![]() ![]() In our study with Columbia colleagues Michael Yin, Anne-Catrin Uhlemann, and David Ho, we find that at 12 weeks around 25% of COVID patients with lingering symptoms reported fatigue, 25% reported insomnia, and around 20% reported increased heart rate or dizziness, but only 15% reported neurocognitive deficits like difficulty with short-term memory. In reality, I think the burden of moderate to severe long COVID is much lower, along the lines of 1% to 5%. Furthermore, many long COVID symptoms are commonly caused by other chronic conditions so it is important to confirm that they are actually due to COVID infection. Studies that use a liberal definition report that between 20% and 80% of COVID patients develop long COVID, but those studies probably overestimate how many people have moderate to severe long COVID. This definition is very broad and includes a lot of people who only report very mild symptoms such as mild fatigue or chronic nasal congestion. A lot of research studies use the criteria of having at least one symptom for more than 12 weeks after the acute infection. How many people develop long COVID after their initial infection? The omicron variants are mostly causing upper respiratory infections, so we’re seeing fewer pulmonary complications and also fewer neurocognitive issues and other symptoms, such as increased heart rate, lightheadedness, and chronic fatigue. I also suspect that the new omicron variants have mutated to the point where they’re acting very different than the original virus and the delta variant. First, it’s been shown that vaccination can help prevent long COVID. There are a few reasons contributing to this. LP: Fortunately, we’re seeing less severe long COVID in the past several months. Since then, my long COVID patients are not as debilitated. She went from being a high-functioning person to someone who could no longer work. My first long COVID patient had symptoms that waxed and waned for more than six months. It’s hard to know whether symptoms like muscle and respiratory deconditioning were due to hospitalization or COVID. So perhaps the severity of the illness and duration of the hospital stay contributed to their long COVID. Many were on a ventilator for a long time. SR: When COVID first started, a lot of people were hospitalized for COVID pneumonia. How has long COVID changed over the past two years? And it’s very common to have weeks or months of fatigue after infection with Epstein-Barr virus, or "mono." We also see similar things happen after HIV infection, influenza, and other viral infections. We’re seeing both of those symptoms with long COVID. After recovery from Ebola virus, it’s very common to have chronic fatigue, as well as chronic joint and muscle pain. It is not entirely surprising that we’re seeing long-term symptoms after COVID. There’s a whole other type of long COVID that involves the heart and lungs, likely due to the fact that they had severe illness impacting the lungs and heart during the acute infection. Lawrence Purpura: In my clinic, we see patients with a variety of neurologic problems such as ringing in the ears, numbness and tingling in the hands and feet, problems with concentration and memory, and chronic fatigue as well as increased heart rate and lightheadedness due to changes in body position, similar to the known phenomenon called POTS (postural orthostatic tachycardia syndrome). We have also learned that COVID virus can lead to nerve damage that alters the sense of smell and taste, and some people will have nonspecific neurological disturbances, such as tingling or discomfort. These symptoms also occur with other post-viral syndromes. Another big one is executive dysfunction, or what people call brain fog. Recently, I had a patient with an ongoing, lingering cough. Sarah Ryan: The most common symptoms are shortness of breath on exertion, decreased exercise capacity, feeling more tired. What types of symptoms are you seeing? Is long COVID similar to other post-viral syndromes? Ryan has been caring for long COVID patients since the first months of the pandemic and participated in an expert clinical care panel on long COVID assembled by New York state’s Department of Health. He also formed a clinic for patients with severe manifestations of the syndrome. Purpura has established a study of COVID patients to look for factors that raise the risk of developing long COVID, as well as ways to more easily diagnose long COVID, and was recently awarded an NIH grant to study neurologic symptoms of long COVID. To get the latest on long COVID, we spoke with Columbia experts Lawrence Purpura, MD, MPH, infectious diseases specialist, and primary care physician Sarah Ryan, MD. From left: Sarah Ryan and Lawrence Purpura (Columbia University Irving Medical Center) ![]()
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