Covid- 19 Long Hauler Syndrome

What is “Long Haulers”?

“Long Haulers” is defined as persistent symptoms that developed during a Covid-19 infection and lasted longer than the typical 2 weeks recovery. This can not be explained by any other disease. Reported symptoms are as varied as those reported with an active Covid case. Most long haulers report feeling tired/chronic fatigue, shortness of breath, and a persistent loss of taste/smell. Statistics range from 10-40% (of people who had Covid-19 symptoms) having persistent symptoms.

Following are summaries of two research articles tracking persistent symptoms after Covid-19. Both are the results of phone based interviews.

Telephone interview 6 months and 12 months after patients reported an active infection. The first study took place in Italy, study participants came into one hospital for care due to Covid-19, both inpatient and outpatient. The study surveyed 599 people 6 months after hospitalization. The purpose of this study was to identify factors that increase likelihood of developing post-Covid syndrome. Participants were patients (inpatient and outpatient) that were treated in the hospital for Covid, over the age of 18, from March to May of 2020. 90% of patients were symptomatic and presented mild to moderate symptoms. 26% were hospitalized, spending 7 days in the hospital on average. Patients appeared more likely to report fatigue, dyspnea (difficulty breathing), and neurologic symptoms if they had severe symptoms at onset. Patients with mild to moderate symptoms were more likely to have a persistence of altered taste/smell. IgG (antibodies) were much higher in those with long haulers. Also, being female, more symptoms at onset of disease, and ICU admission all increased the risk of getting long haulers.

Telephone interview 7 days after testing positive, then 12 months later. Participants had mild to moderate symptoms (defined as SpO2 above 94%, no hospitalization). Asymptomatic patients were not included in this study. Symptoms recorded were: fatigue, shortness of breath, muscle pain, joint pain, problems breathing, headache, dry cough, chest pain, blocked nose, sinonasal pain, sore throat, weezing, coughing up mucus, loss of appetite, smell or taste impairment, insomnia, dizziness, nausea, diarrhea, red eyes, abdominal pain, vomiting. 53% reported at least one symptom. Most common was “feeling tired” at 27.3%, followed by “smell or taste impairment” at 22%, “shortness of breath”, 12.8%, and “muscle pain” 9.2% Risk to develop symptom persistence or long haulers was increased in females, those between 40 and 54 years old, and those with a BMI greater than 25. Also, presence of 3-7 symptoms during the acute phase significantly increased the likelihood of persistence of symptoms at 12 months, an even higher risk if 8 or more symptoms were reported.

In summary, these studies identified some potential risk factors to developing lingering symptoms or “long-haulers”. Risk factors include: being female, age 40-54, BMI greater than 25, presence of more symptoms at onset of disease - the more symptoms, the higher the likelihood of persistence, being admitted to the ICU, and having a higher level of antibodies.

Treatment:

Unfortunately, there is currently no single treatment to address the varied continuation of symptoms. Currently, medical providers will assess and treat your specific symptoms individually. Physical therapy can be utilized to treat many of the symptoms. At Wasatch Therapy, we can improve your strength and endurance, decrease muscle pain, and work with you to improve shortness of breath. Improving your quality of life is our priority.

References:

Peghin M, Palese A, Venturini M, De Martino M, Gerussi V, Graziano E, Bontempo G, Marrella F, Tommasini A, Fabris M, Curcio F, Isola M, Tascini C. Post-COVID-19 symptoms 6 months after acute infection among hospitalized and non-hospitalized patients. Clin Microbiol Infect. 2021 Jun 7:S1198-743X(21)00281-0. doi: 10.1016/j.cmi.2021.05.033. Epub ahead of print. PMID: 34111579; PMCID: PMC8180450.

Boscolo-Rizzo P, Guida F, Polesel J, Marcuzzo AV, Capriotti V, D'Alessandro A, Zanelli E, Marzolino R, Lazzarin C, Antonucci P, Sacchet E, Tofanelli M, Borsetto D, Gardenal N, Pengo M, Tirelli G. Sequelae in adults at 12 months after mild-to-moderate coronavirus disease 2019 (COVID-19). Int Forum Allergy Rhinol. 2021 Jun 9. doi: 10.1002/alr.22832. Epub ahead of print. PMID: 34109765.

Vehar S, Boushra M, Ntiamoah P, Biehl M. Post-acute sequelae of SARS-CoV-2 infection: Caring for the 'long-haulers'. Cleve Clin J Med. 2021 May 3;88(5):267-272. doi: 10.3949/ccjm.88a.21010. PMID: 33941600.