Managing Symptoms of Long COVID

John Whyte, MD; Janna Friedly, MD, MPH


September 14, 2021

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JOHN WHYTE: Have you had COVID a few weeks ago, maybe your sense of smell hasn't returned? You're having trouble concentrating? There's a phenomenon called long COVID, and we call people who suffer from it long haulers.

To help to explain what this is, as well as how to help manage it. I've asked one of the leading experts. Dr. Janna Friedly is professor of physical medicine rehabilitation at the University of Washington and runs a clinic there on long COVID. Dr. Friedly, thanks for taking time.

JANNA FRIEDLY: Thanks for having me.

JOHN WHYTE: Well, let's start off with this phenomenon. Long COVID. It's estimated more than 2 million people are suffering from it. How would you define it?

JANNA FRIEDLY: So, long COVID is when people have an initial COVID infection, and they may recover from the initial infection but then continue to have longer-term symptoms, so symptoms that last for a month or longer after their initial COVID infection. And people who have long COVID have a variety of symptoms that range from things like headaches to extreme fatigue to changes in their memory and their thinking, as well as muscle weakness and joint pain and muscle aches, among many other symptoms.

JOHN WHYTE: Are there any special lab tests that you order to help patients figure out if that's what they may be suffering from? Because as you point out, some of these symptoms aren't specific to COVID.

JANNA FRIEDLY: Now, patients with long COVID tend to have a variety of symptoms. So a lot of the diagnosis is based on the history of having COVID recently, and subsequently, developing these new symptoms. So it's mostly a clinical diagnosis, but there are some lab tests that we do to look for, particularly, for markers of inflammation. So we are still learning about long COVID and what causes it, but it's thought to be related to your immune system response to COVID that really sets off this cascade of inflammation, and so sometimes we're able to see some of that in the lab tests that we do.

JOHN WHYTE: Now, let's be fair, Dr. Friedly. People are going to be saying, “What are those lab tests?” So what are some of those that you order?

JANNA FRIEDLY: So some of the -- in general, we start with some of the basic labs to look at your white blood cell count, your red blood cell count, and then what we call a comprehensive panel to look at your electrolytes and how well your kidneys and your liver are functioning. And then there are specific markers for inflammation like a sedimentation rate, or a CRP. Those sometimes are helpful for us. We oftentimes see abnormalities in people's d-dimer, which is another marker of inflammation and can be associated with some of the vascular changes that we see.

JOHN WHYTE: Is there a typical patient that may make you think more this patient might have long COVID? And correct me if I'm wrong: Initially, we were thinking we'd see this in people that are older. And now, we're actually seeing a fair number of young people who present, and I have some data. Correct me if I'm wrong: When you started your clinic at UW, it was two people a week.

Now, it's been 25 people a week. And many of those are younger people. So can you talk to us about what that population is that you're seeing and the impact on young people? Because people like to say it's like flu. It's not like flu. We don't get long-term complications with the flu, do we?

JANNA FRIEDLY: Yeah, absolutely. So initially, when we started this clinic over a year and a half ago now, we initially thought that we were going to be seeing primarily people who had been hospitalized with COVID; people who are older and had co-morbidities that required rehabilitation after a long hospitalization. But we very quickly realized that there was a very large population of people who were younger and healthier who were not hospitalized initially that had what they thought were mild to moderate initial infections that were really struggling with disabling symptoms.

Just as way of background, I myself had COVID in April of 2020, and I struggled with symptoms for many, many months after I had my COVID infection. So I'm one of those people that was very healthy -- on the younger side, I like to think -- and really struggled with some of these longer-term symptoms. Our patients are debilitated from the symptoms.

We have younger patients who were marathon runners and triathletes and even professional athletes. People who were professionals in their career -- doctors, nurses, lawyers -- and are oftentimes unable to return to any of the activities that they enjoy doing and really struggling sometimes with returning to work as well because of the symptoms.

JOHN WHYTE: There's data to suggest that many patients are still experiencing symptoms a year later. You mentioned you were suffering from it. Can you talk a little bit about your recovery? How did you get to the point of recovery?

JANNA FRIEDLY: Absolutely. I struggled, like many people struggled with fatigue and headaches, as well as muscle aches and pains and inability to do the kinds of exercise that I was able to do prior to COVID. And I used a lot of the strategies that we use with our patients. I focused on making sure that I was getting good-quality sleep, that I was eating a healthy diet, that was more of a Mediterranean style, anti-inflammatory diet to try to reduce inflammation.

And then I started a very gradual restorative exercise program, starting with breathing exercises, stretching, very light strengthening, and low-intensity aerobic exercise and really had to retrain my body to be able to handle the kinds of activities that I was used to doing.

JOHN WHYTE: Do people typically need to see specialists, either cardiologists, pulmonologist? You're at a clinic that can be multispecialty, but what about folks that don't necessarily have that option? What would you advise them, in terms of whether it's their primary care doctor, a specialist? Should they think about enrolling in a clinical trial?

What advice do you have to viewers who may be suffering from long COVID, or a loved one or friend is?

JANNA FRIEDLY: I think the first thing I would recommend is to work with your primary care doctor, and they can really help you to do a thorough evaluation of your condition and help make some of the initial recommendations. What we are finding is that a lot of the symptoms are systemic and not necessarily organ-specific. Having a clinic where there is a comprehensive approach to long COVID and specialists to understand that COVID affects multiple different areas of the body and affects physical symptoms as well as cognitive and emotional symptoms and is able to put it all together for patients is really helpful when that's available.

But definitely starting with a primary care physician would be the first recommendation.

JOHN WHYTE: Are there any approved treatments for long COVID?

JANNA FRIEDLY: There currently are not any approved treatments for long COVID. So a lot of what the approaches that we use are extrapolated from other conditions that have similar types of symptoms. There's a lot of ongoing research going on right now to look at specific treatments for long COVID, and there are some promising results from clinical trials of medications that we've used for other conditions that seem to be helpful in people with COVID.

JOHN WHYTE: And what might those other conditions be? Is it things like fibromyalgia, is it chronic fatigue? Do you have a sense, so viewers can look into that as well?

JANNA FRIEDLY: There's definitely some overlap with chronic fatigue syndrome. So a lot of the strategies that we use are things that have been shown to be helpful in chronic fatigue, and there's overlap with other conditions, neurologic conditions that have fatigue associated with them, like multiple sclerosis, for example, but chronic fatigue is probably the closest syndrome to what we're seeing with long COVID.

JOHN WHYTE: Dr. Friedly, I want to thank you for sharing your insights, sharing your advice about how we can think about managing, treating, and helping folks who have long COVID on their road to recovery.

JANNA FRIEDLY: Well, thank you for having me. I appreciate it.

This interview originally appeared on WebMD on September 14, 2021

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