COVID Long Haulers – COVID Long Hauler Treatments
The majority of people infected with COVID-19 recover in a few weeks but for some, symptoms continue to persist months later. People with COVID symptoms lasting 28 days or more are referred to as long haulers and the condition is called long COVID-19. Whatever the terminology, it is estimated that as many as 30% of people who had the virus experience long term effects.
Given the significant number of people that fall into the long hauler category and the adverse health effects associated with prolonged illness, treating long COVID is vital. This article will briefly examine the characteristics and symptoms of long COVID with particular attention paid to treatment options currently available.
Long COVID Symptoms
The Centers for Disease Control lists the following as symptoms people most commonly reported with long COVID-19:
- Fatigue or exhaustion
- Shortness of breath
- Chest pain
- Joint or muscle pain
- Intermittent fever
- Rapid or pounding heartbeat (heart palpitations)
- Inability to focus or concentrate (sometimes referred to as “brain fog”)
While less common, some people have developed long-term complications including:
- Heart muscle inflammation
- Lung function abnormalities – lung scarring
- Kidney injury – could require dialysis
- Skin rashes
- Hair loss
- Problems with taste and smell
- Difficulty sleeping
- Mood changes
Diagnosing Long COVID-19
While people experiencing long COVID could have tested positive for COVID-19, a positive coronavirus test is not required to diagnose long COVID. In diagnosing long COVID, a doctor will compile the patient’s full medical history in addition to assessing COVID-19 symptoms from initial onset to current symptoms. Tests the doctor may conduct include:
- Blood pressure
- Heart rhythm and rate
- Breathing and lung function
There is not a specific test for long COVID so doctors could run tests to ensure other issues are not causing symptoms. Chest X-rays, urine tests, and electrocardiograms could be ordered and based on the symptoms the patient is experiencing, testing could also include blood work to check:
- Full blood count
- Renal function (kidneys)
- Liver functions
- Troponin (tests for damage to heart muscle)
- Muscle damage
- D-dimer (verify no blood clots)
- Heart health
- Iron levels
Managing Long COVID Symptoms
In cases where long COVID symptoms are not severe, the following home remedies could help patients manage the illness:
- Use over-the-counter medications like acetaminophen or ibuprofen to relieve pain
- Relax and get plenty of sleep
- Stay properly hydrated
- Avoid over-exertion
- Follow a healthy diet
- Limit alcohol and caffeine intake
- Not smoking
Treating Severe COVID-19
Three monoclonal antibody treatments were granted authorization for emergency use in November 2020 by the Food and Drug Administration. Eli Lilly’s bamlanivimab, Regeneron’s combination of imdevimab and casirivimab, and Eli Lilly’s combination of etesevimab and bamlanivimab, were all approved for use in patients over 12 years of age with mild to moderate symptoms at risk of developing or being hospitalized for severe COVID-19. All three treatments must be administered intravenously soon after symptoms develop.
Manmade versions of the naturally occurring antibodies in the body, monoclonal antibodies attack the COVID virus and make it harder for it to affect human cells. When compared to placebo, results from clinical trials indicate that monoclonal antibodies can greatly lower a patient’s risk of dying or needing hospitalization within a month of treatment. However, these treatments are not authorized for patients receiving supplemental oxygen or who are hospitalized as they could worsen the outcomes for these cases.
When COVID infection is severe enough to require hospitalization, there are several medications that can be used to treat the illness.
Since the start of the pandemic, many doctors around the world have treated severely ill COVID patients with corticosteroids. Biologically, this makes sense for patients that develop hyper-immune responses (cytokine storm) to the virus. For these patients, the overreaction from the immune system causes damage to the lungs and vital organs and frequently leads to death.
Potent anti-inflammatory medications, corticosteroids like dexamethasone, methylprednisolone, and prednisone are inexpensive and readily available. Based on the National Institute of Health guidelines, dexamethasone is recommended for patients hospitalized with severe COVID-19. Dexamethasone has been shown to improve mortality rates amongst patients requiring ventilators or supplemental oxygen but does not show benefits for patients not requiring respiratory support.
An antiviral drug, remdesivir was approved by the FDA in October 2020 to treat COVID-19. Patients hospitalized with COVID-19 that are at least 12 years of age and weigh 88 pounds or more, are candidates for the drug. Data from clinical trials suggests that remdesivir may modestly expedite recovery in these patients.
Baricitinib (Combined with Remdesivir)
When used in combination with remdesivir, baricitinib was granted authorization by the FDA in November 2020. This combination therapy is approved for hospitalized patients 2 years and older that require breathing assistance. However, there is insufficient evidence to support using the therapy alone or instead of dexamethasone.
Blood Thinners (Anticoagulation Drugs)
The majority of hospitalized COVID patients are administered medication to prevent blood clots. Low doses of enoxaparin or heparin are usually prescribed by doctors but for patients at high risk of developing blood clots or for those that already have clots, full doses of anticoagulants may be required. Because there is always a risk of dangerous bleeding with blood thinners, doctors must balance the risk when prescribing full rounds of treatment.
After a person recovers from COVID-19, antibodies in plasma are produced to fight the virus and help the patient get better. Convalescent plasma is taken from the plasma of recovered patients and has been used for over 100 years to treat various illnesses like chickenpox, polio, and SARS. Results as to the efficacy of convalescent plasma for treating COVID-19 are mixed and additional research will be needed to determine their effectiveness.
A Word on Hydroxychloroquine for Treating COVID-19
Typically used to treat malaria and inflammatory diseases like rheumatoid arthritis and lupus, hydroxychloroquine is readily available and inexpensive. Early in the pandemic, reports from France and China suggested that hydroxychloroquine helped those with severe COVID-19 symptoms to improve more quickly. However, subsequent research, including a December 2020 article in JAMA, shows no clinical benefits associated with hydroxychloroquine when given to hospitalized adults with COVID-19 respiratory illness.