‘Long Covid’ still puzzles doctors but treatment is possible

Medical professionals are working to understand more about a condition they are calling “long Covid,” among patients who experience lingering symptoms months after recovering from coronavirus.

“Persons with long Covid often present reporting persistent, severe fatigue, headaches and brain fog, which is defined as mild subjective cognitive impairment, approximately four weeks after acute illness,” Dr. Alfonso Hernandez-Romieu, a member of the Centers for Disease Control and Prevention’s (CDC) Covid-19 response team, said during a CDC briefing Thursday.

A study recently published in the journal The Lancet found that of 1,733 coronavirus patients treated in the Chinese city of Wuhan, 76% were still experiencing at least one symptom six months after their symptoms began.

Doctors have reported that the severity of Covid-19 illness may have little impact on whether patients experience long Covid symptoms, Hernandez-Romieu said.

Dr. Allison Navis, an assistant professor at the Icahn School of Medicine at Mount Sinai in New York City, said one of the most common symptoms of long Covid is called “brain fog.”

“Brain fog is a symptom. It is not a diagnosis, and it means many different things to different people,” Navis said. “Oftentimes it’s a combination of short-term memory issues, concentration, or word-finding speech difficulty.”

Navis said brain fog does not appear to have a clear connection to the severity of Covid-19 infection, age or other risk factors. She said doctors have observed these symptoms in younger patients — including children and adolescents — who had mild coronavirus and were previously healthy.

In the absence of a broad diagnosis or treatment plan for people who experience long Covid, doctors have been targeting specific symptoms for treatment, Navis said.

Treating the symptoms

“For brain fog, we don’t have treatments for cognitive changes, unfortunately, so it’s really addressing any abnormalities in blood work that could be contributing, addressing those other contributing factors like sleep and mood,” she said. “If attention is a major issue, medications that can help with attention might be needed.”

For issues with the sympathetic nervous system, which controls the body’s “flight or fight” response, Navis said meditation and breathing techniques can be helpful. For other issues related to the nervous system, she said increasing hydration can help.

For fatigue, she advises patients take it easy on the exercise. “Don’t do anything that causes you to feel worse afterwards.”

She also stressed that patients should get enough sleep and look after their mental health.

“We’re seeing a lot of different neurological symptoms in these patients,” said Navis. “I think it’s important to get a broad history to try and see if there’s a larger diagnosis that might emerge, instead of getting too much tunnel vision on one specific symptom.”

The CDC is working with the National Institutes of Health and World Health Organization to better define and understand long Covid.

“While we don’t know what’s causing these symptoms, they’re very real for patients, and we are seeing patients get better,” said Navis.