Is It Long COVID?

True to its name, long COVID has a lengthy definition developed by the National Academies of Sciences, Engineering and Medicine (NASEM). In a nutshell, according to the NASEM, it’s a collection of symptoms and conditions that continue for four weeks or more after initial COVID-19 or SARS-CoV-2 infection. The problem is that the symptoms are common to other viral infections and disorders such as Epstein-Barr and chronic fatigue syndrome. So how do we know if it’s long COVID?

According to neurologist Jonathan Cheponis, MD, with Lehigh Valley Fleming Neuroscience Institute, the Lehigh Valley Health Network (LVHN) clinical team has been encountering symptoms of “viral fatigue” for decades, but cases were rare and isolated. “Now, we’re seeing hundreds of people with the same symptoms all at once with no trigger other than COVID-19,” he says.  

Dr. Cheponis says that post-COVID symptoms run the gamut from a runny nose and fever to severe cognitive impairment and fatigue.

Some patients describe being very sick and not bouncing back as they have before. Once they get over the fever, body aches and breathing difficulties, the cognitive symptoms stay. Sometimes referred to as “brain fog,” symptoms include slowed thinking, having to work hard to pay attention, and trouble getting started, concentrating, remembering and making decisions.

He describes a “very mixed bag” of a timeline, where some patients regain their health in two weeks, while others have difficulty much longer. “Some patients are still not themselves after two years post-infection,” Dr. Cheponis says.

While clinicians say patients usually eventually recover, it’s impossible to tell them they will be better at a certain time. “No one has had more than five years’ experience with this condition, so we don’t know the outcome,” Dr. Cheponis says. “Experts are digging into this, but we just don’t have an easy answer right now.”  

If you think you have long COVID, it’s recommended you visit your primary care clinician to rule out a thyroid or vitamin deficiency or another kind of infection. From there you may be referred to a specialist, such as a neurologist. Considering there isn’t a specific treatment for long COVID, you may also be referred to a physical therapist who specializes in neurology.

“If a patient is having cognitive issues, we usually see them,” says LVHN physical therapist Sandra Tremblay, Rehabilitation Manager, Neurological Programming, who is certified in brain injury. She says, in addition to common symptoms, she also encounters people with attention disorders, headaches, feeling hot or cold, dizziness, racing heart, gastrointestinal issues and myalgia (muscle aches) or weakness.

“A primary treatment is exercise,” Tremblay says. “Increasing circulation to the brain can help with regulation of heart rate, breathing and balance, which is usually the first complaint, and many of the other impairments.”

In addition, patients typically will undergo physical, occupational and speech therapy, depending on the individual. Other treatments might be mental health if the patient is depressed, for example. Tremblay says that this multidisciplinary therapy is used for patients having concussion, stroke and traumatic brain injury, as well as those who are post-COVID.

“While we don’t always call it ‘long COVID,’ these symptoms have exploded since the pandemic,” Tremblay says. “As always, we treat patients’ symptoms regardless of where they’re coming from.”