What is Post-COVID Syndrome? -Symptoms, causes, treatment

When a New York City hospital began responding to the first onslaught of COVID-19 last spring, doctors at Mount Sinai Health System noticed something changed.

“I had problems with fatigue, fog in the brain, chest pain, and shortness of breath. Racing heart, Gastrointestinal symptoms, and anxiety Depression ” João Bosco, MD, Physician of Mount Sinai. “It was amazing because some of the least ill patients got the most ill at first.”

today We call them “long haul carriers”— People suffering from a variety of mysterious, often debilitating symptoms after a match with the new coronavirus — and many suffer for months.on the other hand Some studies Many doctors say that only patients who have been symptomatic for 12 weeks or more are eligible for post-COVID syndrome (PCS), and those who have symptoms for 4 weeks after COVID infection should consult their doctor.And COVID-19 cases in the United States sOver 27 million orings-And 107 million people worldwide— Tens of thousands of people may join them every month.

Estimates of the number of people who develop post-COVID syndrome 2% To twenty five% that’s all. Interestingly, PCS seems to affect middle-aged adults more than older people, but no one yet knows why it happens or who is most likely to affect it.

“That doesn’t mean it’s not real,” he says. Raleigh Jacobs, MD, Physician COVID Recovery Center At Hackensack Meridian Health in New Jersey. “Many of my post-COVID patients say their primary care physicians rejected and ignored the symptoms. This exacerbates their distress.”

Shayna Zweiback, 27, from East Meadow, New York, who became ill with COVID-19 in March, was one of them. Prior to the pandemic, Zwieback suffered from depression, which was subsequently exacerbated by her physical health problems.

“Before finding Mount Sinai Post COVID Care Center In August, everyone told me that my depression was the cause of my post-COVID symptoms. They made me feel that my illness was my fault, “she says. She felt better for several months after Zwieback recovered. Then out of nowhere her health began to deteriorate rapidly. “First developed Extreme fatigue And Forgetfulness“She says,” I forgot what I was talking about in the middle of the conversation and had a hard time distinguishing between letters and numbers. I rejuvenated by walking blocks and going to grocery stores. It took me a day. ”She had a hard time too. Dyspnea.. “It felt like hungry,” recalls Zwieback.

Now she knows that her physical symptoms are deteriorating her mental health and not the other way around. Mount Sinai launched its first interdisciplinary clinic in May last year to treat these long-haul carriers and learn what works to help future patients. Now that we are too busy to keep up with demand, there are dozens of similar clinics and treatment programs nationwide.

It is important to note that SARS-CoV-2 (the new coronavirus) is not the first virus to cause persistent symptoms, he says. Greg Vanichika Corn, MD, Mayo Clinic Medical Director COVID activity rehabilitation program.. “Previous virus outbreak, Like SARS and MERSSome people have been debilitated for months, sometimes years, “he says. “This virus is still alive and inactive in people with advanced symptoms, but it causes a reaction in the body that causes persistent symptoms. Now let us understand what that reaction is. At this point, there may be suspects. “

Excessive inflammation

The primary candidate is immune system-related inflammation. “Many patients after COVID have high levels of inflammation,” he said. Christian Sandrock, MD, Emerging Infectious Diseases Specialist University of California, Davis, So the person watching the patient Post COVID-19 Clinic.. In fact, when European researchers recently performed cardiac MRIs of 100 patients who recovered from COVID-19, They found that 60% had ongoing heart inflammation— Can cause some of the symptoms reported by many long haul carriers, such as shortness of breath. Chest pain, And an increase in heart rate due to exercise. In addition, the inflammation affected people regardless of their pre-existing condition or the illness they had when they first became infected with the virus.

Autoimmune reaction

For some long-haul carriers, COVID-19 may have triggered an autoimmune response. The immune system mistakenly targets A healthy tissue of the body instead of a virus, says Dr. Vanichkachorn.To Wit: Yale University Researcher Recently found Patients with COVID-19 had more autoantibodies, immune molecules that attack healthy tissues, compared to people without the virus.And like an autoimmune disease Lupus And Rheumatoid arthritis, Which generally causes fatigue and digestive problems, two common post-COVID symptoms. The same mechanism behind these conditions may be causing the same symptoms in people with PCS.

Nervous system problems

Many PCS patients present with symptoms of autonomic imbalance, which refers to dysregulation of the autonomic nervous system (causing involuntary functions such as blood pressure, heart rate, breathing, and digestion). “Dysautonomia affects blood flow, including blood flow to the brain, which can cause fatigue, headaches, brain fog, and exercise intolerance,” said Dr. Vanichkachorn. “When testing patients with post-COVID syndrome, it’s probably a piece of the puzzle, at least for some people, because they often have autonomic dysfunction.”

Blood clots and blood vessel damage

Small blood clots may also play a role. Many patients have high levels of protein in their blood, which indicates that their blood is prone to coagulation. “And taking medicine to prevent coagulation makes you feel better,” says Dr. Sandrock.

Possible Reasons for COVID-19 Patients Frequent blood clots: The virus says it can infect and damage the cells that line the blood vessels William W. Lee, MD, Medical director Angiogenesis Foundation And one author Recent research Conducted by an international group of researchers. This lining is usually as smooth and slippery as an ice rink, says Dr. Lee. This makes it easier for blood to flow throughout the body. However, when the endothelial cells that line the blood vessels are damaged, they become sticky and platelets in the blood attach to the walls of the blood vessels, forming a clot.

“When we examined the tissues of people who died of COVID-19, we found that blood clots were spread everywhere in infected blood vessels, including the lungs, brain, heart, kidneys, and other organs,” he said. I will. “These small blood clots interfere with normal blood flow and damage organs. When they occur in the lungs, they can cause shortness of breath. Microclots in the heart can contribute to palpitation. Endothelial damage has been found in the brains of people with COVID-19 and can contribute to brain fog and heart damage.

Since starting the clinic, Zwieback has met eight specialists, from cardiologists to gastroenterologists. She has had an MRI, CT scan, and blood tests, showing a high level of inflammation. “The goal of treatment is to identify the underlying problem, control the patient’s symptoms, and slowly improve their ability to function,” says Dr. Bosco.Zwieback Migraine, Muscle pain, acid reflux disease, vitamin deficiency, Panic attack, And postural tachycardia syndrome is a blood circulation disorder in which the heart rate spikes when walking. All of these develop after being infected with COVID-19.

Doctors are also helping her deal with existing depression.However, for many patients, mental health problems such as anxiety and insomnia can occur. rear According to November, diagnosis of COVID-19 Research Was announced in Lancet.. In fact, Research With more than 1,500 long-haul carriers conducted by Indiana University School of Medicine Survivor corpsCOVID-19, a grassroots association of survivors, has found that anxiety and sleep disorders are among the top 10 most common symptoms. Members of the corps raise funds for research and document symptoms in the hope of finding a cure.

Breathing exercises

As part of the treatment plan, some PCS patients are taught breathing techniques. “We designed a program to teach healthy breathing mechanisms for patients after COVID. By breathing through the nose and breathing less and deeper per minute, the nervous system calms down. It activates the parasympathetic branches. ” , CEO Stagnation, Breathing training group. We have been working with patients on Mount Sinai after COVID and other long-haul carriers for several months. “Healthy breathing reduces stress and anxiety, helps sleep, and has a positive effect on other symptoms. Some patients are now unable to go from the sofa to the kitchen without being out of breath and dizzy. But now I’m taking a three-mile walk. “

Improving sleep

Getting more, higher quality Shut Eye is another goal for some people with PCS. “Sleep is when your brain removes toxins that you accumulate throughout the day when physical and mental recovery occurs,” he says. Rachel Saras, Maryland, Neurologist Johns Hopkins Post COVID Clinic.. “the study show If you get the flu vaccine when you are sleep deprived, your body will not respond as strongly as you do when you are well rested. ”

Hopkins post-COVID clinicians assess the patient’s sleep with an EEG sleep test to address other issues that may keep the patient, such as stress, anxiety, depression, and environmental factors such as light and noise. Helps identify. “Then we come up with customized plans to retrain their brains to sleep. Often don’t watch cell phones or TV before bedtime, use mindfulness or yoga before bedtime. It includes behavioral changes such as relaxing and relaxing, “says Dr. Saras.

Post-COVID syndrome is difficult because most patients have multiple symptoms, says Dr. Vanichkachorn. A Survivor Corps study identified 98 possible symptoms. Dozens of studies of long-haul carriers that will provide answers someday are underway around the world. “We basically make planes while flying,” says Dr. Vanichkachorn.

In the absence of a clear scientific answer, doctors treating PCS patients say that the best way to protect themselves from post-COVID syndrome is to avoid getting the virus in the first place. “This is not’Flu only“” Says Dr. Bosco. “People need to understand that COVID-19 infection can have long-term consequences and take all necessary precautions, including: Wear a mask, wash hands,and Avoid crowds To prevent infection. ”

If you are infected with COVID-19, please allow enough time for recovery before returning to normal activity. “Both patients with SARS and chronic fatigue syndrome have found that pressing too hard can cause frustration,” says Dr. Vanichkachorn. “We have patients after COVID-19 who were marathon runners. Now they consider walking in the bedroom without breathing to be a victory. Recovery is slower than most people want. However, most patients see a gradual improvement. “

Zweiback acknowledges that slow progress can be very frustrating. She takes time to rest, avoids stress, eats a healthy diet on a regular basis, and continues to rehydrate. “I’ve been ill for 13 months and I’m probably 65% ​​recovered. If I learned one thing, it would be to pay attention to my body, rest when I started to feel tired, and You have to be patient. “

Find a Post COVID Clinic: If you or a loved one develops PCS Use this map Created by the Survivor Corps to find specialized treatment facilities. If you’re not nearby, check with your local university or hospital for new ones that open every month.

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