five children, Washington says her case turned around after she was given convalescent plasma.

Although initial neuropathy in her feet is better, she still struggles with severe fatigue, shortness of breath and increased anxiety and depression.

“I feel like I have bronchitis every day,” said Washington, whose underlying asthma never interfered with daily life before she got COVID-19. “I went from working 16-hour days as a nurse in a nursing home to having to pace myself to do much of anything.”

For a small group of people, often referred to as “long haulers,” fatigue, shortness of breath, dizziness, gastrointestinal symptoms, anxiety and depression can persist for months and can range from mild to incapacitating.

“Informally, we call this condition ‘long COVID,’ or more formally post-acute sequelae of SARS-CoV-2 infection,” said Dr. Emily Link, physician at Penn State Health Cocoa Outpatient Center. “It’s characterized by symptoms that develop during or after COVID-19, that last 12 or more weeks and that don’t have another cause such as injury or permanent damage to organs.”

Dr. Michael Farbaniec, cardiologist at the Milton S. Hershey Medical Center, said he sees a worsening of underlying conditions in patients who were managing them well prior to having COVID-19. “COVID causes a very intensive inflammatory process,” he said. “For example, if you had known heart disease, the stress of having COVID can lead to ruptured plaque, which can lead to a heart attack.”

The National Institutes of Health and the Centers for Disease Control and Prevention are funding studies to gain more insight into the phenomenon about which so little is known right now.

“Mainly what we are seeing is persistent labored breathing, weakness and hypoxemia, which is a below-normal level of oxygen in the blood that can cause shortness of breath, headache or confusion,” said Dr. Daniel Guck, a fellow in pulmonary and critical care at Hershey Medical Center.

How common is long COVID?

Some studies suggest symptoms persist in up to 50 percent of cases, but another recent study suggests only 2.5% of people have symptoms that persist beyond 12 weeks. “However, since more than 30 million people have had COVID-19, that’s still nearly three-quarters of a million people potentially dealing with this,” Link said.

Who is most susceptible to becoming a long hauler?

Doctors say those who had more severe cases of the virus, older people, women and people with underlying asthma are more likely to develop long COVID. “The sicker you are, for example, the more prone you’ll be to inflammation of the heart muscle,” Farbaniec said.

When should I call my doctor about ongoing symptoms?

That depends on the frequency and intensity of your symptoms, Farbaniec said. “A sharp pain with breathing could be because of inflammation of the coating of the lungs or the heart – remnants of the stress of your body’s inflammatory response to COVID,” he said. “On the other hand, tightness or pressure in the chest that gets better when resting could suggest a heart issue like decreased blood flow to the heart muscle.”

Given that COVID can affect many different body systems, it’s best to address symptoms in a multidisciplinary fashion, Guck said. “For example, persistent labored breathing could indicate the need to see a pulmonologist for acute inflammation of the lungs, or persistent weakness could indicate COVID-related inflammatory muscle weakness that a rheumatologist could manage,” he said.

What types of things can I do to ease symptoms?

Treatment is very individualized, but inhalers, fatigue management techniques, reconditioning exercises and adequate rest may help, Link said. Washington finds relief with inhalers for breathing better, pacing herself for stamina and anti-depressants for managing her mental health.

“For many people, it will be a prolonged recovery,” Link said. “But the good news is that the vast majority of people do improve and get back to their pre-COVID selves.”

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The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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