A doctor discusses what to know about long COVID

For some people, COVID-19 infection is short-lived. After a few days or a week of feeling under the weather, they will generally feel ready to resume daily activities. Yet many others will experience long-term effects that linger for months (or years) after their infection. This is known as post-COVID conditions (PCC) or more commonly, long COVID.

An estimated 1 in 13 adults in the U.S. currently has long COVID. Long COVID can be scary and frustrating for you or a loved one to go through — especially with such uncertainty. Fortunately, doctors are learning more about long COVID and potential treatment options.

We spoke to Janna L. Friedly M.D., M.P.H., who is treating long COVID patients at the UW Medicine Post COVID Rehabilitation and Recovery Clinic at Harborview Medical Center, to learn more about the illness and the available support.

Thanks for joining us Dr. Friedly. We know long COVID is something a lot of readers have questions on. When does an infection become long COVID?

Long COVID is a condition where people have persistent symptoms after an initial COVID-19 infection that last for three months or longer. If you’re having symptoms that persist beyond three months after your initial infection, or new symptoms that you didn’t have prior to your infection, it’s generally considered long COVID.

There’s not any one specific diagnostic test for long COVID. It requires a doctor to review your symptoms and to determine if they’re related to the COVID infection.

What are some of the symptoms associated with long COVID?

The symptoms are very broad. Research suggests that there are over 200 different symptoms.

The most frequent symptoms are fatigue, post-exertional malaise (fatigue or muscle aches after exercise) and cognitive symptoms like brain fog.

Do you see these kinds of lingering symptoms with other diseases or is this something unique to COVID?

There’s a long history of post-viral infections that present very similarly to long COVID. Infections like SARS and Epstein Barr. So while some of the symptoms are new with long COVID, this type of lingering infection isn’t unique to COVID-19.

Are certain populations more vulnerable to getting long COVID?

We’re still researching that. In general, people who are hospitalized with COVID-19 tend to have a longer recovery and persisting symptoms, so all of the same risk factors for having severe disease. That would include people who are unvaccinated, older adults, and people with underlying conditions like hypertension and diabetes.

Beyond that we’re still learning about what puts somebody who had a mild infection, or even a mostly asymptomatic infection, at risk for developing long COVID.

There are a lot of interesting reports out there that long COVID seems to affect women more commonly than men, particularly women between 30- 60 years of age. That’s certainly consistent with what we’re seeing in our clinic.

Does that mean certain populations, like women, are more vulnerable to getting long COVID?

The way I think of COVID-19 is that it’s like gasoline, it sets everything on fire. If you had underlying conditions and you get COVID-19, the disease will light everything on fire and make things worse.

A lot of people who have chronic medical conditions or are older may not necessarily associate the worsening of their symptoms or their condition with their COVID-19 infection, when in fact it may actually be related to long COVID.

Then there are people who were considered healthy before their infection and now are experiencing debilitating symptoms. We’re not quite sure if it’s that it’s more prevalent in those populations, or that they’re recognizing it as long COVID and seeking out care more.

Can people ever recover from long COVID?

Absolutely. We see many, many patients who recover completely. I consider myself in that category. I had symptoms for about nine months after my initial COVID-19 infection and feel fully recovered now.

Some people think the vaccine could improve symptoms of long COVID. Is that something you’ve seen?

This is something that is still being studied, but some of the initial research found that a subset of long COVID patients who got the vaccine had an improvement in their symptoms. I’ve seen that in some of my patients, but most patients have no change one way or the other in long-covid symptoms after getting the vaccine.

Should someone get vaccinated if they currently have long COVID?

Yes. We know that repeat infections are very common and that getting the vaccines and the boosters do prevent the more severe symptoms. So, if you get reinfected, the severity of the illness will be much less if you’re vaccinated.

Do people with long COVID have a higher risk of reinfection? And would it be more severe?

There’s no evidence that people with long COVID are more at risk for reinfection or a more severe re-infection. Vaccination makes the biggest difference in terms of severity of the illness.

That’s encouraging to hear. Now what are some of the resources and treatments available to people who do have long COVID?

There are a variety of things that people can do on their own to support recovery. I always recommend patients focus on keeping themselves as healthy as possible. That means getting adequate sleep and making sure that you’re following a heart-healthy diet.

Gently reintegrate into your daily activities and gradually return to exercise. Try gentle stretching, yoga and low-intensity aerobics like walking and swimming. Take it very slowly and incrementally so that you don’t worsen your symptoms.

The next step is to work with your primary care doctor. They can evaluate you for any other conditions that might be contributing to your symptoms and can provide some tailored treatment options.

Are there treatment options for people who don’t have a primary care doctor?

My best recommendation is for everyone to have a primary care physician.

People can also visit clinics that specialize in post-COVID rehabilitation and recovery, like the UW Medicine Post-COVID Rehabilitation and Recovery clinic where I work.

Everybody can also access guidance through the CDC and the American Academy of Physical Medicine and Rehabilitation (AAPMR).

How can you support a loved one who currently has long COVID?

The most important thing you can do is to recognize that there may not be outward signs of long COVID. That means symptoms can be hidden and can fluctuate. People can have good days and bad days; and they can have more energy at certain times of the day.

Help your loved one practice what we call the “Four P’s.”

  1. Pacing: Take frequent breaks.
  2. Prioritizing: Let go of some of the things that aren’t as important. It’s OK to put things off to another day.
  3. Planning: Structure your day around when you know that you’re going to have more energy.
  4. Positioning: Think about your environment and how it affects your activities — position things so that you can sit rather than stand, make sure things you use frequently are easily accessible/close by, and try to limit time in busy and noisy environments that can use up more of your energy.

How have you seen long COVID impact people’s ability to work? If they are struggling in the workplace, how might they raise those concerns with their employer?

It can have a very significant toll on people’s ability to work. About half of people who are experiencing long COVID are either not at work or have reduced their work hours. It’s very challenging.

Because there’s no outward appearance of long COVID, it can be difficult for your employer to see your limitations. That’s why it’s so important to communicate with human resources and your manager. Share the symptoms you are experiencing and how they are impacting your work.

There are lots of modifications you can make to keep working. See if you can modify your schedule to work during the hours where you have more energy. Take more frequent breaks if you can, and try to avoid multitasking, as that can be more physically and cognitively demanding.

Ask to temporarily have a workspace that’s close to the door or a closer parking space to reduce the time it takes to get to work.

Sometimes even changing the lighting (dimmer lights and less fluorescent lights) can lessen symptoms.

I encourage employers to have as much flexibility as possible as people are recovering.

Do you have any final thoughts for readers?

There’s a lot of hope for recovery. Just because you are experiencing these symptoms doesn’t mean that it’s a life sentence, you can get better.

There’s also a hope in the treatments that are coming. There’s a lot of research going on with treatments that will likely become available in the next year.

Patients can even participate in clinical trials, which can be really helpful for everyone. You can find information on open trials through National Institute of Health.

More Information

This blog is accurate as of the date of posting. Information changes rapidly, so check the state’s COVID-19 website for the most up-to-date info at coronavirus.wa.gov. You can also sign up to be notified whenever we post new articles.

The COVID-19 vaccine is now available to everyone 6 months and older. For more information about the vaccine, visit CovidVaccineWA.org and use the vaccine locator tool to find an appointment. The COVID-19 vaccine is provided at no cost to you.

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Answers to your questions or concerns about COVID-19 in Washington State may be found at our website. You can also contact the Department of Health call center at 1–800–525–0127 and press # from 6 a.m. to 10 p.m. Monday, and 6 a.m. to 6 p.m. Tuesday — Sunday and observed state holidays. Language assistance is available.

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