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May 26, 2022 05:00 AM

'Long COVID' poses unique challenges for providers seeking answers

Mari Devereaux
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    Health systems are devoting resources to research and treatments for patients with "long COVID" symptoms, who comprise a significant portion of those infected with COVID-19.

    One in five COVID-19 survivors between 18 and 64 years old have experienced at least one post-acute condition, according to a study the Centers for Disease Control and Prevention published Tuesday. Around one-quarter of COVID-19 patients 65 or older reported persistent symptoms more than a month after having acute COVID-19, the CDC found. The agency analyzed de-identified data from 63.4 million electronic health records of patients with and without COVID-19 from March 2020 through November 2021.

    Toward the beginning of the pandemic, Rush University Medical Center in Chicago, like other health systems, recognized the need for a separate clinic to treat patients with an immunological condition known as long COVID, said Dr. James Moy, an internal medicine professor at Rush Medical College.

    To address issues such as "brain fog," fatigue, muscle aches, numbness, loss of taste and smell, heart palpitations, and lung damage, the long COVID clinic utilizes specialists from various disciplines to treat symptoms, Moy said.

    "We're approaching it as a targeted supportive measure for our patients because each long COVID case presents subtly different," said Dr. Thomas Gut, director of the Post-COVID Recovery Center at Staten Island University Hospital in New York.

    Among former COVID-19 patients, 38% experienced a long-term health condition, compared to 16% of patients no evidence of COVID-19 infection, the CDC study found.

    The most common health issues for COVID-19 survivors include respiratory problems and musculoskeletal pain. Patients also experience cardiovascular, hematological, renal, endocrinal, gastrointestinal, neurological, pulmonary and psychiatric symptoms.

    Adult COVID-19 survivors have twice the risk for pulmonary embolisms or respiratory conditions as those who didn't contract the disease, according to the CDC report.

    Providers are still investigating medications and other therapies for long COVID patients, as well as researching post-acute conditions and how they manifest, Gut said.

    After evaluating symptoms to give patients appropriate care, health systems should focus on gaining a deeper understanding of why those symptoms occur, said Dr. Zijian Chen, medical director for the Center for Post-COVID Care at Mount Sinai Health System in New York.

    "If we're able to see the root cause of the symptoms, then perhaps the next best thing is to find ways to predict who will have symptoms and get those patients in for earlier treatment," Chen said.

    Currently, scientists at Rush Medical College's immunology research laboratory are collecting blood and nasal swab samples to determine whether there are existing tests that could help providers anticipate who will develop long COVID symptoms, Moy said.

    Compared to unvaccinated COVID-19 patients, vaccinated people who experience breakthrough infections have 34% less risk of death and 15% less risk of post-acute conditions, according to a study published in Nature Medicine Wednesday.

    The study examined data from nearly 11 million patients in Veterans Health Administration databases between January and October 2021. Vaccination before infection offers partial protection during the post-acute phase of COVID-19, but reliance on vaccines isn't an optimal way to reduce long-term health consequences, Veterans Affairs Department researchers determined.

    Patients with breakthrough infections still have a higher risk of death and post-acute conditions than people without COVID-19, the VA study found.

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