Although it is more than two years into the pandemic, long COVID is poorly understood, and treatment often focuses on improving specific symptoms like fatigue and shortness of breath. Even definitions of the condition vary. "The CDC definition [of long COVID is] new and returning, or ongoing health problems in people who are at least four or more weeks after the first infection with SARS-CoV-2," Akiko Iwasaki, PhD, professor of immunobiology at Yale University, said in a recent interview. "The WHO definition is similar, but they usually say within three months of initial diagnosis and symptoms lasting for over two months." More than 200 distinct symptoms have been reported in these patients. "That includes things like memory impediments and GI symptoms," Iwasaki explained. "There are many, many different organ systems involved. If you look at all the different surveys, fatigue is the No. 1 symptom that's being reported, followed by cough, headache, muscle pain. Loss of taste and smell is also one of the top symptoms, as well as sore throat and shortness of breath." Long COVID manifests in different ways. Half of patients with severe COVID-19 may experience these lingering symptoms after discharge.
"[In contrast], people who had mild or even asymptomatic infections can develop long COVID over time within about three months of that infection," Iwasaki said. "That tends to be between 5% to 30% [of patients]. They vary because we don't have a universal definition of long COVID."
Long COVID Presents Physical, Psychological Challenges
Scientifically, the cause of the condition remains unknown. However, one current hypothesis is persistent virus or viral remnants in tissue, such as RNA, protein, or both, are triggering chronic inflammation in long COVID patients. "The other hypothesis is autoimmunity," Iwasaki said. "An acute respiratory infection can induce autoimmune conditions in some patients. Once that has developed, it's very difficult to reverse that process. That could be happening in a subset of long COVID patients." Many people improve, but there are cases where some symptoms linger indefinitely. "If you follow the course of these symptoms over time, there's a definite gradual reduction, but it's not going to zero," Iwasaki said. "[There is a] fraction of people who are still suffering after two years of having had COVID. How do we treat those people? Is there something that we can do to reset or reverse the disease? Again, depending on the disease etiology, the treatment will be quite different."
Long COVID Treatment for Healthcare Workers
Meanwhile, healthcare workers with long COVID are being treated with rehabilitation approaches used for similar conditions caused by other viruses. "Many of these cases may have a common pathway with things like chronic fatigue syndrome, post-infectious issues like Epstein-Barr virus, and mononucleosis," Steve Wiesner, MD, Northern California Kaiser Permanente On-the-Job Medical Director for Workers' Compensation Services, said at a recent webinar held by the Association of Occupational Health Professionals in Healthcare (AOHP). There are myriad symptoms associated with long COVID, but it is best not to overwhelm the patient with multiple diagnoses. "Let's not forget our general rehab principles," Wiesner said. "We take the patient where they are, we identify what their functional limitations may be, we develop an integrated rehab approach, and we support them to regain their highest level of functioning. We've been here before -- let's not recreate the wheel. Let's learn from some of these challenges that long COVID is creating."
Engaging the patient means understanding where they are, and that is essentially practicing empathy. "We should be showing empathy in trying to better understand what the patient is experiencing, putting ourselves into that situation, and then developing clear expectations and goals that are realistic for them to get them back to their highest level of functioning," Wiesner said.
The fatigue component and any cognitive challenges experienced by the worker may call for bringing in allied health professionals and medical subspecialties.
Healthcare Workers' Unique Challenges with Long COVID
As one might expect, someone with long COVID who is trying to return to work may experience many psychological factors. What healthcare workers are going back to should not be minimized, Miranda Kofeldt, PhD, a licensed clinical psychologist at Ascellus Health in St. Petersburg, FL said at the AHOP webinar. Subclinical anxiety and depression may be present -- not on the level of a medical disorder, but enough to undermine a return to work.
"Those work-related psychosocial factors and stressors are really key here," she said. "Even if you've worked with the same team for years in a hospital facility, people change through this. Their tolerance for stress changes, and so your workplace is going to look different."
In addition, employees may hold legitimate concerns about returning to an environment from which COVID-19 could be brought home to children or elderly parents. Then, there is the rough tumble of the daily healthcare environment, which could include patients with negative attitudes and misinformation about COVID-19. "Being in the hospital or emergency care settings, as in this example of a paramedic, and trying to treat people who are giving you a hard time about wearing your mask -- how do you handle that?" Kofeldt asked. "Similarly, how do you handle people's different reactions to being vaccinated vs. not?" Guarding, self-protective behavior might manifest in the returning worker. "There are all of those anxieties about making yourself worse, feeling like your workplace isn't supporting you in whatever restrictions that have been placed on your activity -- catastrophizing," Kofeldt said. "Those are some of the psychosocial factors." This article was originally published by Relias Media.
