Long Haul Covid

hello i'm dr ken landau thanks for watching let's talk about the covid long-haul syndrome this occurs when patients are infected with covet 19 virus and then they don't seem to improve after a period of about two weeks conditions now generally accepted originally met with a lot of skepticism jama they report that at least 10 of people going to become long haulers initially we thought that it would occur mostly in people who were in patients in the hospital receiving oxygen therapy the sickest of the sick but now we know you could be an inpatient or an outpatient you know you can be young or old we know you can be otherwise healthy when you're infected or you could carry some baggage some medical diseases everybody seems to be relatively equally susceptible we don't understand the natural history of the disease and it seems that some not all of the people are going to improve after a period of about four to five months but some with symptoms going to last for an excess of a year now most of the time when you're infected with any viral infection especially with covin well it seems that you get better in a period of two weeks but when we're talking about the long-haul syndrome people may tend to initially improve but then the symptoms worsen they become persistent or they can become cyclical in nature they can come and go you can have periods when you're otherwise healthy in periods when you're otherwise symptomatic and now we know that the original infection might have been totally asymptomatic so we don't have that guidepost to say that the symptoms that we now find are related to the infection when we don't know that the initial infection existed well the name originally long-haul syndrome came from an american woman who started a support group she was wearing a trucker's hat and it said long haul on it so that's the genesis of the condition nih recently changed the official name of this condition to the post-acute sequelae of sars coronavirus 2 or pasc pasc dr fauci at the same time announced more than a billion dollar initiative to come to some understanding of what's causing the condition what we can do about it but at the present time we don't have a lot of information about the condition since obviously it's a relatively new virus all we can say is that with most viruses you get better after the initial infection within a period of about two weeks but here you don't and here we don't have any kind of specific diagnostic test to say it's related to the initial covet infection and we have little to guide us as far as the therapy is concerned now about half of the people who have this long-haul syndrome they never had an acute initial test so they didn't know that they were infected could have been asymptomatic would have mild symptoms and now all of a sudden at some point in time they develop some of these chronic conditions that sound kind of peculiar so a lot of doctors were initially skeptical they thought the people might have secondary gain in mind or they thought some of the women were hysterical if they had the symptoms and people would show up at their doctor's offices the family doctor the internist maybe they would see the neurologist or the cardiologist gastroenterologist all with symptoms that are non-specific then there was nothing to lymph link them back to the initial covet infection well when the studies were initially done the studies looked at the people who were in the hospital with acute infection and then they followed them at some period of time but they examined them only one time so we don't know if the symptoms were persistent if they tended to get worse after recovery we didn't know if the patients developed new symptoms after they were discharged from the hospital didn't know if the people who were sicker or people who were less sick developed symptoms that were different now we know a lot more about the condition but there's a lot of question about the disease and now it's thought that maybe the people who have what we now call the long-haul syndrome are actually suffering from the myalgic and cephalomyelitis chronic fatigue syndrome sometimes just called chronic fatigue syndrome sometimes just called myomyalgia and cephalomyelitis but we can simplify the name to post-viral fatigue syndrome it's not a new syndrome we know that it can occur after a variety of viral infections so it occurred after the spanish flu in 1918 it occurred after the swine flu the n1h1 it occurred after the initial sars infection the original in 2002. some of the people were symptomatic for at least 15 years after that infection murs related coronavirus infection can have these kind of symptoms but you could get the symptoms after the common acquired pneumonia or encephalitis or zika disease you can get it after guillain-barre syndrome or ebstein bar syndrome the chronic mononucleosis or mononucleosis you can say chronic you could get it after the acute respiratory distress syndrome ebola all of those may lead to this kind of condition but we don't know a lot about the course we don't know if or when people are going to return to the baseline what we can say is with most viral infections you feel awful for two or three days you know that from the flu then you feel better by two to three weeks here you don't we know that some reports suggest as many as 20 to 35 percent of people between the ages of 18 and 34 aren't going to regain their normal condition of health after two or three weeks from the time of the infection you know syndrome initially if we look at all the people seem to have an average age of about 44 and now whether you were fit or unfit that doesn't seem to have anything to do with whether you're going to develop the symptoms if we're talking about the myalgic encephalitis chronic fatigue syndrome we can say 800 thousand to two and a half million people in the united states may suffer that condition about ninety percent of the people with the condition have not yet received the diagnosis you can learn more about the condition if you watch one of our earlier shows specifically on that topic it was thought that risk factors for the long-haul syndrome were more prolonged or severe illness chronic psychiatric condition thought the older you were maybe women more so than men people with asthma people with hypertension or obesity those people especially if they had pre-existing lung disease seem to be especially susceptible but now we know that that's not really the case we know that everybody seems to be relatively equally susceptible including people who have a lack of resilience people with depression people with anxiety we know that there might be some genetic predisposition to the condition and it was originally thought that the more severe the acute illness was the greater the pulmonary involvement was the more you needed the oxygen the greater you were at risk so initial reports came out and showed that about 60 percent of people developed the long-haul syndrome if they were hospitalized and required mechanical ventilation as opposed to 20 percent of people who didn't require the oxygen treatment now we know that those early numbers were because of skewed population we know that the initial studies were of hospitalized patients now we're looking at people who are principally outpatients well the toll of coronavirus is substantial in the world at the present time we have more than 120 million cases and more than two and a half million deaths in the united states more than 29 million cases and more than 530 000 deaths and just to give you perspective if you look at just the l.a county by itself los angeles county has at the present time more than one and a quarter million cases and more than 22 000 deaths in that one county and that means if we're going to have 10 percent or more of people with the acute viral infection developing long-haul syndrome means that we might have hundreds of thousands of people who have this condition and we don't have any specific tests and we don't even know what to do with them so in one example in jama again journal of the american medical association there was one case where the patient had stabbing pain in the chest so severe caused the patient to cry went to the emergency room five months later the person had been to the emergency room or seen doctors at least 16 times been hospitalized at least three times and had brain fog where they couldn't remember words couldn't keep track of the medicines so the symptoms that are associated with long-haul can be different than the symptoms that you had when you were first infected with the condition whether you were hospitalized or whether you were treated as an outpatient symptoms don't necessarily have to be the same as i mentioned before some can have better days some can have worse days but the people just don't feel like themselves they don't have that same ability to be active about seventy percent of the people are relatively sedentary after infection versus the same seventy percent were active before the infection so the symptoms waxing wayne over time what are they well the symptoms are non-specific coughing shortness of breath sometimes debilitating fatigue that's one of the major symptoms you could have body aches or joint pain or chest pain some people have the loss of smell or taste and that's even if they didn't have the loss of smell or taste during the acute infection may be a sign of the long-haul syndrome some people have difficulty sleeping insomnia or headache well some people rarely may have fever but most people don't some people have a sore throat runny nose nausea diarrhea ear pain rash some people feel feverish even if they don't have an elevated body temperature some people have night sweats so you can see where the people can be misdiagnosed those are just absolutely non-specific symptoms easy bruisability sensitivity to light and sand we know that even if people didn't have any kidney problem at the initial infection they may develop acute renal injury later during their covet 19 the long haul syndrome some people lose their hair some people have mood changes and then they present to the doctor and they ask the cardiologist and the neurologist or the rheumatologist or the dermatologist to make the diagnosis based on the symptoms that they have and nobody can link those back to the initial covet infection well fatigue when we talk about that major symptom it's not like the fatigue you get from having a bad night's sleep the sleep the fatigue rather is much more profound often you feel like you need a nap after you just go walk the dog or if you go up a flight of steps or if you use the vacuum may be exhausting and you have difficulty concentrating oftentimes you watch the television but you forget what happened and you can't perform simple calculations some people struggle to breathe even though they have normal oxygen levels and that's struggling to breathe the extra effort and respiration leads to fatigue sometimes difficulty of breathing and shortness of breath go hand in hand some people have deconditioning because they had a long acute illness some people gasp for air several times some people have infection specific conditions maybe they have post-viral reactive airways so just if you had the flu or if you had any other kind of condition then your airways tend to be reactive especially if you have a history of asthma or atopic condition some people develop some scarring in the lung lung fibrosis scarring in the heart myocardial fibrosis some people can develop post-viral heart failure now new york city cough is the most common presenting symptom of the long-haul syndrome and it seems that a lot of people develop this brain fog that people are talking about it's unusual forgetfulness people are confused they unable to concentrate and unable even when they watch television to know what's happening now these symptoms are highly suggestive of myalgic encephalitis chronic fatigue syndrome and as a matter of fact three-quarters of the people with that condition the myogen encephalitis chronic fatigue syndrome can begin after a viral infection and as a matter of fact the international disease the icd in an international classification of disease they refer to myalgic encephalitis chronic fatigue syndrome as a post-viral syndrome but a lot of people refuse to believe that and some people about seven percent can develop some psychiatric conditions delusions or hallucinations awful hallucinations these people tend to be mostly in their 30s to the 50s but remember it's very rare for people to develop psychosis for the first time in middle age most of the people develop it with schizophrenia and relatively early age late teenage early 20s where they develop it when they have dementia and some people who have the long-haul syndrome are aware that there's something wrong with their thinking process with their mental process as opposed to people with schizophrenia who are totally unaware that anything's wrong and some of the patients who have some of these conditions psychiatric conditions are diagnosed with acute adhd or maybe even panic attacks and that's in spite of the fact that brain scans and spinal taps and all of the other tests that are done show no specific abnormality yet the patients still present with numbness or tingling of the hands or feet or pins needle sensation or vertigo or headache sometimes they have low back pain or stabbing pain stabbing migraines they have a decreased sense of smell they can have peculiarities in the sensitivity to taste or smell things that used to smell quite nice now all of a sudden can take a rancid or a putrid type impression or cause depression well in osmir lack of smell can occur in as many as 18 of these long haulers and it's important because the sense of smell is a sense that we use for alarm so burning food on the stove or a gas leak or sometimes spoiled food or ammonia fumes and because we can't have that normal sense of smell it can change the pleasure with eating and mood and memories and quality of life well the lancet in january of 2021 said that somewhere between 50 and 60 percent of the people with chronic long-haul are going to have fatigue about 60 gonna have muscle weakness about 40 percent shortness of breath and dyspnea and about 25 are going to have some sleep difficulties some problems with joint pain or anxiety or depression or chest pain and a significant number of those going to develop the acute renal injury that i mentioned about 10 15 percent and we know that depending on the different populations that are studied an average can be in some studies that may be 13 of the people going to have symptoms for more than four weeks and that can dwindle down to two percent after a period of about 12 weeks but that seems to be relatively low because studies in italy show that 87 of people are going to have symptoms of two months and in the united states in the united kingdom and in sweden this studies suggest that maybe the symptoms can last for three to six months or even longer and the mayo clinic says well they could last for a year or longer now the good news is that many people seem to feel better after a period of about four to five months but that's tentative and it's variable and it's not guaranteed that you're going to feel better on the other end of the spectrum in china in january of 2021 the lancet published an article that evaluated an initial group of 1733 patients who were hospitalized and they studied them for long haul after a period of about six months and they found the incidence in males and females was pretty much equal but they found that 75 75 percent three-quarters of the people who had the acute infection were still going to have symptoms after a period of about six months and that didn't include people who were the sickest of the six so there were only about four percent of the people who were in the intensive care unit yet 76 of all the patients seemed to have symptoms that persisted for at least half a year and the centers for disease control reported a study that looked at 14 academic centers here in the united states and they found that a significant number of the people had at least one symptom somewhere between two and three weeks later that was 94 of the people and it seems like the symptoms occur if we look out over a period of time in an increasing number the older we get there's no racial or ethnic predominance with the condition now we have another report that reported 91 of the people didn't fully recover by day 40. they were still complaining of the same kind of symptoms of fatigue and the chills and the sweats and the body aches and the headaches and all the brain fog and we know that if we look over a period of time there's going to be a significant number of people whose symptoms just go on and on probably the best study was published in jama it was from the university of washington in february of 2021 and what they did is they looked at 234 patients and they followed them they followed them for a period of three to nine months after the acute illness the average age of these people 48 but they ranged anywhere between about 18 and 94 years of age a little more than half of the people were women and what they found was that persistent symptoms occurred in 27 percent in the 18 to 33 year old group 30 percent and 40 to 64 year old age group and about 43 percent in the senior citizen group so it seems like the symptom is going to last a long time what causes these symptoms we haven't decided this idea some people say it's an immune reaction a vascular reaction a surge in the inflammation residual small amounts of viral particles not the whole virus but maybe some of the antigens from the virus that are left over maybe has something to do with the damage from the lungs the initial infection even though person might have normal oxygen levels might have thickened air sacs and fluid accumulating in the air sacs it makes it harder to breathe maybe there's something wrong with the cells lining the blood vessels the endothelial cells maybe the mitochondria this portions of the cell that make the energy maybe they're dysfunctional some people might be an autoimmune condition or blood clotting persistent low-grade infection although most people say that they can't find any evidence of that dysregulation of the autonomic nervous system all sorts of ideas maybe even mast cell activation maybe a small fiber neuropathy but it all boils down to we don't know and the best choice at the present time not necessarily a year from now or three years from now but right now most people are going with the idea that the symptoms are consistent with myalgic encephalitis and chronic fatigue syndrome but we still have a lot of employers who say that they don't believe that symptoms last that long they think that the people are showing symptoms of stress or anxiety psychiatric problem maybe they're using drugs so it comes down to what do we do to prevent the condition beginning in the first place well right now it's still the social distancing and we're in the mask wash your hands but now we have the vaccine so i've already had my vaccine i'd rush out and get it if i were you if you haven't had the vaccine a lot of ideas about treatment none of them have panned out there's a recent suggestion that maybe if you receive the vaccine after you've started to develop some of the long-haul syndrome maybe the symptoms can decrease or disappear those are just what we call anecdotal there's no specific medical study but you've seen reports in the news over this condition vaccination making the symptoms go away it might work and some people should have the vaccine anyway but now we have specialty clinics that are being set up in major medical centers throughout the united states throughout the world to study this condition hopefully we gain some more information and that's unfortunately the sad state of affairs with this long-haul syndrome non-specific symptoms can persist or come and go no underlying no idea of what the underlying cause of the condition is we don't know that it has to do with faulty immune system or blood clotting or some other kind of a mechanism but the bet right now is myogic and cephalomyelitis chronic fatigue syndrome the new name the post-acute sequelae of sars coronavirus 2 infection tell you what if you haven't gotten the vaccine the best thing you can do is just go get the vaccine you don't have to worry about the names you don't have to worry about anything else because if you do get the infection even if you're asymptomatic you might have symptoms that last for four or five months or even longer and it's not worth it just go get the vaccine anyway thanks for watching if you enjoyed the show please tell a friend consider subscribing so you'll be notified as we post new videos appreciate your interest i'm dr ken [Music] landau [Music] [Music] [Music] you

Channel: wellnowdoctor

Views: 2,137

Rating: 4.9333334 out of 5

Keywords: Long Haul Covid, symptoms after Covid-19, Post Viral Syndrome, Brain Fog, fatigue, muscle weakness, chronic cough, myalgic encephalomyelitis, chronic fatigue syndrome, loss of sense of smell

Id: _lmFYrYignc

Length: 23min 53sec (1433 seconds)

Published: Mon Mar 29 2021