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“ I ’ m afraid of getting COVID-19 because of the potential consequences of long COVID ”
Vaccination reduces the risks of getting long COVID
treat ,” acknowledged Professor Fitzcharles . “ Some stimulants can be used , but they ’ re not ideal for everyone .”
Dr Putrino of Mount Sinai was involved in the development of a breathing exercise regimen that helped some patients improve their fatigue and shortness of breath , according to The Atlantic , but it was far from a cure-all .
Similarly challenging is the treatment of pain , with physicians reaching for the prescription pad in too many instances . “ What we have learned with fibromyalgia is that our drugs are not very good , and we try , as much as we can , to focus on non-pharmacological strategies ,” said Professor Fitzcharles who believes it ’ s better to help patients take control of their lives through good lifestyle practices like appropriate exercise , health eating habits , and weight control .
“ I think this should be the first approach with post- COVID patients ” as well , she said .
The lack of curative treatments combined with the limited data available on what is still a young and new infection means the prognosis for patients with long COVID is still a guessing game .
“ By twelve months I think most people who have had COVID , even though they had persisting lung inflammation , will be getting better ,” said Dr Jenkins . “ What I am not certain about is what ‘ better ’ means . Does better mean ‘ completely back to normal ?’ I don ’ t know , but I am less convinced [ about that ].”
Among those who won ’ t recover completely , a potential scenario is that a majority of them will face a stable level of disability while a smaller proportion will keep deteriorating because of a progressive lung scarring that endangers the entire organ . “ We don ’ t know yet [ whether this is going to happen ], but we need to be vigilant ,” he said .
The prospects might even be bleaker for patients with POTS and ME / CFS symptoms , if we take those chronic ( and incurable ) conditions as yardsticks .
“ Nobody really knows the prognosis because long COVID has been around for less than a year ,” said Dr Chung . “ Since it ’ s similar to POTS , a likely autoimmune disease , I expect long COVID is going to be a chronic problem because when patients develop autoantibodies , they ’ re going to have them for the rest of their lives .”
Similarly , many ME / CFS sufferers battle with their symptoms for years and struggle to recover completely , though Dr Nath highlights there ’ s a wide spectrum of disability , with some patients bedridden while most of them are able to find ways to manage their daily activities .
The same applies to POTS , whose symptoms are not debilitating in the same way for every individual . And in both conditions , severity can vary significantly even in the same patient .
“ POTS symptoms can fluctuate over time ,” said Dr Chung . “ Sometimes they ’ re debilitating , and then they get better for a while even without treatment , which is typical of autoimmune inflammatory problems .”
The lessons of long COVID One key lesson to take away is that COVID-19 doesn ’ t just target the elderly but can turn out to be a dangerous disease for young people as well , including children , with data from different countries showing that even two-year-old kids can have persistent symptoms weeks after infection .
“ I ’ m afraid of getting COVID-19 because of the potential consequences of long COVID ,” acknowledged Dr Chung , who ’ s in his 40s and already vaccinated against the disease . “ I don ’ t want to scare people , but I feel they should know about the longterm debilitating problems of this virus .”
One simple way to reduce the risks of getting long COVID , he added , is vaccination , which can prevent the infection to begin with . For those who can ’ t get the jab , it still makes sense to reduce the risk of infection with standard preventive measures like social distancing , hand hygiene , and avoiding poorly ventilated indoor areas , at least as long as the number of newly infected cases in their areas remains high .
Secondly , doctors need to familiarise themselves with the difficulties of diagnosing and treating long COVID as well as other hard-to-prove conditions to ensure patients feel heard and receive appropriate medical advice . Not having a definitive test to validate symptoms should not be an excuse to dismiss the pain and discomfort many people go through .
“ It ’ s time for medicine to be rooted in just believing the patient ,” Dr Amy Proal , a microbiologist at PolyBio Resarch Foundation , told Vox , noting that doctors often consider patient feedback as the “ lowest form of evidence .”
What we need now is to foster a healthcare environment where patients who experience unexplained symptoms akin to long COVID can access medical care even without a test confirming they had been infected with SARS-CoV-2 . n
38 JUNE 2021 GlobalHealthAsiaPacific . com