Episode #68 - COVID-19: Update on Long COVID

4 March 2022 | Science conversation

Vismita Gupta-Smith

We are talking about long COVID or post-COVID-19 condition today. Hello and welcome to Science in 5. I'm Vismita Gupta-Smith. We are talking to Dr. Janet Diaz today. Welcome, Janet. Let's start Janet with what we have learned so far in the third year of the pandemic about the symptoms of post-COVID-19 condition.

Dr Janet Diaz

Thank you, Vismita. And we've learned quite a bit, I think if you reference our most recent publication on the definition of post-COVID-19 condition, we highlight three symptoms there that are common. One is fatigue. The second is shortness of breath or trouble breathing. And this is an important one for those of you that potentially may have been very active before. So think about your breathing. Are you more limited? Let's say used to run one mile, is it now that you don't feel you're able to run as long because you're feeling shortness of breath? So we have to look at what your functional status was before and how you elicit if you're feeling trouble breathing. And the third is cognitive dysfunction. That is a fancy term of what is commonly referred to as brain fog. And what does that mean? That means people are having trouble with their attention, having trouble with concentration, having trouble with recall or memory, trouble sleeping, trouble with executive functioning. So that's actually the types of symptoms people have been describing. But this is just three, there are actually over 200 symptoms described in the literature from patients who have had or have post-COVID-19 condition.

Vismita Gupta-Smith

Janet, speak to us a little more about the cardiovascular symptoms. 

Dr Janet Diaz

Sure. So the cardiovascular symptoms, again, so cardiovascular symptoms can present in different ways. They can present as shortness of breath, I've already described the shortness of breath, they can present as heart palpitations. Your heart is racing or what we call arrhythmias and other cardiac symptoms can present as myocardial infarctions. Now, there has been a recent report that was looking at patients who had COVID-19, and it followed them up a year after. And this report was coming out of a cohort in the United States, and they found increased risk of cardiovascular complications in that cohort and that those complications are described as having had stroke, acute myocardial infarction, which means heart attack or other causes of thrombosis or blood clots and including death. So they did report increased risk of death in that one year after the acute COVID-19.

Vismita Gupta-Smith

Janet, when should people start worrying that they may have long COVID? 

Dr Janet Diaz

In our case definition, we say people should start worrying about three months after their acute COVID-19 illness. That gives some people time to recover from the acute infection, even if they've had mild disease or more severe disease. After three months, that's when we say, if you have one of these symptoms, then be concerned that you could have post-COVID-19 condition and get evaluated. So another common question is how long does it last? In our case definition, which I keep referencing, we say at least two months. So perhaps you may have a symptom that you're concerned is long COVID. But if it goes away after a week or a couple of weeks or a month, then we don't consider it to be long COVID. Now, if it lasts more than two months, then we start to say, OK, we're concerned that this is long COVID, post-COVID-19 condition. At that point, patients may experience symptoms for longer than that. They may experience up to six months, and there's reports of people experiencing protracted symptoms for up to a year or for more than a year. 

Vismita Gupta-Smith

Speak to us, Janet, about the treatments that we are recommending at this time.

Dr Janet Diaz

Because I've described the condition as being different types of symptoms that affect multiple systems of the body, then the treatment is not one treatment for all patients. The treatment has to be patient-centred and focused on the symptoms the patient is presenting with. Now we don't have any drugs for the treatment of post-COVID-19 condition, but we do have interventions such as rehab interventions or self management techniques in order to help people improve their quality of life while they still have these symptoms that have not yet fully recovered. For example, one of these self-management techniques could be that if you have fatigue, then don't overexert yourself when you are feeling fatigued, try to do your activities at times in the day when you're not feeling fatigued. If you have cognitive dysfunction, as I described before, don't multitask and have too many screens up at the same time or try to do too many things and try to focus on the one activity that you're that you're working on. If you have insomnia, trouble sleeping, then as well work on sleep hygiene techniques and interventions. So there are a series of these types of interventions that can be done, as well as rehab interventions. Now we do recommend that the care of patients with post-COVID-19 condition be done in a coordinated, integrated way. We do think at the centre of that care model should be someone who knows you, your primary care physician, a general practice clinician that knows you. Then they can reach out to the different specialists in an integrated way, in a coordinated way in case you need evaluation by a specialist. That can include a neurologist or a cardiologist or a pulmonologist or a mental health specialist or rehab specialist, or someone to help with social work or social or peer to peer support groups. So together, this type of care model, we think, is most optimal for patients who are living with post-COVID-19 condition.

Vismita Gupta-Smith

Thank you, Janet. That was Science in 5 today. Until next time then.  Stay safe, stay healthy and stick with science.