EMERSON DIVES INTO ‘LONG COVID’ POOL
Hospital studying lingering effects of coronavirus in some patients
CONCORD » Over a year after COVID-19 first touched down in the U.S., doctors still have much to learn about what has been colloquially dubbed “Long COVID.” In these patients, strange symptoms have lingered for months, even if the patient originally had only a mild case of COVID-19. Many of these patients are young or middleaged and were previously healthy. Emerson Hospital in Concord is jumping into the fray to try to understand this complicated syndrome.
“COVID long-haulers” most commonly experience symptoms including “fatigue, body aches, shortness of breath, difficulty concentrating, inability to exercise, headache, and difficulty sleeping,” according to a Harvard Health blog post. It’s not limited to those symptoms, however. One doctor reported his patient had “extreme fatigue, bulging veins, excessive bruising, an erratic heartbeat, short-term memory loss, gynecological problems, sensitivity
to light and sounds, and brain fog,” as he recounted to STAT News. A small number of longhaulers have also described distressing psychotic symptoms, as the New York Times reported.
Early in the pandemic, Emerson rehab therapists were assigned to work in the hospital’s critical care unit to help with the surge in COVID-19 patients. They started to speculate about what the long-term implications of the virus might be. “We had a discussion about what did you see in the inpatient (side) and how can we move that into a outpatient support for those patients that have experienced dizziness, weakness, you name it from being on a (ventilator),” said Terrie Enis, physical therapist and the director of ambulatory service line development.
Matt O’Connor, a physical therapist at Emerson, took the lead on the research and is developing a rehabilitation program for these long-haulers that encompasses physical therapy, occupational therapy, speech therapy, pulmonary rehab, cardiac rehab and more. “When you think collaboration, it really doesn’t get any better than this,” Enis said.
Because long COVID is such a new and mysterious element of the disease, O’Connor’s research hasn’t been easy. “The variability that patients show in presentation and severity of symptoms made it kind of challenging to pin down what was actually happening,” he said. “As time has gone on, and we’ve learned a little bit more about them, the perspective that we got from the hospital definitely helps us understand what our patients are going through more than anything.”
Although no one has figured out the cause of long COVID, O’Connor has a theory, based on what the medical community knows about past viral diseases like SARS and MERS. “It seems like a common thread between a lot of the patients who are experiencing these kind of bizarre and random symptoms is this autonomic dysfunction,” he said. “Their body really ramps themselves up into ‘fight or flight’ mode at really what would be an inappropriate level.
He said patients have reported walking a short distance and feeling tired the next day, or feeling exhausted even after watching a few hours of TV.
Although O’Connor said he has only seen about 10 patients for long COVID recovery so far, there seems to be little pattern among them. His youngest patient is 32, and his oldest is 85, and not everybody has had a serious case of COVID-19 to begin with.
Although there are outliers, some symptoms seem to be common, including physical and cognitive exhaustion, which O’Connor said is the primary symptom, but other symptoms he’s seen include “headaches, there’s been ear pain, chest pain, heart racing, changes in blood pressure with changes in trunk and neck position has been common, something that’s called (postural orthostatic tachycardia syndrome, or POTS), which people have been reporting on a lot more now. But it’s really everything and anything,” he said.
He gave the example of an old
er male patient he had, who had trouble walking for more than two minutes without needing a break. With physical therapy over the course of a few months, he is now able to take walks with his wife again.
Another patient, a middleaged male, had a “cognitively demanding job,” and had to take time off due to his brain fog. With a structured program of physical therapy and neurospeech therapy, he has shown improvement. Neuro-speech therapy teaches patients energy conservation and coping strategies in a “toolkit,” as Enis called
it, to help them get through their days. O’Connor gave the following example of how this works: “Say someone was a teacher, and they were just having trouble remembering their kids’ names. We’re going to help the patient develop strategies to either pair a name with a face or keep some flashcards around, even if it isn’t just a full immediate recovery, it’s a way to mitigate how their symptoms affect their life, so they can continue to do their job, live their life, without feeling impaired by what they’re dealing with,” he said.
Although the program is small
now, Enis said Emerson has heard a “high degree of interest” about it. “I don’t think we know yet what the impact is going to be. I think it’s fair to say it’s going to be pretty large… I think we’re just at the tip of the iceberg,” she said. Research has already suggested that about 10% of COVID19 patients become long-haulers.
And Emerson is committed to unlocking the issue. “We’re here for people who need it, and we’re learning new things every day,” O’Connor said. “We’re hoping to be a good resource for the community and hopefully for the surrounding area in the future.”