Boston Herald

Doctors battle against debilitati­ng long-haul COVID

- By dr. Jeffrey gold Dr. Jeffrey Gold is a family physician and the owner of Gold Direct Care in Marblehead.

“Long COVID” is one of many scary phrases that have entered our vocabulary since the pandemic upended global life.

Those who have it are afflicted with a COVID that seems never to go away, a lingering torment that demoralize­s as much as it incapacita­tes. With the current panic over the Delta variant, there’s a danger that we will not accord this slowburn condition the attention it deserves.

With symptoms ranging from severe fatigue and lightheade­dness to anxiety and, in some extreme cases, psychosis, these long-haul patients are begging for help. They aren’t a niche segment of the population. Studies indicate that as many as three out of 10 people infected with COVID-19 may experience long COVID. One study of hospitaliz­ed COVID-19 patients found nearly 80% experience­d lingering aftereffec­ts six months after discharge. And yet, doctors struggle to find an explanatio­n for their conditions.

Another part of the problem is that almost all studies of long COVID focus on its effects in the unvaccinat­ed. Very little research has been done on those with a “breakthrou­gh infection” — the contractin­g of COVID-19 after vaccinatio­n. Preliminar­y research in Israel suggests that symptoms of COVID can endure for up to six weeks in breakthrou­gh cases.

What makes long COVID so puzzling is the variety of possible symptoms, of which there are potentiall­y hundreds. Patients report shortness of breath, fever, difficulty concentrat­ing and skin conditions, to name a few. Some patients experience hearing loss and now need to wear hearing aids. Still others report fatigue so severe that they struggle to get out of bed or move from the couch. There’s no diagnostic test for long COVID, and brain MRI scans and other tests fail to yield results.

But this list of symptoms also gives researcher­s multiple vantage points from which to study the condition.

Some scientists theorize that fighting COVID 19 leaves behind viral particles that trigger a generalize­d cycle of inflammati­on long after the body has defeated the pathogen itself. Others think the virus may burrow in human tissues, allowing it to surface sometime later when immunity weakens. Viruses like HIV and herpes simplex are known to act in this way.

In select cases, doctors have diagnosed patients complainin­g of long COVID symptoms with a rare condition known as postural orthostati­c tachycardi­a syndrome, POTS for short. POTS arises from dysfunctio­n in the autonomic nervous system, the part of our bodies that regulates functions such as breathing, heart rate, blood pressure and digestion. The condition often appears suddenly, following a viral infection.

The more doctors research and learn, the more easily they can attend to long-haulers’ symptoms. And in guidelines released mid-June, the Centers for Disease Control and Prevention recommende­d doctors focus their approach on patients’ specific symptoms.

Thus, in the fight against long COVID, doctors should target the symptoms patients are experienci­ng with treatments already proven to address those indication­s.

For patients experienci­ng high blood pressure, for instance, doctors can prescribe beta blockers to slow their heart rate. Those patients who feel extreme fatigue can benefit from medicines used to treat chronic fatigue syndrome. Some patients with a POTS diagnosis see positive results from a drug called ivabradine. Other long-haulers have tried intravenou­s immune globulin transfusio­ns to reduce inflammati­on.

A number of drugs, FDAapprove­d for other ailments, are finding welcome additional use in the treatment of COVID. Empagliflo­zin, commonly used for Type-2 diabetes, promises to protect against COVID-related organ failure. Baracitini­b, an anti-inflammato­ry drug developed for rheumatoid arthritis, has shown notable effectiven­ess in reducing COVID-related mortality.

Patients experienci­ng respirator­y problems may benefit from a new drug known as Tavalisse, which has FDA approval for use in patients suffering from a rare condition known as thrombocyt­openia. Meanwhile, a recent study found that Low Dose Naltrexone — a therapy greenlit for patients who suffer from chronic fatigue or chronic pain — shows potential to safely and effectivel­y disrupt COVID-19’s ability to attack the body.

The finding of a treatment to alleviate lasting symptoms is a prayer answered for long-haulers. Many have been forced to quit their jobs because their symptoms are too severe to let them work a full day. Those fortunate enough to attend long-haul rehabilita­tion still average 100 days of care before recovery.

Curing long COVID requires dedicated research and investment. With tens of thousands of Americans getting infected with COVID-19 every day, the scientific community must double down on finding cures.

 ?? Ap file ?? NO PATTERN: Long COVID patients present a baffling array of symptoms. The CDC recommends that doctors concentrat­e on treating the symptoms.
Ap file NO PATTERN: Long COVID patients present a baffling array of symptoms. The CDC recommends that doctors concentrat­e on treating the symptoms.

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