He recalled on the morning of March 22, 2020, saying: “The first thing I woke up in the morning was to feel very stuffy and breathless. I went to the bathroom to breathe, and then immediately coughed up blood. Going into the sink… I went there that day. The hospital, tested positive for COVID.”
Reagan said that last spring, he was in and out of the hospital with acute COVID-19 for two months.
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But even with that difficult, the experience he has experienced since then may be considered equally bad or even worse: his current symptoms include persistent chest pain, neuralgia in the hands, feet and legs, seizures, tremors, and loss of one eye. Vision.
He said: “Since then, it has become a roller coaster.”
He said: “I realize that I have been hurt a lot by COVID. It has completely changed my life.” He was unable to return to the active life he liked before.
Unlike Reagan, last summer, when 34-year-old Stephanie Condra (Stephanie Condra) contracted COVID-19, she did not have to be hospitalized. Her symptoms are relatively mild: fatigue, shortness of breath, stomach pain and colic, and low-grade fever.
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However, Kondela said that after she seemed to have recovered from the acute illness, she began to experience a series of health problems. These problems will continue to worsen but have not been eliminated: severe sinus pain, nausea and loss of appetite, crushing fatigue, Dizziness, burning sensation in the chest, dry cough, brain fog, confusion, concentration and word retrieval problems.
She explained: “My symptoms are constantly developing. I get the same symptoms time and time again, as if one disappeared and then appeared again.”
Condra said that she started to get better in early 2021, but she said that her progress was slow and stopped. She said: “Actually, I can only work up to four hours a day.”
It has been more than a year since the pandemic, and it is very clear that SARS-CoV-2 (a virus that causes COVID-19) is a tricky virus: some people don’t even know they are infected, while others are hospitalized. , Some of them died. More and more people get sick and then never recover completely. In support groups, they sometimes call themselves long-distance travelers; their condition is also called long COVID, persistent COVID, post-COVID syndrome or acute post-COVID syndrome.
What are we learning
No one knows what percentage of people infected with SARS-CoV-2 continue to develop post-COVID syndrome.
A new research letter published in the journal JAMA Network Open on Friday is clarifying this situation. Researchers from the University of Washington followed up 177 laboratory-confirmed patients with SARS-CoV-2 infection for up to 9 months, which is the longest follow-up so far. It is worth noting that this group included 150 outpatients with “mild” disease who were not hospitalized.
They found that 30% of respondents reported persistent symptoms. The most common are fatigue and loss of smell or taste. Compared with before getting sick, more than 30% of the respondents said that their quality of life was poor. Fourteen participants (8%) (including 9 people who have not yet been hospitalized) reported that they had difficulty performing at least one daily activity (such as daily chores).
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The researchers write that there are 57.8 million cases worldwide, “even a small percentage of long-term disabled patients may have a huge impact on health and the economy.” According to the latest data compiled by Johns Hopkins University, there are currently more than 110 million cases worldwide.
A larger study published in The Lancet in early January found that of the 1,733 coronavirus patients treated in Wuhan, China, 76% of the patients still had at least one symptom six months after the onset of symptoms . But this group consists entirely of hospitalized patients.
Treatment is a long and winding road
The Post-COVID Care Center of the Mount Sinai Health System in New York City was the first such center to open in May. So far, the center has received more than 1,600 patients-including Reagan and Condra-and there is still one month to wait for appointments.
“It is difficult to predict who will have these symptoms,” Dr. Chen Zijian, the medical director, told me when I interviewed him last summer. “The patients we see at the center are of all ethnicities. They are in their 20s to 70s and 80s. Your male and female patients are evenly distributed.”
He said that suffering from a mild illness or being healthy from the beginning cannot avoid persistent symptoms.
“I think if… you already have a disease, the infection of the virus will make it worse. But, again, we have also seen previously healthy patients suffering from relatively mild disease,” Chen said.
He said that age is not a predictor either.
Another confusing aspect of post-COVID syndrome is the widespread and seemingly random health problems faced by some patients.
Dr. Christian Sandrock is Professor of Pulmonary Critical Care and Infectious Disease Medicine at UC Davis School of Medicine in Sacramento, California. As the director of the intensive care unit, he was one of the doctors who evaluated patients in the post-COVID-19 clinic at the University of California, Davis, Davis. In October, it was the first such center to open in the region.
“When we look at the long-term symptoms… the main problems we find are fatigue, drowsiness and sleep disturbances, which account for about half of what we see. Loss of taste and smell is a very specific phenomenon that we will see. Shortness of breath is a very specific one, as is chest pain.” Many patients have multiple symptoms, and symptoms can recur.
Sandrock divides symptoms into several categories. Problems such as chest pain, shortness of breath, and heart inflammation are cardiovascular diseases. Depending on the underlying cause, chest pain and shortness of breath may be classified as respiratory diseases, and decreased exercise endurance and abnormal lung function can also cause respiratory diseases. He classified rashes, hair loss, and even tooth loss into the category of dermatology. Fatigue, brain fog, and feeling uncomfortable belong to the constitution. Neurological categories include loss of smell and taste, sleep disorders, cognitive changes and memory impairment. He explained that depression, anxiety and mood changes all belong to the category of psychosis.
As for the cause of these symptoms, Sandrock pointed out some culprits. Some reasons may be due to long-term hospitalization or complications in the Intensive Care Unit (ICU), which are known to severely affect the body and have a lasting effect. Some may be caused by microvascular disease-capillary damage, which is behind many symptoms, from chest pain to “COVID toes” to fatigue and even brain fog. Certain inflammations can be caused by autoimmune reactions triggered by high levels of inflammation, such as joint and body pain, sleep disorders, depression, and fatigue. According to Sandrock, some viruses may be a direct infection of the virus, such as loss of smell and/or taste.
Sandrock said that treatment is very individualized, depending on the symptoms and the underlying cause of these symptoms.
He said: “The treatment needs to be customized.” “We have to take time to look at the needs of the patient. Some of them-they really just have chest pain, shortness of breath and low oxygen levels. In this case, we can solve it. Another person may have A lot of brain fog, inattention and sleep disturbance-these are many other things we need to do next.”
It may involve referral to other specialists in the clinic, medication and rehabilitation. He said the drugs include immunomodulators, anti-inflammatory drugs, antidepressants, beta-blockers and/or steroids. Rehabilitation, such as cognitive, pulmonary and/or cardiac rehabilitation. Sleep research can eliminate any cause of sleep disorders.
But there is a constant. “The only consistent treatment I have seen is a lot of what we call supportive treatment. So this does involve a better life and a higher quality of life, without a better deadline. But it means you Sleep is really needed. Sleep continues to be important,” Sandrock pointed out, reducing stress, meditation and yoga are also part of it.
He said that patients need to adjust their lives to reduce stress and slow down their pace in order to recover. He said: “Therefore, we want people to be really patient with themselves and know that they spend a lot of time at work. Therefore, I think this is critical.”
Dr. Dayna McCarthy, a member of the Mount Sinai Post-COVID Care Center, agreed that patients must adjust their expectations of themselves and slow down.
“We are like rubber bands. We just want to go back to the way we were before. So, I think this is one of the biggest challenges. But if people can’t do this, they will stick to it. After the delay, the symptoms will not disappear. It will get better.”
The improvement was hard-won, and progress was extremely slow. Sandrock said: “It is difficult to measure these improvements every day. As these symptoms continue to worsen, this improvement is very stuttering. You know, three steps forward and two steps back.”
McCarthy called the process “very slow,” and he said that with the help of supportive treatment and time, the patient will indeed get better. She said: “But a lot of things have fallen on patients. They have to understand and accept the fact that their lives need to be changed to make them better.” “Moreover, when you are young and healthy, you are used to being in the fifth Gear status-you are “forwarding at full speed” and now we tell you that you really have to take a step back to get your body back and recover what it needs. (For patients, this is a very difficult thing , To deal with and hug it,” she said.
Need more research
Both Sandrock and McCarthy said that more research is needed to better understand the post-COVID syndrome, including who gets the disease and the best treatment. But, as McCarthy said, now that the conditions have been recognized and “science is falling behind,” they are optimistic about the future.
“So people have to come together in the system, but also nationally and then internationally. Therefore, there is a large-scale collaboration between scientists and healthcare professionals and they are looking for answers. It takes time. But I am very happy to report this,” she said.
Sandlock said he was pleased to learn that the National Institutes of Health recently announced that it would provide research funding as part of its “Acute Sequelae After SARS-CoV-2 Infection” (PASC) program.
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As for Michael Reagan and Stephanie Condra, they are doing their best.
“I make optimistic and positive decisions consciously every day. I can’t always control what happens in my life, but I can control my lifestyle. If I carry myself with grace and dignity, I will get better. “Reagan said. “I have a very supportive family. I have a partner who supports me. I have a job (and) colleague who knows me well. I have an excellent doctor. So I try to see what I am grateful for.”
Condra said: “I really have to give up my sense of control, I don’t know when this will end for me. However, I really appreciate the improvements that are taking place, and at least (restored) a certain level of quality of life. And being able to take advantage of the days, I feel better for a few weeks… but it’s incredible, it’s already a long time.”