A large number of patients that experienced COVID-19 will have persisting lung symptoms such as shortness of breath, wheezing, cough,  and decreased exercise capacity.  These problems are usually worse in patients who became so ill that they required hospitalization.

The evaluation and treatment for these pulmonary symptoms is the same as for symptoms caused by regular asthma and emphysema.  Vital signs and a chest examination are the first steps and along with symptoms, determine whether further testing is needed.

Additonal testing may include: imaging by x-ray, CT scan or MRI, pulmonary function testing, exercise testing, and cardiology consultation.  Typical treatments include bronchodilators, inhaled steroids, and frequent follow up for assessment of line function.

These symptoms seem to be related to damage in the lining of breathing tubes.  The cause of this damage is an active area of scientific study in an effort to understand how to reverse it and treat symptoms caused by it.

Treating Long COVID Lung

How should  patients with Long COVID Lung be managed?  Physicians and researchers are refining the best approach and since this is a new problem in medicine, new approaches are being developed daily.

Since patients with Long COVID lung are not hospitalized, a home-based way of tracking symptoms and lung function is needed.

The most standardized method available for self-measurement of lung performance is pulmonary expiratory flow or PEF.

This is measured using a peak expiratory flow meter that is portable, inexpensive and easy to operate by patients.

When the readings from these devices are logged, the numbers can be used as a reference for how lung function is progressing.

If these readings indicate improvement, medication supporting lung function can be reduced. If these readings indicate that lung function is not improving, more intervention is needed.   I recently reviewed all of the currently available PEF devices and you can read my recommendation here.

How Does

Long COVID Lung

Affect

You?

Long COVID Lung symptoms of cough, shortness of breath, and fatigue can dramatically limit your normal activities.  The cough can disrupt your sleep, create headaches, and disturb your work productivity.  Shortness of breath, both at rest and with exertion can be alarming!

What Causes

Long COVID Lung

At the moment, Long Covid Lung appears to involve damage to the lining of the small breathing tubes (bronchioles) throughout the lung.  This is based on CT scans of patients who have recovered from acute COVID-19 infection.  These finding are seen in patients who did not require hospitalization for their COVID-19 infection!

The cause of this damage is an area of active scientific investigation.  I’ll post updates as new discoveries occur.

Wellivery and Long COVID

I have created a dedicated page about Long COVID as a launching point for exploring what we know about Long COVID, its cause, treatment, and longterm affects.

Clinic Trials Long COVID

You have either heard of or experienced first hand the “brain fog” associated with COVID-19 infection.  This disordered operation of thought and memory occurs during an active COVID-19 infection.  But what about later, down the road?  Do these issues persist? Is this Long COVID Brain?

The most comprehensive investigation of brain issues weeks after recovery from active COVID-19 was published in Nature (Douaud et al.)

These investigators performed brain scans on a 785 patients on two occasions.  Sometime after the first scan, 401 patients in this group tested positive for COVID-19.  The scientists compared the brain images before and after COVID-19 infection and compared these images with those obtained in 384 COVID-19-negative controls.  They reported structural changes in three main areas:

1. A decrease in the outer layer of brain (grey matter) densely filled with nerves most noticeable in the front of the brain and in a layer called the parahippocampal gyrus;
2. Signs of brain damage in the part of the brain connected to the olfactory nerve which is responsible for the sense of smell; and,
3. An overall decrease in the size of the brain.

In addition, they found a decrease in cognitive skills like computation, judgement and memory in those patients who tested positive and showed the changes in brain structure.

These cognitive changes have been reported previously (Taquet et al, Taquet et. al.).

How Does

Long COVID Brain

Affect

Brain Function?

In the Douaud et al. study, the investigators used a neuropsychological measure called the Trail Making test, which reflects a number of complex brain functions that together comprise Executive Functioning.  Executive functioning is essential for planning, organizing and executing tasks.  We don’t know yet how long these brain disorders last.

Wellivery and Long COVID Brain.

I will track and update this section of Wellivery.com to give you the best information about this topic.

What Causes

Long COVID Brain?

At least 2 major theories that have been proposed to explain the brain effects of Long COVID.  So far, the mechanisms that have been proposed have not been proven.  Getting the answer to this question will be a key component of understanding how to treat, prevent, and possible reverse Long COVID brain.

Wellivery and Long COVID

I have created a dedicated page about Long COVID as a launching point for exploring what we know about Long COVID, its cause, treatment, and longterm affects.

Infection with COVID-19 has shown us many unique medical problems caused by the virus.  Once you as a patient get out of the danger zone with your initial infection, you may not be out of the woods.  Many patients COVID-19 are reporting new problems beginning many weeks later.  A number of body systems seem to be injured by this virus.  The heart and blood vessels is one we are learning more about.

Long COVID Heart

The most interesting source of this information comes from a recent study published in Nature Medicine by Xie et. al. showing that COVID-19 produces a number a serious disorders that become evident weeks after recovery from the initial infection.  They include:

• Strokes (due to blood clots in the blood vessels of the brain);
• Heart Rhythm problems;
• Heart attacks (ischemic heart disease);
• Inflammation around the heart (pericarditis);
• Inflammation of the heart muscle (myocarditis);
• Heart failure; and
• Blood clots in vessels throughout the body.

Even minor symptoms from COVID-19 have been assciated with these disorders!

What To Do About It?

Be on the lookout for symptoms. Long COVID has a broad set of symptoms that appears at least four weeks after the initial COVID-19 infection.  Symptoms in this list related to the heart and blood vessels should alert your doctor to the possibility that more serious disorders exist.  More testing will be needed in each case to make sure you are ok.

Treating Long COVID Heart

So far, the disorders of the heart and blood vessels from COVID-19 are treated using standard, well established medicines or procedures.  Whether we can prevent the development of these disorders is not yet known.

My Job?

My job as a physician is to evaluate your symptoms, get a diagnosis of the underlying disorder, and launch treatment and/or intervention.  Perhaps in time, there will be specific treatments and interventions for heart and blood vessel problems caused by COVID-19.  For now, you keep an eye on your health and I’ll watch the scientific and medical literature for new information.

I’ll post new scientific discoveries on this page, so BookMark it now!

Long COVID treatment is becoming a serious topic as doctors and scientists come to appreciate just how many COVID-19 survivors are likely to experience this disorder.  Both the CDC and the WHO are working establish more knowledge about it.  But first, what are we talking about?

The definition of Long COVID is evolving and this evolution is occurring faster than almost any other area of medicine.  Consequently, we will know dramatically more about Long COVID in 6 months. 

For now, Long COVID is a broad set of symptoms that appears at least four weeks after the initial COVID-19 infection.  None of these symptoms are unique to COVID-19 and are seen in other disorders.  

Treating It

In some of these other disorders, well defined treatments have been established. My job as a physician is to evaluate these symptoms, determine if they are part of a non-COVID disorder and launch treatment.  

For example, after recovery from COVID-19, many patients complain of shortness of breath. Shortness of breath is also a symptom seen in poorly controlled asthma. If the shortness of breath these patients report is from asthma, and we make the diagnosis of asthma, then asthma medicine can be prescribed with good relief of the symptoms.

What if asthma is not diagnosed in these patients? Would asthma medicine still provide them relief? These are valid and very important questions that doctors and patients will be discovering the answers to as we move forward.

Moving Ahead!

I believe there are a few main points to remember:

1. At this time, it is believed that most post-Covid symptoms will resolve in a period of six months to one year.
2. The medication or interventions that improve the long COVID symptoms are already well known.
3. Most Long COVID patients can be managed by a primary care physician.
4. As a physician, the most important task is to keep Long COVID patients hopeful while being vigilant for treatable serious underlying diseases. 
5. Just as with all chronic health problems, building an expert, accessible, healing relationship between the patient and physician is be the best way to move through the Long COVID recovery process.

Long COVID will present some treatment challenges.

There is much that we don’t know about this disorder.  But, we know a lot about helping patients overcome the limitations of a chronic disease.  We can apply that knowlege and those approaches to help patients overcome Long COVID for life!

First, we need clarify what is meant by Long COVID.  The definition of long COVID is being perfected but for now, it refers to new mental or physical symptoms that are present four or more weeks after your acute COVID infection.  We know the SARS-CoV-2 virus causes COVID-19 and we are getting better understanding about why infection with SARS-CoV-2 creates so much lung damage.  How this virus causes the symptoms of Long COVID in other body systems is still being worked out but, we have some clues.

Yep!  Hamsters get COVID-19 and they suffer the same complications as human, including LONG COVID!

This means they can be studied for clues to how COVID-19 induces Long COVID in humans.

The first symptom of long COVID explored in hamsters was loss of smell.  Hamsters loose their sense of smell with COVID-19 just like humans and this effect can be long lasting.  The study describing these observations performed by Zazhytska et al. was published in the journal Cell.

In hamsters that suffered lasting loss of smell, evaluation of the olfactory nerve showed damage to a particular structural cell in the olfactory (smell) bulb connected to the nose.  The damage to these cells results in a large amount of inflammation which impairs the normal functions of olfactory nerve cells in the same tissue.  The nerve cells are not damaged but cannot maintain their normal smell-functions resulting in loss of the sense of smell.

The normal immune response eventually gets control of this inflammation, allowing the olfactory nerve cells to resume their normal smell-related functions and the sense of smell returns.

The same inflammation-related malfunction was found in other areas of the hamster brain.   If true in humans, this may explain neurological and mental changes that have been reported in Long COVID.

Fixing it.

Studies are currently looking to see if shutting down the inflammation response with medication will allow more rapid recovery of these neurological functions including smell and other mental health functions.

Until we have a more detailed understanding of the cause of lasting changes in the brain and other body systems in Long COVID, we will focus on assisting patients with a wide variety of symptoms. Our overall goal is to improve functional capacity and quality of life in these patients.

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.