New clinics offer hope and treatment for long-term Covid
Late last spring, Brian Block, MD, noticed that some of the people entering his clinic at the University of California at San Francisco – the one he and his colleagues created to help people recover from severe Covid – were not the ones he had anticipated. Along with those who had been hospitalized with Covid, which was the population he and his colleagues expected to treat, around a quarter of patients were people who had never been hospitalized for the disease. They had had a “mild” acute Covid – a fever, a cough from which they recovered quickly. But months after thinking they’d beaten the disease, they no longer felt themselves – heart palpitations, brain fog, inability to exercise even almost as before. The group has acquired the nickname, in some quarters, of “long-haul” from Covid.
Meanwhile, across the country, Monica Lypson, MD, saw the same in a post-Covid clinic she co-founded at George University Washington, DC “The predominant patients who come to our clinic are people in the prime of their lives; Maybe they were marathon runners or people who did CrossFit four times a week and now can barely go around the block, ”she says. “We thought most people would be post-hospitalized, but a lot of our patients have never even seen their doctor as part of their care.”
To manage the workload, dozens of post-Covid clinics have sprung up in major hospitals and universities. Doctors are scrambling to help the estimated 5-10% of people, between 1.5 and 3 million Americans, who have recovered from the characteristic symptoms of Covid (you know them now: cough, fever, fatigue) and are in pain. currently Post-Acute Sequelae of SARS-CoV-2 Infection (PASC).
PASC – which is also called “long Covid” or “long-haul Covid” – is characterized by an assortment of persistent problems. “Even though these symptoms alone are not life threatening, they feel like a major change for the people who experience them,” says Monnie Wasse, MD, director of the post-Covid clinic at Rush University Medical Center. Especially because so many of those struggling with the long Covid are young and previously felt healthy. “It feels like a slow progression to chronic disease,” she says, and as a result, anxiety often skyrockets. “People who were otherwise okay are now wondering how long they’re going to have these symptoms,” adds Dr. Wasse. “It can lead to a feeling of hopelessness.”
The search for the cause
Doctors are in PASC’s place now that they were with Covid itself about a year ago: Although there are so many unknowns, some promising theories have emerged. Some experts believe that the spike in inflammation that occurred when the immune system battled Covid ended up causing a lot of collateral damage. It’s possible that the regulation of the autonomic nervous system has been out of balance, so that the fight-or-flight signal turns on and off when it shouldn’t, altering heart rate and breathing for no apparent reason. Or the virus itself could have triggered the onset of an autoimmune disease similar to lupus or rheumatoid arthritis. Until a theory had scientific evidence to back it up – something that has yet to happen – the attention of these clinics has turned to symptom relief. They do not prescribe, for example, an anti-inflammatory diet, as it is not yet clear whether inflammation is the cause.
Some experts have wondered how many of these symptoms are from Covid and how many could simply be from pandemic life. The founders of the clinic suggest that this symptom-based approach is helpful in both cases, and that multidisciplinary clinics are a crucial step in helping people experience some relief.
Because this is such a new disease, your primary care doctor, if you have one, might not know the right questions to ask or even what to look for. “This is a disease that did not exist 18 months ago, so there is no one specialty that is perfect for treating all the problems a person faces,” says Dr. Block.
Not only will you save time and energy by meeting several specialists in the same clinic – a cardiologist for your beating heart, a psychologist for your anxiety, an Alzheimer’s specialist to help you with memory problems. , a pulmonologist for your difficulty catching your breath during exercise – they all talk to each other and share ideas to improve your care and our understanding of the disease.
“We meet so many people who have had a hard time being assessed and who have seen what they are going through rejected,” says Dr. Block. “It doesn’t help their symptoms or their emotional well-being.” Many of these clinics are located in large cities, but they often offer telehealth, so you can get treatment even if you live far away.
A dose of hope for long-haul travelers
While there is not yet a standard approach to supporting PASCs, clinics tend to operate the same. Doctors first perform a series of tests such as stress tests for your heart (maybe your rapid pulse is due to an existing heart problem, not your battle with Covid) and a scan of your lungs for exclude other diseases. If nothing comes back to explain what is happening, current treatments are used to relieve symptoms. Consider anti-anxiety medications or talk therapy for your mental health, an antidepressant that might help relieve some of the brain fog, compression tights to make sure blood is flowing well, and rehab sessions to help develop. exercise tolerance. Integrative medicine specialists may also recommend therapies involving diet, supplements, and sleep. “It’s a combination of art and science to try to find the right approach,” says Dr. Wasse.
The National Institutes of Health are so determined to find an approach that in early 2021, they announced $ 1.15 billion in funding for research to determine the causes, prevention and treatments of PASC. Vaccines could turn out to be part of the solution – anecdotal evidence suggests some people feel better after receiving the Covid vaccine, although science has not yet determined why.
The founders of the clinic echo each other to express their hope. “To my knowledge, in the history of medicine, we have never developed, successfully completed clinical trials, produced and administered a vaccine in one year, but we did,” says Soo Yeon Kim, MD, co-founder from the Johns Hopkins Post-Acute. Covid-19 team. “Under normal circumstances, figuring out why there are long-haul routes and how to deal with them would take a few years, but with over $ 1 billion spent on research, we would expect to see results much sooner.”
This story originally appeared in the July / August 2021 issue of Men’s health.
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