Many patients ask me about steroids early in the treatment of long COVID-19. While it’s true that steroids are often used in hospitalized patients with active COVID-19, the evidence for their effectiveness in patients who are recovering is not strong.

In fact, in animal studies of how COVID affects the brain, it appears that the non-judicious use of steroids in COVID-19 infection can make things worse.  That’s because early in COVID-19 infection, the immune system needs to be fully functional and at full speed.  Steroids like prednisone and dexamethasone shut down immune defense systems, which gives the virus an unchecked advantage in spreading inside the body.

When COVID-19 patients land in the hospital, its usually because their lungs are failing.  The current evidence indicates that in some people, due to underlying disease or genetic factors, COVID-19 infection triggers a hyper-reaction in their immune system.  The lungs are at ground zero of this reaction and are damaged in the cross-fire.  In this setting, steroids are used to tone-down the immune response to lessen lung damage.

How Would Steroids Help in Long COVID?

We are at the very edge of understanding this question. The first studies that will answer this will be conducted in hamsters, a species that remarkably mimics COVID-19 infection in humans.

It will be sometime before we know how applicable these findings are to humans. Nonetheless, these studies are encouraging and provide additional insight into COVID-19 and long Covid symptoms.

Long COVID is a fascinating medical challenge!  Helping patients navigate to recovery from Long COVID is a top priority at Wellivery.  Keep track of Long COVID developments by bookmarking the Wellivery Long COVID page.

Long COVID (also called Postacute Sequelae of SARS-CoV-2 Infection or PASC) is a new clinical diagnosis and as such, the diagnostic criteria for this disorder have not been settled.

What we can say is that survivors of COVID-19 infection are frequently reporting  new mental and physical problems that last weeks to months after their acute COVID-19 symptoms passed.

 

Does everybody with COVID-19 get long COVID?

This is very important question and is a moving target, like so many other aspects of COVID-19.  Only a few studies have been performed that can shed any light on this question.  In 2021, a systematic review of 57 published studies from around the world, covering 250,351 patients diagnosed with COVID-19 found that long covid symptoms occurred in 54% of survivors at 1 month, 55% at 2-5 months, and 54% at 6+ months (Groff et al, 2021).

Ok, so if 50% of COVID-19 survivors get long COVID, how many is that, in the U.S. and the world?  To get that number, we need to know how many people have gotten COVID19 and survived.

 

How Many People Have Survived COVID-19??

In the U.S. the current data from the CDC says 78M have survived COVID19 (as of 2/8/2022).  This number is currently increasing by 243K cases per day.

World-wide, WHO data indicate 397M cases, increasing at 1.8M cases per day;

On this point, we run into an ugly truth about how many people have had documented COVID19.  You see, I was there in early 2020, working in the ER when health systems said: “don’t come in unless you are really sick”, and, ‘we don’t have enough COVID tests to offer it to patients that aren’t being admitted”.  Then, throughout 2021, patients were instructed to assume they had COVID19 if they developed typical symptoms and had been exposed to a person known to be positive. We have all witnessed the widespread failure of COVID testing access.

 

The result: A lot of people that had, and currently have COVID19 didn’t get and aren’t getting counted.

 

So, you wouldn’t be shocked if I suggested the numbers offered above are a large under-representation of the true number of people infected with COVID19.  But, how far off is that number?  Why do I care?  Well, if ~50% of people surviving COVID19 are getting long COVID, it is important to know the size of that group so we can organize a clinical response that can reasonably deliver the needed care.

Estimating the ‘true’ Numbers

Though not often discussed in the media, epidemiologists appreciate that undercounting of COVID19 cases has occured.  In an effort to derive the real case counts, Reese et al considered the reasons for “underdetection” and derived a correction factor.  For every hospitalized patient,  2.5  patients weren’t counted. For every COVID19-positive patient that wasn’t hospitalized, 7.1 were not counted.  Let’s just consider the non-hospitilized scenario: To find the actual number of non-hospitalized COVID19 cases in the U.S., we need to multiply the CDC number by ‘7’.  That yields 546M, more than the population of the U.S., which suggests, as we know, that many people have gotten COVID19 more than once.

How Many Long COVID Patients Should We Prepare to Treat?

Given the currently reported undercounts, along with daily increases and the non-hospitalized correction factor (7. 1), it becomes clear that the current incidence of long COVID could easily be 273M.  As a frame of reference, the incidence of other chronic diseases is:

• Diabetes: 34 M
• Pre-diabetes: 88 M
• Heart Disease: 30 M
• Mental Health: 52 M
• Obesity: 119 M

This means long COVID is already the #1 chronic disease in the U.S.

How is the U.S. health system going to respond to the needs of 273M patients with a new chronic disease?

We’ll get into that next.

If you believe you have long COVID, schedule an appointment on Wellivery to get an assessment.

Long COVID is a fascinating medical challenge!  Helping patients navigate to recovery from Long COVID is a top priority at Wellivery.  Keep track of Long COVID developments by bookmarking the Wellivery Long COVID page.

You’ve heard a lot about COVID-19 but now you are wondering: What is Long COVID?

Long COVID is a new clinical diagnosis, emerging from the COVID-19 pandemic.

Survivors of COVID-19 reported new mental and physical problems that persisted for weeks or months after their acute COVID-19 symptoms passed.  The current working definition of long COVID is:

What kinds of problems?

• Shortness of Breath
• Poor endurance
• “Brain fog”
• Cough
• Chest pain
• Headache
• Palpitations and/or tachycardia
• Joint pain
• Muscle aches
• Tingling and numbness
• Abdominal pain
• Diarrhea
• Sleep difficulties
• Fever
• Lightheadedness
• Unable to function daily
• Pain
• Rash (e.g., urticaria)
• Mood changes
• Loss of smell and taste
• Menstrual cycle irregularities

As you can see, these symptoms are not unique to COVID-19 and are often seen in other medical conditions.  The observation that they occur as new problems after COVID-19 is likely related to the body systems involved in the acute infection phase.  Both the CDC and the WHO are actively considering this disorder and though their definitions are different, they are unified in emphasizing both the large number of patients experiencing it and the need to develop a health system response to care for sufferers.

If you believe you have long COVID, schedule an appointment on Wellivery to get an assessment.

Long COVID is a fascinating medical challenge!  Helping patients navigate to recovery from Long COVID is a top priority at Wellivery.  Keep track of Long COVID developments by bookmarking the Wellivery Long COVID page.