Distinguishing Features of Long COVID - eMed Digital Healthcare
Now that it has been two and a half years since the start of COVID-19, countless people around the world are discovering that some of their COVID-19 symptoms are lingering for weeks, months, and even years. These long term COVID effects are called “post-COVID-19 syndrome,” or more commonly referred to as “long COVID.” And what makes something long COVID? The fact that the symptoms impair people’s lives after having COVID-19 and can’t be explained by other health issues.
According to the World Health Organization (WHO), long term COVID effects are coronavirus symptoms that persist long after people contract the virus or re-appear three months or later after a person first contracts COVID-19. Most often these symptoms are caused by persistent inflammation that impacts different parts of the body.
Long COVID is more common than we think. In fact, as of June 2022, the Center for Disease Control (CDC) and National Center for Health Statistics (NCHS) reported that nearly one in five American adults developed long COVID symptoms. According to some CDC studies, as of September 2022, 13.3% of people experience long COVID for one month or longer. Two and a half percent of people self-reported experiencing long COVID for 3 months or longer, and more than 30% of people that were hospitalized due to long COVID have suffered from long haul effects of COVID for six months or longer.
A recent study on more than 30,000 individuals with laboratory-confirmed COVID-19 infections found that one in 20 people reported not recovering at all, and four in 10 people said that they still hadn’t recovered months later.
Long COVID is Complicated
There are innumerable variables that affect whether someone has long COVID, which will require years of extensive research to fully understand. That is why organizations like the CDC, National Institute of Health (NIH), and other reputable research institutions are continuously launching new research studies to find out what is causing these long term effects. In short, however, there is no simple answer as of yet.
Most Common Long COVID Symptoms
Some long COVID symptoms occur more often than others. Some of the most common long COVID symptoms include the following:
1. Fatigue and Post-Exertional Malaise
Long COVID fatigue is described as an extreme, chronic level of exhaustion that impairs people’s lives and cannot be explained by another health issue. Post-exertional malaise (PEM) is when symptoms worsen with even the most minor form of mental or physical exertion, most commonly after 12 to 48 hours. Once worsened, people with PEM continue to experience more severe COVID-19 symptoms for days or weeks.
2. Respiratory Issues
Given that COVID-19 is a respiratory ailment, it’s no surprise that respiratory symptoms are some of the most common long COVID side effects. Some of the most common respiratory issues reported by people with long COVID include shortness of breath, cough, and chest pain.
a. Shortness of Breath/Difficulty Breathing
Shortness of breath is characterized by difficulty breathing after any form of physical exertion.
Shortness of breath can impact both simple and complex COVID-19 cases. In simple COVID-19 cases, for those who were immobile while having COVID-19, shortness of breath is the side effect of having to rebuild stamina and endurance after being sick. Some people can also develop shortness of breath as a novel long COVID symptom.
More severe COVID-19 cases and individuals with compromised immune systems due to previous heart or lung issues, diabetes, cancer, or autoimmune disorders are more susceptible to experiencing shortness of breath. If you suffer from long COVID shortness of breath along with leg swelling or an oxygen level that is below 92%, you should immediately seek medical attention.
b. Long COVID Cough
One of the most common distinguishing features of COVID-19 is often a persistent, dry cough. Note: not everyone with COVID-19 develops a long COVID cough. Coughing is caused by irritation in respiratory airways, leading to respiratory inflammation. Some additional side effects include congestion with or without phlegm.
A long COVID cough can last for months after a person contracts the coronavirus. This is usually because irritation in the airways persists even after the coronavirus itself clears up.
COVID-19 is primarily a respiratory or lung disease, although it can also affect the heart. COVID-19 causes inflammation of the heart muscles, leading to a series of possible symptoms such as palpitations, shortness of breath, and chest pain. Some very uncommon cardiovascular ailments that are associated due to long COVID include postural orthostatic tachycardia syndrome (POTS), heart attacks, and heart failure.
According to the American Heart Association, countless studies over the past couple years report that it’s not uncommon for individuals to suffer from heart damage post-COVID. In one study done on select groups of U.S. veterans that was featured in Nature Medicine, researchers found that U.S. veterans that previously suffered from COVID-19 between the dates of March 1, 2020 and Jan. 15, 2021 were 63% more likely to later suffer from cardiovascular issues. Some of the most common heart issues that people suffer from post-COVID include heart palpitations, postural orthostatic tachycardia syndrome (POTS), heart attacks, and even heart failure.
When should I see a doctor if I’m having heart symptoms after coronavirus?
1. Heart Palpitations
Heart palpitations occur when a person’s heartbeat is irregular, beating too fast, or is fluttering. If you find yourself continuing to suffer from long COVID heart palpitations, you should see a doctor. This is especially true if you already had a heart condition prior to contracting COVID-19.
The definition for Postural orthostatic tachycardia syndrome (POTS) lies within the name itself. Each of the words within the title explains what this condition means: postural referring to body positioning, orthostatic referring to standing upright, tachycardia referring to a heart rate over 100 beats per minute, and syndrome referring to a group of symptoms that happen together. So, in summary POTS means having a faster heart beat, dizziness, and fatigue whenever transitioning from a standing to supine position.
There is no treatment for POTS and luckily it is not life-threatening, but there are several ways to manage POTS symptoms, which include adjusting your diet, medication intake, and level of exercise. If you are experiencing any of these symptoms for the first time, you should seek medical attention.
For further reading, here’s a great source by John Hopkins University you can reference.
2. Chest Pain
There are many possible causes of long COVID chest pain. According to Dr. Wendy Post at John Hopkins School of Medicine, “if you have chest pain when you inhale, you might have lung inflammation. Sudden, severe chest pain could be a blood clot in the lung (pulmonary embolism).”
If you experience new chest pain or your long COVID chest pain can be accompanied by shortness of breath, nausea, or lightheadedness, you should seek medical attention right away, as those symptoms together can be a sign of a heart attack.
Long COVID chest pain that is extremely severe is also cause for concern, as it can be an indicator of a blood clot in the lungs. Chest pain that occurs when you inhale is a sign of lung inflammation and is something that you should also monitor post-COVID.
3. Heart Attacks
“Very few people have a severe heart attack, such as an acute myocardial infarction, or MI, due to COVID-19,” says John Hopkins cardiologist Dr. Wendy Post. However, heart attacks have been associated with previous COVID-19 infections due to its impact on blood vessels and heart rate regulation. These are two of the most common catalysts for developing a Type 2 heart attack (when the heart needs more oxygen than it can get). If you think you may be suffering a heart attack due to long COVID, you should seek medical attention immediately.
4. Heart Failure
A diagnosis of heart failure after COVID-19 is very rare. Heart failure describes when a heart cannot keep up with the necessary workload to get blood flowing to all parts of the body. Therefore, when you suffer from heart failure, your body isn’t receiving the oxygen and blood needed to function effectively.
If you suffer from heart failure, your heart will overcompensate by either enlarging, developing more muscle mass, or trying to pump out blood at a quicker pace. The body can only function while keeping up such behaviors for so long though.
While uncommon, because SARS-CoV-2 can cause inflammation to bodily organs such as the heart, it’s possible for long COVID to lead to heart failure. Therefore, if you suffer from severe long COVID symptoms or your long COVID symptoms are worsening, seek medical attention as soon as possible.
While very uncommon, individuals with COVID-19 experiencing respiratory issues can experience kidney damage due to continuous low blood oxygen levels. The body’s immune response to suffering from COVID-19 can also lead to long-term kidney damage. This is because some forms of COVID-19 can cause the body to send a rush of small proteins called cytokines into the body to fight the virus. Unfortunately, such an influx of cytokines in the body can lead to damaged kidney tissues and the inflammation of bodily organs.
If you’ve suffered from a severe case of the coronavirus that led to acute kidney issues, then you’re more likely to develop long COVID kidney damage. If you experience short or long-term damage to other bodily organs, such as the heart or lungs, you’re also more likely to develop long COVID kidney damage. This is because the functions of all of the bodily organs affect one another. Individuals with kidney or other health issues prior to contracting COVID are also more susceptible to developing long COVID kidney damage.
Even the fact that COVID-19 can cause blood flow issues that lead to the development of tiny blood clots in the bloodstream can lead to long-term kidney damage. This is because tiny blood clots in the bloodstream can clog small blood vessels in the kidneys. If you let your long COVID kidney damage persist too long, it can eventually cause you to suffer from kidney failure.
Signs of Kidney Damage from COVID-19
To minimize the chances of developing long COVID kidney damage, try to recognize the signs of kidney damage from COVID-19 early. That way you can receive any necessary treatment as soon as possible. Some of the most common signs of kidney damage from COVID-19 include high levels of protein or blood in the urine and abnormal blood work.
Loss of Taste and Smell
Loss of taste and smell is a common side effect of having COVID-19. This is due to one of two factors: either 1. Damage to the olfactory sensory neurons or surrounding neurons or 2. Congestion that blocks our olfactory sensory neurons and therefore, our ability to smell and taste. With short COVID, 8 out of 10 people may lose their sense of taste and smell and recover it within 30 to 60 days of a COVID-19 infection. However, for those with long COVID symptoms, recovery will take longer. A recent study showed that 75-80% of cases are resolved within two months, and 95% of cases are resolved within six months.
Neurological and Mental Health Issues
In research done by Yale School of Medicine, it was found that most neurological issues due to COVID-19 are a result of immune-system mediated injury, as opposed to the virus directly attacking or impacting brain cells.
Neurological issues caused by COVID-19 can be broken down into two buckets - mild/moderate symptoms vs. more severe. Most individuals will experience no or mild to moderate neurological symptoms, such as confusion, delirium, sleepiness, poor cognitive function, intense headaches, and uncomfortable skin sensations. Severe ailments may include increased risks of strokes, epileptic seizures, hearing and vision abnormalities, or symptoms similar to Parkinsons.
In fact, a research study published by the University of San Diego on this topic in June 2022 found that 89% of the study’s participants were experiencing fatigue and 80% of the study’s participants were experiencing headaches. Many of the study’s participants even reported suffering from memory impairment, insomnia, and decreased concentration.
However, the cause of long COVID related neurological issues is much more complex and still unknown. While still uncertain why this is happening, physicians such as Dr. Serena Spudich from the Yale School of Medicine are recognizing that “there are many, many reports now of people having persistent symptoms for months…Often, they’ve had complete resolution of their fevers and breathing problems, but they continue to have problems with thinking, concentration, memory, or difficulty with strange sensations and headaches.”
Research conducted by the Washington University School of Medicine in St. Louis states that approximately 40 million people are suffering from neurological disorders due to COVID-19 worldwide, and of those who contracted SAR-CoV-2, 77% are more likely to develop memory problems, often referred to as “brain fog.”
According to research done in September 2022 by a team at Harvard for the Journal of the American Medical Association (JAMA), individuals who suffered from psychological distress before contracting COVID-19 had a 32% to 46% increased risk of continuing to have long COVID mental health ailments after an acute case of COVID-19. Those who reported high levels of two or more forms of psychological distress, such as long COVID depression and longCOVID anxiety, had a 50% increased risk of developing long COVID mental health symptoms. This study goes to show that a person’s mental health can have some sort of effect on a person’s physical COVID-19 symptoms.
According to the Mayo Clinic, acute digestive issues such as heartburn, trouble swallowing, irritable bowel syndrome, constipation, diarrhea, bloating, and incontinence, are very common side effects of a COVID-19 infection.
In a study conducted by the Mayo Clinic, approximately 16% of the subjects reported still having digestive symptoms 100 days after their COVID-19 infection resolved. The most common long COVID-19 symptoms they continued to experience included abdominal pain in 7.5%, constipation in 6.8%, diarrhea in 4.1% and vomiting in 4.1%.
Treating Long COVID
Currently there is no tried and true treatment for long COVID, however, there is growing evidence that some medications, including some antiviral drugs or anticoagulants, may help. The medications currently being tested to treat long COVID include Paxlovid, colchicine, sirolimus, antihistamines, antidepressants, and/or steroids, beta blockers, and/or fludrocortisone. There is no sufficient evidence yet to confidently say any of these medications can help improve or cure long COVID to date.
However, research conducted by the CDC does suggest that those who are vaccinated and experience an acute COVID-19 infection are less likely to report long COVID symptoms than those unvaccinated.
With that said, you do have agency and the opportunity to mitigate the effects of long COVID by making an appointment with your primary care doctor for a thorough check-up, eating healthy, and incorporating exercise into your daily routine. There is always the possibility that some post-COVID ailments are not related to COVID-19 and require medical consultations and examinations to ascertain that they don’t have a different root cause.
There is no better time for you to get these symptoms and possible chronic health issues checked out once and for all. According to Michael Mina, MD, PhD, an infectious disease epidemiologist, immunologist, and physician who recently left his post as professor at Harvard School of Public Health and Harvard Medical School to become eMed’s Chief Science Officer, “COVID and Long-COVID are teaching the medical community to consider lasting symptoms that arise from other pathogens too...symptoms that have previously usually been chalked up to "it’s in your head" ... much to millions of patients frustration and sanity.”
Therefore, with the concerns that you may have about your health post-COVID, take comfort in the fact that now more than ever, with proper communication with your doctor, you can get all your healthcare needs met.
Testing and Treating COVID-19 with eMed
One of the best ways to possibly combat long COVID is to get diagnosed and treated for COVID-19 as soon as possible. This requires having COVID-19 telehealth kits on hand, and starting to test once you either think you’ve been exposed or start feeling symptoms that may or may not be COVID-19 related. If eligible, this is the fastest route to getting treatment early on to prevent symptoms from getting worse, and possible hospitalization.
Here at eMed, we recognize navigating the health system alone can be daunting, and may even discourage people from seeking answers or treatment. So, we have made it our mission to assemble the pieces for you through an at-home test that is cost-effective and easy to navigate.
eMed proctors will guide you through the testing process and connect you directly to an eMed telehealth provider who will do a medical assessment and determine the best course of treatment for you. The medical consult will result in instructions for care, and if eligible, a prescription either for pick-up at your desired pharmacy or delivery directly to your home.
By cutting out the process of finding a primary care physician, making an appointment, and navigating a complex health care system, we have tried to carve out the fastest possible route to getting your answers and treatment when it’s most effective - within the first 1-2 days of exposure or infection.