While we’re all vaccinated and might have forgotten about covid-19, it’s important to remember that the virus is still around us, and could still affect us after getting vaccinated. It’s also important to note that many of us will still struggle with the side effects months, and maybe years after catching the virus.

Many people keep talking about the symptoms during covid, but barely anyone acknowledges the effects of the virus after it leaves out bodies.

Here we’re bringing you some of the most important things we heard from Dr. Greg Vanichkachorn, medical director of Mayo Clinic‘s COVID Activity Rehabilitation Program, who had a virtual talk last week about the lasting effects of Covid-19.

Long Haul Covid

Long haul COVID is a condition that is typically associated with extreme fatigue, and it’s not just any normal fatigue, but quite profound. Patients will often say that they need to take a nap or three to four hours or even fatigue lasting for days after performing simple activities like doing some light household chores or going around the block for a walk.

In addition, patients also complained of significant shortness of breath and neurological problems like headaches and troubles thinking.

But these symptoms, which are often focused on by the media, are only the tip of the iceberg.

Every day we are learning more from our patients and we’re hearing more about symptoms that are and can possibly be related to long haul COVID things such as troubles with sweating, GI (gastrointestinal) issues like severe Constipation, headaches and even hearing loss.

And unfortunately, this is a condition that does not seem to be going away despite all of our best efforts with the pandemic such as controlling contacts and introducing vaccines – People are still suffering. We are now more than a year out from the start of the pandemic, and there are patients who are experiencing symptoms still.

Patients are getting better, but there are some also for who these symptoms will be their new baseline in life, unfortunately.

Have the factors that make a person more likely to develop long COVID been identified?

To answer this question, Dr. Greg Vanichkachorn said:

When we originally started to encounter this condition, we assumed that the risk factors that would make someone more likely to have an acute severe infection, like advanced age or uncontrolled high blood pressure or diabetes, would be the factors that lead to long haul COVID.

But this is not actually what we have seen in our research. In fact, 75% of the patients that we have seen here at Mayo in our program had very mild infections and did not need to be hospitalized. Some did not inquire about any medical care at all.

In addition, only about a quarter of our patients had any form of pre-existing cardiovascular, respiratory, or mental health condition. Only about 5% of our patients had any pre-existing chronic fatigue or fibromyalgia, which is something that’s been related to this condition. So, the takeaway point that I often leave with people is that really long-haul COVID is a condition that can affect anyone.

Have the biochemical changes that cause a person to develop persistent covid been identified?

Somewhat; so it’s important to remember that this is still a very new condition, even though we are more than a year out from when we first started hearing about this. But most of the research out in the world has focused on just trying to identify how this condition presents across different social-economic groups and ethnicities.

However, that being said, there are some initial findings now in the research that indicate there may be a problem or indicate what the problem is on a biochemical level. For example, out of the University of Arkansas this past year, there is research that found auto-antibodies against certain proteins in patients who are experiencing a long haul COVID and those antibodies were against something called Angiotensin-converting enzyme, which is involved with how the coronavirus effect infects people.

There’s also been other research showing that the immune system is altered and not functioning normally in patients with long haul COVID. There’s also been a lot of research indicating that there can be neurological issues like neuropathy in patients who have long-haul COVID.

The most common theory right now is that long-haul COVID is caused by a hyperimmune or autoimmune problem that’s affecting the body in many ways, including the neurological system.

Which are the therapies used to treat these patients with prolonged symptoms? How much progress has been made in this regard?

Dr. Greg Vanichkachorn noted that the primary problem that we find in long-haul COVID is that patients are extremely deconditioned. Any medical condition can cause someone to be deconditioned after just a few days, but this especially seems to be true with COVID-19 infections.

One of the things that we focus on primarily is helping patients re-strengthen their bodies and get back to their normal daily function but in a safe manner.

Patients with this condition often report something called post-exertional malaise or fatigue that can last for hours to even days after a simple activity. Because of this, many patients have a hard time trying to do normal activities during the day or even exercise, because it causes a flare of their symptoms.

So very early on in our treatment program, we will have our patients work with both physical and occupational therapists that can help them recover appropriately without causing too much stress on their bodies.

We don’t like to think of this as exercise, but a rather consistent low-level activity that allows the patient to slowly recover.

About half of the patients report having some difficulties also with their thinking. This has been something referred to as brain fog and it appears very similar to concussions and so will often have our patients visit with our concussion specialists to help their brains also recover.

And of course, there are many symptoms, as we have heard that are associated with this condition. The shortness of breath or headaches or nausea and dizziness. So we also use medications and other treatments to help with these symptoms so that patients can participate in physical and mental rehabilitation better.

And I’ve spent a lot of time trying to find the secret, like medicine or supplement that they can use to quickly fix patients who are suffering from this condition. But unfortunately, they haven’t found that yet.

If I am vaccinated and sick with COVID-19, am I less likely to have persistent covid?

Dr. Greg Vanichkachorn said:

So, I have had the opportunity to visit with patients who have been vaccinated and then had COVID-19 and then developed long haul COVID. But fortunately, those cases are very rare, and it does seem that individuals who are having prolonged symptoms, the ones that are vaccinated, they tend to get better, much, much faster.

While I remain hopeful that the vaccine is playing a role in reducing the amount of long-haul COVID. I will say that we are also now seeing patients recovering much earlier in their long haul COVID course; We’re now seeing patients recover about five weeks out from their infection versus 3 months.

So, it begs the question, is it the vaccine that’s making long-haul COVID less severe in these patients? Or the fact that they’re getting treatment?

Too early it’s too early to tell, but of course, we always recommend the vaccine.

Recently the FDA approved the use of monoclonal antibodies as a prevention for severe COVID symptoms. How long are could monoclonal antibodies be used for? And how exactly do they work?

The monoclonal antibody treatment can indeed be helpful for acute infections. The overall effect of these treatments is to basically help boost the immune system and give the body more weapons to fight off infection.

How long this can be used in, whether or not this can be used for long haul COVID remains to be determined. Much of the use of this medication is through an emergency use situation, so it has very limited ways it can be used, and we don’t have the research right now or the research protocols to try this in patients with long haul COVID, but it is something that would be interesting to look at in the near future.

And I am particularly interested in trials involving this for long haul COVID patients, because we also have had reports of patients getting better after they get vaccinated. Perhaps some sort of immune boosting therapy or a therapy that resets the immune system could be helpful in these patients, like the monoclonal antibody treatment.

Many patients who have COVID for three months are experiencing dysfunctions with their taste and smell. Is this something that will get better in time? What should patients expect in the coming months?

Yes, they have seen many patients with long haul COVID who have prolonged troubles with their taste and smell that sometimes lasting 6 to 8 months. But almost all of these individuals do get back their normal taste and smell with time.

There are specific treatments that can be used.

For example, there’s something called olfactory retraining, and there are some supplements such as fish oil that had been touted to help.

Is it safe to take the vaccine while post COVID COVID prolonged symptoms are still taking place?

Yes, a lot of patients with post COVID syndrome symptoms got the vaccine. A small portion of them, less than 10%, report having improvement or even resolution of their symptoms.

Most patients don’t have any different experiences with the vaccine as those who don’t have long COVID.

Some patients do experience a mild flare of their symptoms that last about a week, but they have not seen anyone get worse in the long COVID state after getting their vaccine.