For an estimated 10% to 30% of people who survive acute COVID-19 illness, the road to full recovery is lengthy and plagued with an array of persistent ills ranging from “brain fog” to fatigue, shortness of breath, gastrointestinal distress, impaired sense of smell, and neurological symptoms.
Doctors call this syndrome, “long COVID or post-acute COVID-19,” and patients call themselves “long haulers.” The cause of the varied symptoms isn’t precisely known, although similar post-acute, lingering complications have been seen in survivors of other coronavirus epidemics. It’s a complicated picture for medical specialists, because the virus affects many organs of the body, and scientists are working to understand the wide variety of symptoms in long COVID, what triggers them, and how best to manage and treat afflicted patients.
“It is clear that care for patients with COVID-19 does not conclude at the time of hospital discharge. Interdisciplinary cooperation is needed for comprehensive care of these patients in the outpatient setting,” according to a recent review article in Nature Medicine co-authored by Kartik Sehgal, MD, a Dana-Farber medical oncologist, along with almost three dozen other investigators from multiple institutions. The review covered the current medical literature on long COVID, the specific effects on different organs, and a roadmap for care of patients at high risk for post-acute COVID-19 through dedicated COVID-19 recovery clinics.
Potential vaccine benefits beyond protection
One of the most intriguing recent developments — which has emerged since the publication of the review article — is that some long-haulers who have received a COVID-19 vaccine say their symptoms have been somewhat or even dramatically alleviated. There haven’t been any formal studies, but a patient advocacy group, Survivor Corps, said it surveyed 900 long-haulers and found that 41% reported some benefit — sometimes slight, sometimes almost full recovery — after being vaccinated.
“There have been a lot of anecdotal reports,” says Sehgal. “Even though we have not proven or recommended it as a measure to treat lingering symptoms, in general we recommend that everyone get a COVID-19 vaccine.”
Sehgal and other scientists are mulling several hypotheses for the vaccine’s apparent ability to help long-haulers.
“One possible explanation is that there are low levels of virus — or possibly just the genetic material of the virus — hiding as a reservoir in the body, causing long-lasting, low-level inflammation,” Sehgal says. “It’s possible the vaccine activates the immune system to take care of that, and that may be why the patients are feeling better.”
Another possible explanation, he says, is that in long haulers, the immune system is malfunctioning even after the virus has left the body, and that is the underlying cause of the symptoms. The effect of the vaccine might be to reset the immune system, in some patients.
Still, scientists are a long way from fully understanding the cause of long haulers’ symptoms and whether the vaccines could be an important form of treatment.
Meanwhile, says Sehgal, the medical community can help by “making sure patients know they’re not alone, and are really experiencing these persistent effects. Physicians must keep an open mind when they are evaluating patients who may be presenting with unusual symptoms.”