What Do We Know About Long COVID

COVID-19 has presented itself in many different ways due to the number of its variants and each individual’s unique response to infection. Many who have had COVID-19 are still experiencing lingering symptoms—known as long COVID—even after the infection itself has moved on. 

Theodore Bailey, MD, JD, MA, Chief of the Division of Infectious Diseases at GBMC, said this should not be a surprise when you understand how infections in general move through the body. 

“Long COVID is not a chronic infection; it’s a chronic, lasting injury as a result of having had COVID,” Dr. Bailey said. “And that effect is not unique to COVID. You could have Hepatitis B and get cirrhosis, a scarring of the liver. If you cure the Hepatitis B, the scarring of the liver is still there. We know many, many infections can cause lasting injuries; COVID is just one more infection on that list.” 

Ongoing research on long COVID seeks to answer questions such as:

• Why does it affect some people and not others?
• How can we differentiate between somebody who has lasting injuries because of COVID and someone who is experiencing them for another reason?
• What can we do to intervene and when?
• How can we prevent long COVID?
• Who is most at risk?
• Can we reverse the damage?

But until those questions can be answered, it’s important to understand the facts. 

Symptoms

Just as the COVID-19 infection acts differently in everyone, so does long COVID. Common symptoms are exercise intolerance, loss of stamina, fatigue, racing heartbeat, brain fog or a change in accuracy of efficiency in thinking as well as a lasting and disruptive loss of taste or smell. 

These symptoms can also be indicators of different problems. Experts and clinicians are now challenged to determine the root cause in order to effectively move forward with treatment options. 

In addition to the more mild symptoms listed above, Dr. Bailey identified two major injuries that could occur as a result of COVID-19: one to the automatic nervous system and one to the lungs. 

“We know COVID can target the nervous system and may affect the nerves we don’t control like our ability to respond to increased levels of activity, which can cause fatigue and a lack of energy. One of the more extreme versions is something called POTS.” 

Postural orthostatic tachycardia syndrome (POTS) affects blood flow and causes lightheadedness and an increased heart rate when standing. The condition preexisted COVID but has become more prominent since. 

“The other injury that can happen is when the virus alters the actual structure of the lung tissue. It can cause the cells of the lung to fuse with each other to form syncytia, which means the elasticity or just the mechanical function of the lung may be permanently impaired well beyond the infection itself. That’s another major change that seems to occur in some patients.” 

Solutions

If you suspect you have long COVID, or are experiencing symptoms, the first place to start is to schedule an appointment with your primary care physician. They will be able to look at the symptoms in relation to your medical history and advise on potential next steps. 

Lung issues can be treated by a pulmonologist, and a POTS diagnosis would require a cardiologist. There are also a rising number of long COVID clinics, that will by nature accumulate the greatest level of expertise and experience in treating this set of symptoms. 

“In visiting a long COVID clinic, you will benefit from and contribute to the accumulation of experience of this issue,” Dr. Bailey said. “This is not homogenous. We talk about Eskimos having 30 different names for snow, and for long COVID you want an expert who is aware of all the different iterations so they can treat specific types on their own terms instead of resorting to one stereotype as if there is a one-size-fits-all treatment for it. That kind of expertise and discrimination is going to be most available in these clinics so seeking those out would be the most practical thing to do.” 

While long COVID symptoms can be concerning or stressful, there is help available as well as extensive research being done to work through the causes, types and treatments. GBMC does not have a long COVID clinic currently, but GBMC Health Partners primary care practices can be great starting places for those questioning the origin of their symptoms. Additionally, clinical experts across specialties at GBMC such as infectious disease, pulmonology, physical therapy and more are continuing to educate themselves as long COVID research unfolds in order to treat patients with the best and most up-to-date care possible.