The idea of complications occurring after a viral infection is not new, explains Dr. Purpura. “The truth is that it’s something that can be expected after certain viral infections.” With post-Ebola syndrome, for example, which Dr. Purpura has studied among Ebola survivors in West Africa, some people experience long-term fatigue, joint pain, headache, hair loss, and an eye condition called uveitis, which can lead to vision loss if left untreated.
The most common long COVID symptom is fatigue. Long-haulers also report neurologic problems like the brain fog Elizabeth experiences and shortness of breath, cough, intermittent fever, joint pain, chest pain, diarrhea and gastrointestinal issues, and skin rashes, along with anxiety and depression, chest pain, and other cardiac complaints. Among them, “Cardiomyopathy and pericarditis and myocarditis have been well-described in the acute phase [of COVID],” Dr. Purpura says. “Although rare, these problems can persist for several weeks to several months, especially if a patient goes on to develop heart failure or arrhythmias.”
Fast heart rate is another cardiac symptom some patients experience. Postural orthostatic tachycardia syndrome, or POTS, “can result in a fast heart rate, lightheadedness, or even passing out in very severe cases,” he says.
While there aren’t treatments for long COVID, there are healthy habits that can help alleviate some symptoms; for example, establishing a regular sleep routine can help with insomnia, which is known to exacerbate other symptoms like chronic fatigue and feeling generally unwell. However, for the more unusual cardiopulmonary and neurological symptoms, Dr. Purpura says, more research is needed to know what treatment options will be effective.
What makes long COVID complicated is its novelty — scientists and researchers are still working to understand it. At the start of the pandemic, doctors and nurses were just trying to treat the surge of patients; now, more than a year later, the medical community is grappling with the increasing number of long-haulers and how best to care for them. More studies like the one at NewYork-Presbyterian/Columbia are underway to learn what drives these symptoms and why certain people are more prone than others.
Dr. Purpura and other researchers have theories about what’s behind these perpetuated symptoms. “[When it comes to brain fog] we suspect that there may be some sort of underlying inflammatory response after their acute illness,” he says. “There are other hypotheses, including an autoimmune-type syndrome or low-level persistence of the virus. We just don’t know yet.”
In addition to researching the factors that contribute to the lingering symptoms, “We are doing work in other key areas: characterizing the risk of reinfection and understanding how COVID-19 vaccines impact the clinical and immunological course of the disease in these long COVID patients,” says Dr. Magdalena Sobieszczyk, chief of infectious diseases at NewYork-Presbyterian/Columbia and associate professor of medicine at Columbia University Vagelos College of Physicians and Surgeons. “Importantly,” she adds, “we are working to learn about the contribution of environmental, familial, household, and community-level factors on the clinical outcomes in patients who live with long COVID. There is much to learn in these areas, and we are taking an integrated and very comprehensive approach.”