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B4 — THE OBSERVER & BAKER CITY HERALD
TUESDAY, FEBRUARY 1, 2022
What we now know about long COVID
By NICOLE VILLALPANDO
Austin American-Statesman
AUSTIN, Texas — Doc-
tors at UT Health Austin
have been trying to solve
the puzzle of why some
COVID-19 patients remain
sick for months or now years.
Since last July, people
who have what some call
long COVID or long-
haulers COVID have been
treated at a post-COVID-19
program at UT Health
Austin, the clinical arm of
University of Texas Dell
Medical School.
“Now, we’ve learned a
lot,” said Dr. W. Michael
Brode, the medical director
of the post-COVID-19
program.
People who continue
to have symptoms from
COVID-19 long after the
initial infection fall into
three categories:
• People who were hos-
pitalized and were even on
a ventilator who have lin-
gering symptoms from the
ventilator and recovering
from a serious illness. They
typically get better within
six months to a year.
• People who have lin-
gering symptoms such
as a cough that can go on
for three to six months,
as a cough can with other
illnesses.
• And there are people
whose COVID-19 infec-
tion triggered a new dis-
ease, Brode said. This new
disease is long COVID or
post-COVID-19 or long-
haulers COVID. Typically,
these were not the people
hospitalized for COVID-
19. It doesn’t seem to
matter how severe the dis-
ease initially was. Instead,
their autonomic nervous
system has been disrupted
by COVID-19. That’s the
system that controls such
things as breathing, heart-
beat and digestion.
“This third group the
medical community doesn’t
Joseph Prezioso/AFP/Getty Images-TNS
Medical workers treat a patient suff ering from the eff ects of
COVID-19 in the ICU at Hartford Hospital in Hartford, Connecticut,
on Jan. 18, 2022.
know what to do with,”
Brode said.
Their common com-
plaints often are fatigue
similar to chronic fatigue
syndrome and brain fog.
They also might have
shortness of breath,
rapid heart rate, dizzi-
ness because of changes in
blood pressure, problems
with digestion, trouble reg-
ulating their body tempera-
ture and diffi culty sleeping.
A common phenomenon
is post-exertional malaise,
in which they actually get
worse after physical or
mental activity.
People also can experi-
ence food allergies or sen-
sitivities that they have not
had before, or they might
have rashes. Some people
also experience heightened
anxiety or new anxieties.
Brode said that, while
long COVID can happen to
anyone, there are some defi -
nite groups of people that
it seems to happen to more
often: otherwise healthy
women in their 30s and 40s;
men in their 40s and 50s;
and teenagers.
We still don’t know how
long these symptoms will
last, Brode said.
“We have people who
were sick in March and
April of 2020 who are not
fully recovered,” he said.
The program is now
seeing about 150 patients.
What happens in long
COVID?
COVID-19’s eff ects are
still being researched, but
some clues can be found in
previous viral outbreaks,
as well as less talked about
side eff ects that can come
after any virus.
“In some ways, I’m
becoming a student of his-
tory,” Brode said. “This
clearly happened after the
1918 Spanish fl u and the
1890s fl u.”
Long COVID is the
body’s reaction to the
COVID-19 virus, which
is a systemic disease
that invades everywhere.
COVID-19 is happening
in the vasculature — the
body’s arrangement of
blood vessels. Because
COVID-19 is new, it’s
a disease that the body
doesn’t recognize to know
how to handle properly.
Researchers have looked
at skin biopsies in people
with long COVID and
found small fi ber neu-
ropathy, or damage to
the smallest nerves in the
body. Those nerves reg-
ulate the body’s sensory
perceptions. These same
small nerve cells also are
found in the nose, the ears,
the heart and lungs, which
is why such COVID-19
symptoms as loss of
smell, diffi culty with bal-
ance, rapid heart rate or
shortness of breath might
continue.
Unlike people who had
severe COVID-19 and were
hospitalized and on ven-
tilators, people with long
COVID don’t have damaged
lungs or damaged hearts, at
least not that shows up on
tests, Brode said. It could be
that current tests aren’t good
enough to detect the small
fi ber damage, he said.
Instead, the people who
have long COVID might not
have anything wrong with
their lungs or heart, but the
autonomic nervous system
thinks they do. It’s like the
body is still sending sig-
nals that it’s experiencing
the virus and needs to react,
triggering rapid heart rate
and shortness of breath.
Treating variant by
variant for long COVID
Right now, the Austin
program is working with
people who were infected
in the fi rst three waves,
through the delta variant. It
is too early to treat people
who got the omicron variant
because the center typically
starts working with people
who have had symptoms for
at least three months.
Brode has not seen any
diff erence between people
who were infected with
the original coronavirus
and people infected with
the delta variant. He sus-
pects in a few months he
won’t see a diff erence in
people infected with omi-
cron compared with delta
or earlier variants.
“It’s hard to prognosti-
cate,” he said, but the hope
is that there might be less
long COVID with omicron
because of the number of
people who have been vac-
cinated. Vaccination tends
to reduce the symptoms of
the virus in a breakthrough
case. The hope is that, if the
COVID-19 virus is a trigger
for long COVID, perhaps
the vaccine can help protect
against that, “but it doesn’t
bring it to zero,” he said.
He estimates that right
now about 4% of people
who have had COVID-19
fall into the third category
of people and will have long
COVID. His hope is that
with omicron, it might get
to as low as 1% for people
who had that variant.
are off ered medications.
There have yet to be tar-
geted therapies specifi c to
long COVID, but Brode is
hopeful there will be and
that the post-COVID pro-
gram at UT Health will be
able to participate in clinical
trials for those.
How doctors are
treating long COVID
Most lingering
COVID-19 symptoms will
start to get better within
four to 12 weeks after the
initial infection. See your
primary care physician
if they are getting worse,
there are new symptoms,
or it’s been four weeks
without improvement.
Treat the symptoms by
doing such things as using
over-the-counter cough
medicine for cough or acet-
aminophen for headache.
If you’re experiencing gas-
trointestinal issues, try
smaller meals more often
and stay hydrated.
If you are dizzy when
getting up, get up slowly to
allow your blood pressure
to adjust. Brode said he has
seen a lot of people in the
hospital after COVID-19
because they have fallen.
If it’s exhaustion or
brain fog, don’t try to
push through it and do too
much; that can make symp-
toms worsen. Take frequent
breaks and slowly build
back up to your usual level
of activity.
“I think this is a time
to really listen to the body,
give yourself some grace
and just rest when your
body says so,” Brode said.
But if you’re having
trouble getting back to
your usual activities, phys-
ical therapy from someone
who knows how to treat
people after COVID-19 is
important, Brode said.
If things haven’t
improved by three months,
ask for a referral to the
post-COVID program.
At fi rst, doctors were
treating each symptom
to try to ease those. Now,
they are leaning on treat-
ments that have worked for
chronic fatigue syndrome
or dysautonomia — when
your body can’t regulate its
autonomic nervous system.
Some antidepressant medi-
cations that are more stim-
ulating have been shown to
be helpful with fatigue and
anxiety. It also helps with
infl ammation in the brain.
Doctors are prescribing
physical therapy, but not
standard courses in which
you push through to build
up strength. New proto-
cols have been written to
provide physical therapy
designed for people with
post-exertional malaise.
That means slowly getting
moving again.
“I have not met anyone
who pushing through that
wall is eff ective,” Brode
said. “In all scenarios, it
makes it worse.”
Doctors also can pre-
scribe mental health
therapy to help with the
long-term eff ects of having
a chronic illness.
Much of the other ther-
apies are about treating the
symptoms. Melatonin two
hours before bedtime is sug-
gested for people who are
having diffi culty sleeping.
For people who lost their
sense of smell, nasal ste-
roids and smell therapy
can help regain that sense.
People with daily headaches
What to do if COVID-19
symptoms linger
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