A number of people who get infected with the COVID-19 virus develop what is called long COVID, but what is it, and who is at risk? Dr. Monica Verduzco-Gutierrez, an academic physiatrist and professor and chair of the Department of Rehabilitation Medicine at the Long School of Medicine at UT Health San Antonio, said while there are still many unknowns, they are learning more.
Verduzco-Gutierrez should know. She specializes in the care of patients with traumatic brain injury, stroke rehabilitation and interventional spasticity management. However, during the COVID-19 pandemic, she also began to focus on those rehabilitating from COVID. She opened post-COVID recovery clinics and has become an expert in the space.
Recently, she spoke at Encompass Health’s Medical Director Meeting on her work with those recovering from COVID. In the following Q&A, she discusses long COVID and what we know at this time.
Who Is at Risk for Long COVID and How Common Is It?
Data from the CDC as well as from initial research has shown that people who have experienced more severe COVID-19 illness, especially if they were hospitalized or in the ICU, will have a greater risk for post-COVID conditions. Other risk factors are people who had underlying health conditions, such as asthma, obesity and type 2 diabetes, and those who are unvaccinated. There has been additional research illustrating a number of initial symptoms—five or more—or certain symptoms during primary infection, such as hair loss, headache and sore throat. Finally, SARS-CoV-2 viral load is another risk factor and immune response.
Overall, a CDC study revealed that one in 13 adults in the U.S. have long COVID symptoms, or nearly one in five adults who have had the virus.
What is the Criteria for a Diagnosis?
Currently it is a clinical diagnosis with persistent or new symptoms at least four weeks after infection. That is the start of when post-COVID conditions can first be identified.
Unfortunately, we don’t have any definitive blood test yet.
What Have You Learned about Long COVID patients?
In August 2020, I started two post-COVID clinics in San Antonio, one through UT Health San Antonio and the other with University Health System. Part of the reason I developed both clinics was to ensure that patients have access to care, whether they are in the safety net system or have private insurance in the community.
The most common symptoms that we see in the clinic are definitely fatigue, post-exertional discomfort, headaches, pain, symptoms consistent with chronic fatigue syndrome, ongoing shortness of breath, concentration or memory issues—what people describe as brain fog—and a myriad of other symptoms.
What are the Treatment Options and the Long-Term Prognosis?
The treatment options are very individualized for patients. It’s important to screen for post-exertional symptom exacerbation because our traditional models of rehabilitation might actually make those patients worse. Some patients who present with more myalgic encephalomyelitis or chronic fatigue may actually need more rest, prioritization of their activities and energy conservation learned through occupational therapy and pacing, along with monitoring for triggers that can exacerbate their symptoms. Patients with cognitive complaints definitely benefit from speech therapy or neuropsychology.
The long-term prognosis is still unknown, but some patients can get over it in month while others have been dealing with it since the beginning of the pandemic. Having long COVID and having reinfections have been shown to put you at risk of developing other diseases, more disabilities, more hospitalizations and even death in some populations.
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