Asking for a Friend: UT Health Austin Clinicians Answer Your Questions About Long COVID

Michael Brode: “It’s a great question. Two groups of people are really developing long COVID. The first is, it seems, people who are more predisposed to autoimmune disorders, usually younger people and women in a group that were not hospitalized for the illness who may have other connective tissue disorders, such as Ehlers-Danlos syndrome or autoimmunity that predisposes. The other group is people who were sicker when they initially got COVID-19. The group of people who were in the hospital are more predisposed to having longer symptoms.”

Michael Brode: “The neurologic effects, unfortunately, there are a lot of them. Commonly, we’re seeing headaches and we’re seeing some people having nerve pain, but the one that I think gets a lot of interest is that some people are describing what we call autonomic dysfunction. The autonomic nervous system is the automatic part of the nervous system that controls heart rate, blood pressure, temperature regulation, and the movement of the gut. Those small fiber nerves can be injured from long COVID and affect all those systems, such as regulating blood pressure, regulating the heart rate, or having a lot of stomach issues because it’s not moving properly. We’re really finding, especially with long COVID, it seems predominantly to be a neurologic disorder.”

Jeff Saniuk: “The disclaimer we always give in the clinic is that while there’s no current recognized treatment, FDA-approved treatment, currently, we’re recommending we treat the symptoms, because symptoms of fatigue, symptoms of anxiety, and shortness of breath, we have medical treatments for these particular symptoms. We try to keep in mind this paradigm of, generally, we understand post-COVID-19, long COVID, as a disease of inflammation, immune dysregulation, and these are things that we try and address in our treatments. But by and large, if you have shortness of breath with long COVID, we’d recommend albuterol inhalers, for example. If you have anxiety, we recommend counseling, exercise, and antidepressant medications. The treatments can be varied and are targeted to what you feel specifically.

Michael Brode: Our goal is to find targeted curative therapies, and that’s why we’re doing research with researchers at The University of Texas at Austin. In the meantime, while we’re still trying to find those targeted therapies, we have excellent symptomatic care and medications and lifestyle modifications we can make to help with this disease.”

Michael Brode: “COVID-19 has been a humbling process for everybody in the United States, especially clinicians and scientists. We are not the masters of Mother Nature, and I think, really, first of all, to the skeptics, we’ve seen over and over hundreds of patients telling us the same thing. They’re having fatigue, they feel worse when they push through, and they’re having diffuse neurologic symptoms. Just because we can’t explain it doesn’t mean it’s not real, and we’re seeing the same thing over and over with patients, so we absolutely believe them.”

Jeff Saniuk: “I would say, if there’s one thing I could tell patients, it’s that you’re not alone. We have a lot people coming in feeling like they’ve been invalidated before. Fortunately, it’s more and more a recognized condition, long COVID, but you need to know you’re not alone in this. We’re here to help. Just seek us out if you need us.”

Michael Brode: “For long COVID, we’re seeing people having a lot of persistent lung issues after their infection. Usually, it can make their asthma worse or they just feel short of breath and they never had that before. What we’re seeing is it’s complex and we don’t quite understand it yet. For some people, asthma is really wheezing or constriction of their lungs. But for some people, when they walk, they just feel very short of breath and that may not actually be a problem with their lungs. It may be related to fatigue or circulation and not actually a lung problem. The answer’s a little bit of yes, it can make asthma worse, but the breathlessness is not always asthma, although sometimes it feels like that. We’re just starting to understand it.”

Michael Brode: A good question. It’s variable for most people. The initial COVID-19 illness can last up until four weeks. That’s when a lot of the symptoms will go away and then the healing process starts to slow. We usually think people have long COVID when it’s been lasting about 12 weeks, or three months, and people are slowly getting better over time. Usually, people notice that their health is not improved after the initial illness and they’ve never fully recovered, although, there is a group of people that have a honeymoon period in which they go about a month feeling better before they start developing the long COVID symptoms. What I hear most talking with patients in our clinic is that the fatigue, the brain fog, and this term called “post-exertional malaise,” where you do an activity that should not be tiring and it just wears you out, for a lot of people is long COVID and is the toughest part to deal with. While we don’t have a cure for this, we have good ways of managing it. A lot is focused on managing the energy, not pushing through, listening to your body, resting when you need it, and then, of course, talking to your doctor to see if there are other available treatments to help you with the recovery process.