The most mysterious and prolonged COVID-19 symptoms: severe fatigue, chronic headaches and difficulty thinking and remembering

The multicapilarity in which COVID-19 attacks the health of people around the world continues to amaze much of researchers. Not a week goes by without a new line appearing between the contagion milestones. One problem that is beginning to emerge is that of treating those who, even after passing the critical moment of the most traditional lung infection, must continue to be treated for collateral damage that ends up being more profound, lasting and multiple than the initial infection. .

Since testing positive for COVID late last year, Sherry Flynn, 47, of North Carolina, has been plagued by a long list of illnesses, including severe fatigue, blood clots, chronic headaches, rapid heartbeat, general body pain, impaired thinking and memory, and type 2 diabetes. And he has accumulated a shelf full of medicines that try to relieve all his ailments.

About two months after the diagnosis, Flynn’s primary care physician referred her to a newly opened facility: the COVID Recovery Clinic at the University of North Carolina School of Medicine. There, they indicated that they could treat her for all of her symptoms and perhaps could find other ways to help her rehabilitate rather than just prescribing all of these drugs.

The clinic takes care of many of these patients, commonly known as long distance carriers. On a Tuesday afternoon in May, eight of them came to the facility to see a team of therapists and doctors. Like Flynn, every patient hoped to find, if not a cure, at least relief from the myriad of symptoms that had plagued them for months following their COVID diagnosis.

For three to four hours, these people underwent a comprehensive medical examination by various specialists. A rehabilitation doctor, internist, psychiatrist, neuropsychologist, physiotherapist and occupational therapist visited each patient’s examination room to assess their condition. “It’s a big effort for them to come for half a day, and we want to make sure it’s worth it.”, confirms the clinic’s co-director, John Baratta, who developed this multidisciplinary approach.

The specialist believes that coordinated care between these specialists offers the best opportunity to put patients on the road to recovery. This coordination treats the patient as a whole rather than each symptom as its own illness. Similar clinics have opened in the United States as doctors research the best ways to treat a new, puzzling, and multifaceted disease without proven therapies.

Long-term effects are becoming common. Study published in the journal Nature Medicine analyzed around 300 patients in Bergen, Norway, almost all diagnosed in the city over several months in 2020. Six months after their initial diagnosis, 61% of the group had persistent symptoms. The most common problem was fatigue, followed by difficulty concentrating, altered smell or taste, memory problems, and shortness of breath. Many of these patients were young, between the ages of 16 and 30, and had initially only had a mild or moderate case of COVID.

Another study, published in JAMA Network Open magazine by researchers at the University of Washington, suggests that about 30% of COVID patients may experience ongoing problems of varying severity, such as fatigue, loss of taste or smell, and shortness of breath, at least four weeks after they no longer test positive for infection. Some people reported symptoms months later. The U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report found that 69% of outpatient adult COVID patients in Georgia had one or more outpatient visits 28 to 180 days after diagnosis, and many of these people had symptoms potentially related to the original disease.

The entire cluster of long-term COVID symptoms has been named the post-acute sequelae of SARS-CoV-2 infection (PASC) by the United States National Institutes of Health, which announced they are planning spend $ 1.15 billion over the next four years to study these effects.

The new clinics are also examining the disease as they attempt to treat it. Many, like those at UNC, are based in academic medical centers where patient care is combined with ongoing research in an effort to better understand the causes of these lingering problems, predict who is most vulnerable, and design the best treatments. Baratta began to think about opening the UNC clinic last year when he noticed that some patients in his physical medicine and rehabilitation practice were taking longer than expected to recover from COVID. “Most people did it in a matter of weeks, but we started to see individuals with really severe and persistent debilitating effects that lasted for months. We realized the need for specialized care “, he comments.

The UNC opened in February to treat physician-referred patients 18 years of age or older who have been diagnosed positive with coronavirus and have had post-COVID symptoms for at least four weeks. “It’s really surprising to me how many people who have had a milder illness have these persistent symptoms. Baratta cautions, echoing the findings of the Norwegian study. Probably more than three-quarters of the patients we see have never been hospitalized for COVID. “

The UNC facility is the only long-term COVID clinic in a large, densely populated stretch of the Southeastern United States between Atlanta and Washington. Their ability to serve patients is overshadowed by the number of people who need help. HTo date, the clinic team has evaluated just over 300 people. Some suffered damage to their lungs, heart, kidneys, brain or other organs. Others suffer from fatigue, headaches, cognitive problems commonly referred to as “brain fog” and shortness of breath, but have no noticeable organic damage.

In the absence of therapies established specifically for the prolonged symptoms of COVID, clinicians are pushing their way through treatment protocols, relying primarily on approaches that have been used successfully in other conditions with similar symptoms. A patient diagnosed with post-exercise discomfort, a type of fatigue caused by physical or mental activity, undergoes a series of heart and lung tests, and has a blood test to assess your electrolytes, vitamins, and thyroid levels. The idea is to rule out other contributory medical conditions before putting the patient on a rehabilitative exercise regimen. Neurological stimulants such as Adderall, Dexedrine, and Ritalin have been shown to be effective in improving energy and focus. Albuterol, an inhaled drug often used to treat asthma, along with breathing exercises improved this function.

Finding the right treatment is a learning process and resources are scarce. “We have focused our efforts on people with a confirmed history of COVID so that we can better use our resources within the clinic. And we’ve changed the assessment metrics to better target the people we see, ”says Baratta.

However, the people the clinic sees may not represent many of those with these issues.

Meanwhile, Flynn has a positive experience at UNC. His treatment includes physical rehabilitation and speech therapy. You are also considering mental health counseling for depression caused by your multi-month illness. Although her progress is slow, she says she is grateful to have doctors who know “what it means to be a long-term carrier.”

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