Columbia physicians review “long-haul” COVD-19

The novel coronavirus (COVID-19) pandemic has taken the lives of millions of people around the world but has also left hundreds with lingering symptoms or completely new symptoms weeks after recovery, according to a new review of post-acute COVID-19 syndrome published in the journal Nature Medicine.

Much is unknown about what causes these symptoms and how long they last, but with nearly 29 million in the United States since last March, physicians are increasingly seeing "long-haulers" in their practices.

Co-authors Ani Nalbandian, MD, a cardiology fellow at Columbia University Vagelos College of Physicians and Surgeons, and Kartik Sehgal, MD, medical oncologist at Harvard Medical School and Dana Farber Cancer Institute, along with senior author Elaine Wan, professor of medicine in Cardiology and Cardiac Electrophysiology at Columbia University, spearheaded the review effort, bringing together more than 30 experts from Columbia and other medical centers hit by the initial wave. The review summarizes what the physicians were seeing in their own patients and what others had reported in the literature. The experts represented a wide range of fields, including neurology, cardiology, and nephrology, who discuss the symptoms that patients and providers should know about COVID-19 long-haulers.

Chest pain has been reported in up to 20 percent of COVID-19 survivors two months after recovery from the infection, COVID-19 can unveil previously unrecognized cases of diabetes, and a few percentages of patients experience strokes, pulmonary embolisms, and other complications from blood clots. Patients may also experience heart arrhythmias. Arrhythmias can lead to stroke, heart failure, and long-lasting damage to the heart, which patients may not be aware of, she said.

Most people who experience long-term symptoms may have had health issues before contracting the virus or they developed very severe illness during COVID-19 infection, the researchers said. However, any of these issues can happen to any patient who had COVID-19. For example, young patients without prior medical illness have developed autonomic dysfunction and fast heart rates after COVID-19. It's not just the most vulnerable who have issues after COVID-19, the researchers said.

The researchers collectively refer to long-hauler symptoms as “post-acute COVID-19 syndrome,” which they said does not always correlate with the severity of the acute COVID-19 infection itself. The majority of COVID patients never come to the hospital for treatment.

These symptoms can also present weeks or months after initial COVID-19 infection, the researchers said, presenting with new onset of heart racing, palpitations, and chronic fatigue. Other patients complain weeks later of new chest discomfort or difficulty with decision making, memory, and concentration. While many think of COVID-19 as a respiratory illness, patients may still have other clinical symptoms due to issues with other organ systems, the researchers said.

The authors also call for healthcare systems to establish dedicated COVID-19 clinics.  Setting up such clinics in the United States has been difficult since physicians are still busy taking care of new COVID patients as subsequent waves come in. However, clinics should prioritize follow-up care for those at high risk for post-acute COVID-19 and those with the highest burden of persistent symptoms, the researchers said.

Additionally, patients should be vocal about their symptoms, even if they aren’t recognized as related to COVID-19. Practitioners should also refer patients to active clinical trials and research studies. Though the medical community now has a better grasp of the constellation of the long-term symptoms that occur after COVID-19, we don't know the duration and the long-term complications, the authors said.

"Based on this review, all of us recognized that there needs to be interdisciplinary care to treat patients longitudinally," said Nalbandian in a statement. "Care for patients with COVID-19 should not conclude at the time of hospital discharge."