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

As people with prolonged Covid cope with ongoing symptoms like fatigue, chest pain, shortness of breath, and mental confusion, the ongoing question has been when, and if, those symptoms could potentially end.

With previous research indicating that persistent symptoms can last for at least several months among those who were never hospitalized, new data from a research letter published in JAMA indicates that up to one-third of predominantly outpatient patients continue to have symptoms, some of the which last 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 of 177 patients between 3 and 9 months after the onset of Covid-19, with an average age of 48 years (age range, 18-94 years).

Of the 177 mostly outpatient 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 mental confusion, among 23 patients (13%) who reported other symptoms.

Among surveyed patients, hypertension was the most common underlying chronic condition. 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%) experienced ongoing symptoms.

“This small study shows that a long series of post-Covid-19 symptoms can occur in certain people.” said Amesh Adalja, MD, infectious disease physician and senior scholar at the Johns Hopkins Center for Health Safety. “The key is to untangle the cause, the risk factors and determine if all these patients are the same or represent different disease processes.”

“For example, loss of taste and smell is different from a limiting symptom of ADL (activities of daily living),” offered Adalja.

Finding out if there is a common immune defect among all patients who develop Long Covid is one of the biggest challenges that researchers have been trying to solve, as Adalja suggests.

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

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

That said, we do know that patients present with symptoms that indicate a loss of fine regulation of the autonomic nervous system, a system that controls involuntary functions such as heart rate, respiration, blood pressure, sweating, and body temperature. An example of such dysfunction is manifested as POTS syndrome (postural orthostatic tachycardia syndrome), in which postviral inflammation is believed to alter the ability of blood vessels and nerves to respond to changes in blood volume or pressure, resulting in leading to an inappropriately elevated heart rate. 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 elevated heart rate and other symptoms associated with POTS, according to the results of a new study published recently in the Journal of the American College of Cardiology. The study found that the drug significantly reduced heart rate while standing compared to placebo, mitigating the typical increase in heart rate associated with standing in POTS patients. The usefulness of ivabradine may be derived from its ability to selectively lower heart rate, without lowering blood pressure.

While there are many subtypes of POTS syndrome, it is possible that this drug could 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 and fluid gain. retention. While beta-blockers can also be used, they can lower blood pressure, increasing the risk of depression and fatigue.