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Recovery from COVID Long Haul Syndrome May Require Specialty Care

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We are learning more all the time about long-term effects of COVID-19, which is sometimes call "long haul" COVID. A new study found more than one in three patients had at least one symptom three to six months afterward.

COVID-19 long-haul symptoms can affect multiple organ systems. Lingering symptoms can include shortness of breath, cough, fever, fatigue, depression, anxiety, joint and muscle pain, headache and brain fog.

Here, according to University Hospital physicians with the UH Covid Recovery Clinic, are common ways COVID-19 can affect different systems of the body.

The Nervous System

“There's a whole host of neurological manifestations of COVID infections,” says UH neurologist Cathy Sila, MD, Director of the Stroke Center at the Neurological Institute at University Hospitals.

“In general, it’s very common for patients with critical illness to be in a confused state, with trouble organizing their thoughts or understanding what’s happening to them.

“Cognitive impairment is one of the neurological problems most distressing to patients. It impairs people’s ability to get back to a normal life. We found some of this may be directly related to the virus. Some of it is indirectly related, due to the stress of the situation. It's complicated trying to sort out what's related to the virus, what's indirectly related. But we have treatment plans for this.

“We also know there are strokes related to the clotting disorder from COVID-19. These can affect the arteries, causing paralysis, speech difficulties and difficulties walking. They can also affect the veins in the brain and cause brain swelling. That can lead to terrible headaches and difficulty doing daily activities. There are a number of infectious and immune-related complications that can affect the brain, the spinal cord and peripheral nerves.

“It’s important to understand if it’s the infection or immune response causing the problems, because they're treated differently.”

Lungs and Breathing

“It’s not uncommon for patients who recover from the acute phase of COVID-19 to have continued respiratory symptoms, such as shortness of breath, chest pain and coughing,” says UH pulmonologist David Rosenberg, MD, MPH.

“These symptoms may last weeks or months. But if they become worse, you may be developing a complication of COVID-19. The inflammation from COVID-19 can cause pneumonia throughout the lungs, even during the recovery phase. The blood can be sticky because of the inflammation, and you can develop blood clots. Also, the inflammation from COVID can irritate asthma.

“Because the heart and lungs are integrated, some COVID-19 patients with ongoing breathing problems are diagnosed with a heart problem.

“The virus can cause inflammation of the muscle of the heart or the pericardium, the membrane surrounding the heart.  These problems can lead to shortness of breath

“If you're developing worsening respiratory symptoms, you really need to seek medical attention.”

The Heart

“A lot of patients who've had COVID-19 and have recovered from their acute illness come into clinic with symptoms, such as chest pain, shortness of breath, palpitations and lightheadedness,” says UH Harrington Heart & Vascular Institute cardiologist Imran Rashid, MD.

“A large number of those admitted to the hospital during the acute phase of COVID-19 have some evidence of heart-related damage, such as inflammation of the heart muscle.

“When patients come to clinic and they have chest pain, we want to find out if there been COVID-related heart injury and whether it is ongoing.  Then we have to decide, based on their presentation, whether they need special tests, such as additional imaging, either echocardiography or MRI, to find out if there's still an active process going on.

“If there is evidence of, say, chest pain and the patient has inflammation in the lining around the heart, we can provide medical treatments to help alleviate the inflammation. If there's any evidence of heart muscle dysfunction, then we have appropriate medical therapies that support the heart to help it recover.

Physical Medicine and Rehabilitation

“We see patients in our rehab hospitals who've had long-term COVID symptoms, some very severe cases that rehabbed through the intensive care unit and then into the rehab hospitals for a matter of weeks, or even over a month,” says Michael Schaefer, MD, a sports medicine and physical medicine and rehabilitation physician at University Hospitals.

“Patients have a variety of symptoms. Profound sense of fatigue seems to be the worst thing and kind of a fogginess that is hard to pin down. But a lot of patients, as far as physical medicine rehabilitation comes into play, have pain associated with their recovery also. And sometimes it's hard to tell if this pain is directly from COVID, the neurologic effects of COVID, or maybe just because of deconditioning or immobility.

“The joints of the body are all self-lubricating. So, as you move, the joint actually secretes more of its own natural lubricant fluid. Things feel better from a neurologic perspective. Moving joints and muscles actually works to block pain. Patients who move more do better long-term. So, if you're really knocked down from COVID, very fatigued, have a lot of muscle weakness, people just aren't moving as naturally or as much as usual so things start to hurt worse.

“When treating long-haul symptoms, such as impaired breathing, we also focus on maximizing the rest of your functioning. We can look at the rest of the body and figure how to make that function as best as possible. Losing weight, getting stronger in the muscles, improving the cardiac fitness, all those things can really take the stress or take the demand off of the lungs, so you can function much better.


“The patients we're seeing who are post-COVID have a variety of sleep problems that are common in the community. In recovery from a viral illness or critical illness, there is poor sleep and disruption of the sleep/wake cycle, and also stress and disruptions in activity levels. All these distract from good sleeping habits,” says Kingman Strohl, MD, who specializes in pulmonary and critical care medicine and sleep medicine at University Hospitals.

“People with a tendency for insomnia before COVID-19 often have more problems afterwards. The same drugs no longer work as well and some have developed bad habits. People with sleep apnea before COVID sometimes need adjustments in their therapy because they may develop sensitivity to the treatments, sleeplessness, circadian rhythm disorders and so forth.

“Also, the stress of being intubated in the hospital can lead to post-traumatic stress disorder, which can lead to sleep difficulty, nightmares and restlessness.

“At the intake for the University Hospitals COVID recovery clinic, there is a general sleep questionnaire to give patients an idea how they are doing with the several dimensions of sleep. The goal is to measure and restore sleep health.  Sleep problems can occur at any point after COVID-19 illness, including the stress in the transition back to work and the transition back to family life in recovery, which in some cases can be quite long. Patients should talk to their physicians about their sleep problems.

Other Areas of Concern

  • Ongoing joint pain or joint swelling is cause to see a rheumatologist for evaluation. Testing can show whether the problem is an inflammatory, auto-immune condition. The diagnosis is key to effective treatment.
  • Persistent COVID-19 can trigger or worsen behavioral health problems. Doctors are seeing a range of problems from mild anxiety and health fears to extreme paranoia. Patients whose mental health is suffering due to COVID-19 are encouraged to get professional help.

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At University Hospitals, we believe having a primary care provider is essential to your health and well-being. Our primary care physicians and nurse practitioners provide comprehensive, compassionate and continuous primary care for patients of all ages. We are committed to building a healthy relationship with you and your family to detect and minimize long-term health issues, or just help you get over that illness that's going around. Need a primary care provider? Find one here.