Nearly a third of Covid-19 survivors have symptoms, some up to 9 months later, new study finds

As people with long-lasting Covid grapple with lingering symptoms such as fatigue, chest pain, difficulty breathing and brain fog, the lingering question is when and if these symptoms can potentially end.

Previous research indicating that persistent symptoms can last for at least several months in those who have never been hospitalized, new data from a research letter published in JAMA indicates that up to a third of predominantly ambulatory patients continue to present symptoms, some lasting up to 9 months.

While the study by researchers at the University of Washington was small, it adds to the ongoing body of literature detailing the chronicity of the disease in a growing number of people. For their study, the researchers conducted a follow-up questionnaire with 177 patients between 3 and 9 months after the onset of Covid-19, with an average age of 48 years (age group, 18-94 years) .

Of the 177 predominantly ambulatory patients (90% never admitted to hospital), the researchers found that the most common chronic symptoms were fatigue (24/177 patients) and loss of smell or taste (24/177 patients). Four patients (2.3%) also reported brain fog, among 23 patients (13%) reporting other symptoms.

Among the patients surveyed, hypertension was the most common underlying chronic disease. Overall, 49 of 150 outpatients (32%) and 5 of 16 inpatients (31%) reported at least 1 persistent symptom. The study found that of 31 patients with hypertension or diabetes, 11 (35%) had persistent symptoms.

“This small study shows that in some individuals a long tail of symptoms after Covid-19 can occur.” said Amesh Adalja, MD, an infectious disease physician and principal investigator at the Johns Hopkins Center for Health Security. “The key is to disentangle the cause, the risk factors, and determine if all of these patients look the same or represent different disease processes.”

“For example, loss of taste and smell is different in nature from a symptom limiting ADLs (activities of daily living),” Adalja said.

Determining if there is a common immunologic defect in all patients who develop Long Covid is one of the biggest challenges the researchers have attempted to address, as Adalja suggests.

Research on Covid-19 suggests role of post-viral inflammation of SARS-CoV-2, leading researchers to compare Covid-19 to other chronic diseases such as ME / CFS (myalgic encephalomyelitis) seen in patients with chronic post-viral fatigue and post-developmental weakness Epstein-Barr virus, Ebola, Ross River virus, various enteroviruses, as well as West Nile virus and Borrelia burgdoferi (Lyme disease).

Dr Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said in a Medscape interview with Dr Eric Topol that patients with long-term Covid can develop “a very similar post-viral syndrome at EM / SFC. But confirming this is an ongoing challenge.

That said, we do know that patients have symptoms indicating a loss of fine regulation of the autonomic nervous system – a system that controls involuntary functions such as heart rate, breathing, blood pressure, sweating, and body temperature. An example of such a dysfunction is manifested by POTS syndrome (postural orthostatic tachycardia syndrome), in which post-viral inflammation is believed to interfere with the ability of blood vessels and nerves to respond to changes in volume or pressure. blood pressure, leading to excessively high heart rates, low blood pressure and fainting. POTS can cause significant impairment in daily functioning and is one of the most serious conditions associated with Long Covid.

The heart failure drug ivabradine (Corlanor) can potentially help improve high heart rates and other symptoms associated with POTS, according to the results of a new study recently published in the Journal of the American College of Cardiology. The study found that the drug significantly lowered standing heart rates compared to placebo, alleviating the typical heart rate surge associated with standing in patients with POTS. The usefulness of ivabradine may be derived from its ability to selectively reduce heart rate without lowering blood pressure.

Although there are many subtypes of POTS syndrome, it is possible that this medicine may help treat Long Covid patients with this disorder. Current approaches include midodrine, a drug that increases blood pressure but often has debilitating side effects (skin tingling, abdominal pain, urinary problems, dry mouth, dizziness, drowsiness, chills, and goose bumps) and fludrocortisone which can cause weight gain and fluid retention. Although beta blockers can also be used, they can lower blood pressure, increasing the risk of depression and fatigue.