Late last spring, Brian Block, M.D., noticed that some of the people coming into his clinic at the University of California, San Francisco—the one he and his colleagues created to help people recover from severe Covid—weren’t who he’d anticipated. Alongside those who had been hospitalized with Covid, which was the population he and his colleagues had expected to care for, about a quarter of the patients were people who had never been hospitalized for the disease. They’d had “mild” acute Covid—a fever, a cough that they’d recovered from quickly. But months after thinking they’d beaten the illness, they didn’t feel like themselves—heart palpitations, brain fog, an inability to exercise even close to how they used to. The group acquired the moniker, in some circles, of Covid “long-haulers.”
Meanwhile, on the other side of the country, Monica Lypson, M.D., was seeing the same thing at a post-Covid clinic she’d cofounded at George Washington University, in D. C. “The predominant patients who show up to our clinic are people in the prime of their lives; they might have been marathoners or people who did CrossFit four times a week and now can barely walk around the block,” she says. “We thought most people would be post-hospitalization, but many of our patients never even saw their physician as part of their care.”
To handle the caseload, dozens of post-Covid clinics have popped up at major hospitals and universities. Doctors are scrambling to help the estimated 5 to 10 percent of people—that’s between 1.5 and 3 million Americans—who’ve recovered from the defining symptoms of Covid (you know them by now: cough, fever, fatigue) and currently suffer from Post-Acute Sequelae of SARS-CoV-2 infection (PASC).
PASC—which also goes by “long Covid,” or “long-haul Covid,”—is characterized by an assortment of lingering issues. “Even though these symptoms alone aren’t life-threatening, they feel like a major change to the people experiencing them,” says Monnie Wasse, M.D., director of the post-Covid clinic at Rush University Medical Center. Especially because so many of those dealing with long Covid are young and previously felt healthy. “It feels like a slow roll into a chronic illness,” she says, and as a result, anxiety is often spiraling around it. “People who were otherwise well are now wondering how long they’re going to have these symptoms,” Dr. Wasse adds. “This can lead to a feeling of hopelessness.”
The search for the cause
Doctors are at the place with PASC now that they were with Covid itself about a year ago: While there are so many unknowns, some promising theories have emerged. Some experts think that the spike in inflammation that occurred when the immune system fought off Covid ended up causing a lot of collateral damage. It’s possible that the regulation of the autonomic nervous system got knocked off-kilter, so the fight-or-flight signal goes on and off when it shouldn’t, changing heart rate and breathing for seemingly no reason. Or the virus itself could have triggered the start of an autoimmune disease similar to lupus or rheumatoid arthritis. Until a theory has scientific evidence supporting it—something that hasn’t happened yet—the focus at these clinics has turned to relieving symptoms. They’re not prescribing, say, an anti-inflammatory diet, since it’s not clear yet that inflammation is the cause.
Some experts have questioned how many of these symptoms are from Covid and how many might just be from pandemic life. Clinic founders suggest this symptom-based approach is useful either way, and that the multi- disciplinary clinics are a crucial step in helping people feel some relief.
Because this is such a new disease, your primary-care physician—if you have one—might not know the right questions to ask or even what to look for. “This is a disease that didn’t exist 18 months ago, so there’s no specialty that’s a perfect fit for addressing all the issues someone is facing,” says Dr. Block.
Not only will you save time and energy meeting with multiple specialists at a single clinic—a cardiologist for your racing heart, a psychologist for your anxiety, an Alzheimer’s specialist to help with memory issues, a pulmonologist for your difficulty catching your breath during exercise—they all talk to one another and share insights to improve your care and our understanding of the disease.
“We meet so many people who had trouble being evaluated and had what they’re experiencing dismissed,” says Dr. Block. “That doesn’t help their symptoms or their emotional well-being.” Many of these clinics are in major cities, but they often offer telehealth, so you can get treated by them even if you live far away.
A dose of hope for long haulers
While there isn’t a standard approach to caring for PASC yet, clinics tend to run in a similar way. Doctors first perform a series of tests such as stress tests for your heart (maybe your racing pulse is due to an existing heart issue, not your battle with Covid) and a CT scan for your lungs to rule out other diseases. If nothing comes back to explain what’s going on, current treatments are used to help with the symptoms. Think antianxiety medication or talk therapy for your mental health, an antidepressant that could help with some of the brain fog, compression tights to make sure blood is flowing well, and rehab sessions to help build exercise tolerance. Integrative-medicine specialists might also recommend therapies involving diet, supplements, and sleep. “It’s a combination of art and science in terms of trying to find the right approach,” says Dr. Wasse.
The National Institutes of Health is so committed to finding an approach that in early 2021 it announced $1.15 billion in research funding to determine causes, prevention, and treatments for PASC. Vaccines might turn out to be part of the solution—anecdotal evidence suggests that some people feel better after receiving the Covid vaccine, although science has yet to pin down why.
Clinic founders echo one another in expressing hope. “To my knowledge, in medical history we have never developed, passed clinical trials, produced, and administered a vaccine within a year, but we made it happen,” says Soo Yeon Kim, M.D., a cofounder of the Johns Hopkins Post-Acute Covid-19 Team. “Under normal circumstances, figuring out why there are long-haulers and how to treat them would take a few years, but with over a billion dollars going into research, we are expecting to have results much sooner.”
This story originally appeared in the July/August 2021 issue of Men’s Health.
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