Some COVID-19 long horrors have been symptomatic since the first wave. Can they still get better? | National

A year later, the two have one thing in common. They are not returning to normal.

Ezekiel-Gibson needs additional oxygen for slight exercise and fights severe fatigue. She is unable to work and is thinking of applying for a disability. Clark has returned to a long job in his home office, but now instead of running, he walks and deals with intermittent symptoms such as fatigue, headaches, chills, chest tightness, and throat stenosis. “I never felt normal or healthy before COVID,” he said.

Some long-distance survivors from that first wave are stuck — thank you for being alive, as the increased vaccine dose pipeline provides many Americans with a more normal life hope. But I’m not sure what the coronavirus did in their future.

The virus made a leap from animals to humans just a year ago, so no one knows if a year later people who are still ill can continue to improve. They don’t have many treatments to offer, but doctors are hopeful to see that many long-haul carriers continue to make slow improvements.

“I hope they all get better. That’s the hope and we’re working hard to achieve it,” said Rene Alvarez, head of the heart disease department at Jefferson Health. “The body is incredible.”

However, doctors also say that some patients may have permanent damage, such as those who have scars in the lungs and those who have suffered a stroke or blood clot damage in other parts of the body. Said. Benjamin Abramov, a physiotherapy and rehabilitation doctor who leads the recovery clinic after COVID-19 in Penmedison, said COVID-19-related nerve injuries can “take a long time to resolve” and are sometimes permanent. Said that. Patients who had serious health problems before they got sick are now much more disabled, Alvarez said.

Hospitals are increasingly creating interdisciplinary post-COVID-19 treatment programs for survivors, which many call long COVID-19. (Usually simple Anthony Fauci wants to use a label that is more scientifically accurate but much more memorable: SARS-CoV-2, or the acute sequelae of PASC.) Temple Health And John’s Hopkins Health System launched such a program in April. There was one Mount Sinai health system by May. Penn started in June and the Deborah Heart and Lang Center started in January this year. Virtua will open soon.

“Once these clinics are established, we are quickly overwhelmed by the number of people seeking care,” said Emily Brigham, a pulmonologist who co-directs the Johns Hopkins program. It has seen almost 400 patients.

“Everyone needs to help attend and take care of these people …. this will be with us for a long time.”

Concerns about persistent symptoms are high enough that the National Institutes of Health announced last month that it would spend $ 1.15 billion over four years on a long COVID-19 study.

Doctors said that a large number of COVID-19 patients who survived their stay in the intensive care unit, especially those who needed a ventilator or ECMO device to support their heart and lungs, would need follow-up therapy at an early stage. I was expecting it. They had already identified post-intensive care syndrome in people who needed such care due to other infections. These patients often suffered from weakness and emotional problems for months. Many could not get back to work.

Even more surprising was the influx of patients like Clark. They were not ill enough to require hospital treatment, but they also had persistent and sometimes debilitating symptoms. “There are many mysteries out there,” said Abramov.

Such persistent symptoms are not unprecedented among people infected with other viruses, including other coronaviruses such as MERS and SARS, but doctors have seen many such patients. there is not. As some have pointed out, it could be because a huge number of people first encountered the new virus. If only a small percentage of the 28 million Americans infected so far develop persistent symptoms, it is still many.

Doctors are not sure how many people will be infected with COVID-19. A study based on a study of people tested positive for COVID-19 in the United Kingdom found that 20% had symptoms that lasted more than 5 weeks and 10% lasted more than 12 weeks.

According to a recent analysis in China, 76% of hospitalized patients have at least one symptom, most commonly malaise, sleep disorders, anxiety, or depression, six months after their first illness. I was suffering. Many had impaired lung function. A study at the University of Washington last month also investigated people who had been out for six months but most were not hospitalized. Thirty percent had one or more persistent symptoms such as fatigue, loss of smell and taste, headache, and dyspnea.

There are no data yet on people who have been symptomatic for a year, but local doctors said some of the current patients have been ill since the first wave. “It’s not a small number of patients,” said SooKim, a physiotherapy and rehabilitation expert who co-supervises the Johns Hopkins team. “There are still quite a few patients since April or May. Personally, I don’t know how long it will take.”

Eric Sztejman, a Virtua pulmonary doctor, said most patients will be well in 6-8 weeks. “Everyone after that is a long-haul carrier,” he said.

Doctors have not found a way to predict which COVID-19 patients will recover quickly and which will not. The ranks of long-haul carriers include people with serious COVID-19 risk factors such as old age, obesity, and diabetes, as well as young and healthy athletes. The first and most ill people face the longest recovery and the greatest risk of organ damage, doctors said. Various treatments have shortened ventilator usage time, which may work for some people who become ill and hospitalized in the post-pandemic wave. Some outpatients were also able to receive monoclonal antibodies to combat the infection.

In many cases, long-haul carriers complained of “brain fog” or problems with concentration and word discovery, saying that “even watching TV would be a chore.” There are also nerve damage, weakness, arrhythmia problems, and numbness due to a fast heart rate after exercise. Kim said he saw a patient with autonomic nervous system dysfunction that caused dizziness and a fast heartbeat.

Tests cannot always explain what the patient is feeling. “Most of these people had a perfectly normal work-up,” said Jefferson’s lung and emergency physician Jessica Most. One of the possible causes is damage from systemic inflammation. The other is direct damage from a virus or a small blood clot. Researchers are also looking at whether the disease causes problems with the immune system. Nerves can be damaged if the patient is angry or placed in the stomach to improve breathing.

For now, treatment often revolves around helping patients grow stronger. Most people said she was trying to find a way to retrain the nerves involved in the brain-lung interaction. She teaches patients how to breathe more slowly.

According to doctors, patients often feel much better after one year than after six months. The cough disappears and the sense of smell usually returns. As with some heart problems, fatigue improves. Many patients slowly regain strength. Therefore, doctors think it is too early to give up on a very long carrier.

Gerald Cliner, director of the Temple Lung Center, believes that the “majority” of patients will eventually recover.

Michael George, 53, from Woolridge Township, Gloucester County, and Antonio Ellis, 44, from Toms River, Ocean County, told a similar tragic story about COVID-19, which began last March. Both had to be ventilated and then underwent ECMO at Cooper University Hospital.

“When I breathed, I actually heard the lungs crackling,” George said. “… I felt your lungs were made of glass, a thin glass plate.” He was in Cooper and then in a specialized rehab hospital for a total of 74 days. “When I had to lift the weight for the first time, it was a pound of weight, and I pulled my muscles,” he said.

Ellis, a Manchester Township police sergeant, spent 45 days in the intensive care unit and 30 days in a medically induced coma. When he left the hospital, he was too weak to brush his teeth.

Both faced painful recovery, but have returned to near normal, with the exception of hand and foot neuropathy. “I used to be able to run 5 miles, but I can’t run 5 miles,” said Ellis, who has a damaged lung but is functioning normally. “I can do two, but it’s not pretty.”

George, who works in IT, had to learn to type again. He has spent months exercising his fingers and still feels numb on all his fingers.

George’s wife, Janice, 58, was ill for about three weeks, but she was also at home with her 16-year-old son at the time of the virus infection. She did quite well during the summer, but in the fall she began to experience dizziness, headaches, and daily dizziness. Her doctor can’t find any explanation for it other than COVID-19. “It’s like fibromyalgia,” she said. “They don’t know how to handle it because they don’t fully understand where it comes from.”

Having run a mile in less than six minutes before getting sick, Clark has recovered from a frustrating and recurrent roller coaster. He was unable to undergo a coronavirus test for his first illness because he had no fever, but doctors diagnosed him as COVID-19. He participated in a post-COVID-19 rehab program in Penn in the fall. However, it recurs again after that, and I can only walk for 20 to 30 minutes every night. He moved near Washington two months ago and started a new job. He said it could take away all the energy he has.

Ezekiel Gibson remembers being completely stuck when he was at Virtua Marlton Hospital. Her arms and legs hurt. She felt better after her second hospital stay. It was an achievement to take it upstairs and take a “heavenly” shower.

Currently, she can breathe normally while sitting still, but she needs oxygenation to do anything else. “Walking around lowers the pulse oximeter,” she said. Her lungs are injured. A recent breathing test was only 7% better than what she took in July. She was disappointed that she had to maintain oxygen. “Walking around with a tank” isn’t fun, but she feels better after accepting the new normal.

She is saddened by the loss of her best friend who became ill at the same time she became ill after attending the same funeral. Like other patients, she sometimes feels the shock of anxiety when something like a recent trip to the hospital reminds her of how ill she was. She has hope, but it is realistic.

“First and foremost, I’m grateful that I’m alive, so I’m trying to lead with gratitude,” she said. “There are more than 500,000 people who aren’t here to talk.”

Brigham, a Johns Hopkins pulmonologist, said he knew how frustrating it was for long-distance patients to become medical pioneers. “It’s a difficult conversation,” she said. “Patients need to know these answers to plan their lives, but often we don’t.”

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