In the months following Covid-19 infection, patients report dyspnea and fatigue

“I can only walk to the corner,” she said. “In terms of running, I can’t imagine when that will happen.”

She is one of the thousands of people around the world who have had Covid-19 chronic. Gahan and other Covid-19 “long-haul carriers” have yet to see the perception of the illness that has helped them for months and feel that the end is invisible.

“I’m a clinical psychologist and I’m not worried about this,” she said. “If a doctor just says” I don’t know, “it’s better than saying that Covid’s symptoms last only two weeks. “

Many are hospitalized with Covid-19 and are at risk of becoming “long-haul carriers”

Researchers at the Academic Respiratory Unit of the North Bristol NHS Trust in the United Kingdom examined 110 Covid-19 patients who required a median 5-day hospital stay between March 30 and June 3.

Twelve weeks after the patient was discharged, 74% of the patients reported symptoms such as shortness of breath and excessive fatigue.

However, despite these symptoms, 104 of the 110 patients in the study had normal basic blood test results, only 12% showed abnormal chest x-rays, and 10% had vital capacity. It showed restrictive lung function by spirometry.

The British Medical Journal released new guidance for healthcare providers in August on how to treat long-distance Covid-19 patients. We estimate that up to 10% of all people who test positive can develop a long-term illness. Guidance includes specific blood tests to be performed, possibly referral to the patient for pulmonary rehabilitation, and having the patient use pulse oximetry to measure oxygen saturation in the blood at home.

These results faced an early-established narrative in the pandemic, with many healthcare professionals averaging Covid-19. The patient gets sick for a few weeks, gets rid of the virus, and then gets well.

It turned out not to be the case for everyone. The BMJ guidance cites “psychiatric factors such as decreased or recurrent antibody response, reinfection or inflammation, other immune responses, poor health, and post-traumatic stress” as causes of long-term symptoms. .. We found that patients with SARS and MERS had similar similarities.

Dr. Mayrankhan, a pulmonologist and professor of medicine at the University of Michigan, said: “Many of the patients I have followed have been complaining of coughing, breathing problems and severe fatigue since the first infection.”

Long-haul carriers and autonomic imbalance

One of the key issues in the care of each long-distance Covid-19 patient is how many of its symptoms can reach the heart and lungs, and how much the disease is the result of a deeper form of the nervous system. According to Noah Greenspan, a New York-based physiotherapist and founder of the Pulmonary Wellness Foundation, the coronavirus is dysfunctional.

Before engaging in physiotherapy or respiratory therapy, he has all patients undergo a complete work-up from a doctor to rule out heart disease, stroke, or pulmonary embolism before starting physiotherapy. ..

Some patients have mild symptoms and can begin more traditional rehab programs, he said, “but others have turned into the largest group of people who are these long carriers. There is one. “

A major trend across Greenspan’s Covid-19 long-haul carriers is a condition called autonomic imbalance, characterized by miscommunication between the autonomic nervous system and other parts of the body. is.

The autonomic nervous system regulates automatic physical functions such as breathing, sleep, and digestion. When it is not working, symptoms can manifest in a myriad of different ways depending on the person.

“Reach for the symptom bag and pull out the symptom bag, that’s what they have that day,” Greenspan said. “It’s a twisted ball of thread, and it takes a week to untie a string.”

Shortness of breath and cardiovascular problems exist in patients, according to Greenspan, but they are usually not the most common root cause of patient misery.

Others with Gavid and long-distance Covid-19 symptoms face a condition called postural orthostatic tachycardia syndrome. This refers to the sharp rise in heart rate that occurs when moving from reclining to standing. When gravity is pulled, blood collects in the legs. This condition can cause dizziness, lightheadedness, and fainting.

“When they stand up to get water, their heart rate goes up by 50 to 75 points,” Greenspan said. “They have a fast heart rate that has nothing to do with what they are actually doing and is not commensurate with their workload.”

According to the BMJ and Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases, many patients have neurological symptoms consistent with myalgic encephalomyelitis / chronic fatigue syndrome. The diagnosis requires at least 6 months of symptoms, a benchmark that most long-haul carriers have yet to reach.

Lung damage is often not the biggest problem

Many Covid-19 patients feel that the healthcare system is illuminating them and tell them that if their entire life is disrupted by the aftermath of Covid-19, there is nothing wrong with it.

Corey Coopersmith, a 36-year-old fitness consultant in Las Vegas, has been unable to work since her first illness in late February. He suffers from a constant flow of symptoms, but after visiting a healthcare professional, a series of “normal” tests were discovered.

“I had my lungs tested a month ago and had a 120% gas exchange test,” Cooper Smith said, and doctors told him “your lung function is excellent.” ..

However, a breakthrough happened when I last visited an immunologist who tested for abnormally low functioning of immune cells such as T cells and B cells.

“Have you been tested for HIV?” The immunologist asked Cooper Smith, he recalled. “Your blood work looks like someone with AIDS.”

Cooper Smith, a mixed martial arts fighter in his twenties, was in great shape when he signed the Covid-19 in February. It boasted a resting heart rate of 58 beats per minute.

But if you wake up in the middle of the night and go to the bathroom, POTS can raise your heart rate to 200.

He purchased a continuous airway positive pressure machine, a device with a face mask that pushes oxygen into the lungs to allow him to sleep under new constraints.

“I’m out of breath there and fight hard,” he said.

Lung damage is often not the biggest problem

Cooper Smith is one of the many Covid survivors trying to figure out why he feels stuffy despite his good lung function.

“My lungs feel pretty well recovered,” said Gahan, a British clinical psychologist.

Her main problem was identifying the causes of the storm of illnesses, which are primarily neurological symptoms such as migraines and numbness in the legs and hands. She feels that autonomic imbalance can explain it.

“I can’t do anything but sleep,” she said, and pointed out how light, sound, and emotional stressors exacerbate her ongoing illness. “I can’t stand any interaction.”

Patients hope that the story of stopping recovery does not put others at risk of infection by traveling, parties, or gathering in large groups prior to vaccine development and distribution.

“It’s not about fatigue, it’s about the really annoying symptoms of how long you know your entire life,” Gahan said. “Think about people like me when you’re thinking about what decisions you should make.”