The Long Haul for Long Covid Patients

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Some Covid-19 survivors are experiencing long-term side-effects including fatigue and pain. Andrea Piacquadio from Pexels

Covid-19 has caused misery around the globe for more than a year now. There is much evidence in the literature to support the concerns for those with chronic illness and the severe illness that they experience. The American Heart Association (AHA) has reported that for patients in China the most severe cases of illness occurred in those with high blood pressure, heart disease and diabetes. In the US, and elsewhere, obesity has been an additional risk factor for hospitalization. Almost 2/3 of US patients hospitalized for Covid-19 last year had obesity, high blood pressure and diabetes. The authors suggest that hospitalization most likely could have been avoided if patients did not have these conditions. The literature is also showing that large numbers of Covid-19 survivors are being discharged from hospital while experiencing disability and anxiety related to Covid-19.

The literature is also showing that diabetes, high blood pressure and obesity are not the reasons why some patients are returning to their local hospital months after discharge. Emergency department staff worldwide are flummoxed by these patients’ conditions and their symptoms.

These patients have nagging symptoms related to their breathing, their heart, and even their digestive system. Their shortness of breath (SOB) has returned, their heart has started racing for no apparent reason, and they can have nausea, vomiting, and diarrhea-- again for no apparent reason. They have what is now termed “Long Covid”, and medical staff worldwide are recognizing the increased prevalence of these serious, long-term effects. These patients are often referred to as “Covid Long Haulers.”  There is no consensus on a definition, and the two terms are used interchangeably.

In December, at a Long Covid Forum, one speaker estimated that 5 million people worldwide are confronting post-Covid symptoms. 

In response, Post Covid Care Centers (PCCC) are popping up in many US hospitals, including Mount Sinai in New York, University of California, San Francisco Health, the University of Michigan and the University of Pennsylvania. The PCCCs specialize in treating patients who are experiencing a broad range of symptoms that span several organs and systems.  

 

How can PCCCs help Long Covid

Just as we are learning how to care for patients with Covid, we are learning how to care for patients with Long Covid.

In 2020 a multidisciplinary team of health care providers recognized the scope of potential disability affecting the UK and developed a post Covid-19 rehabilitation plan.  The proposed plan was quite comprehensive and was intended to assist the active population to return to their previous level of health and regain as much independence as possible.

Peter Staats, MD,, Chief Medical Officer at electroCore, Chief Medical Officer at the National Spine and Pain Centers, and President of the World Institute of Pain recommends creating ‘Living Guidelines’ to help PCCCs provide care that is tailored to the specific needs of Long Covid patients. These guidelines would evolve as we learn how to provide the best care for Long Covid patients. The guidelines would also be updated as the patient’s symptoms improve.  The term ‘Living’ lends itself to the ‘remitting and relenting’ aspect of Covid-19 symptoms. When symptoms return the guidelines for care are adjusted to allow these symptoms to again be included in the plan of care for the patient.

The FDA also has approved use of a hand-held device designed to help control inflammation.

 

Where Covid first lands 

When someone is first infected with the coronavirus, it attacks the lungs, causing difficulty breathing, which in turn limits the amount of oxygen that reaches the cells.  Patients sometimes need intubation and medications to get the oxygen they need. If the treatment doesn’t work, they lose their lives.  

But those patients are considered the severe cases; many people who have recovered from even mild cases of Covid-19 are experiencing persistent residual organ damage, vascular problems and persistent inflammation.  Some common symptoms are:

  • Neurological issues – brain fog, headaches, migraine
  • Respiratory problems like SOB, cough that just won’t go away
  • Cardiac (heart) problems such as racing heart rate (tachycardia),  inflammation of the heart (endocarditis)
  • Vascular issues such as blood clots and strokes (ischemic and hemorrhagic) 
  • Gastrointestinal difficulties like persistent nausea, vomiting, diarrhea
  • Fatigue

Large numbers of recovering Covid-19 patients have various heart problems that had not been diagnosed prior to them getting Covd-19. It is possible that some of these patients had these conditions prior to getting Covid-19, but given the large numbers, it is unlikely that all had undiagnosed conditions prior to their infection.

It is yet unknown why patients experience persistent, recurring symptoms and serious effects on the brain, lungs, heart and other organs. Perhaps the Covid-caused inflammation either does not completely resolve or it returns again and again.

 

Long Covid’s possible treatments

New research suggests that stimulation of the vagus nerve can reduce the symptoms.  

 

What does the vagus nerve do?

The vagus nerve is the longest nerve in the body. It extends from the gut to the brain. It is an information superhighway, because the vagus nerve is the command and control center for inflammation. Its job is to coordinate a first-line of defense against invading infections. Once Covid-19 attacks the lungs, that attack can cause the body to over-react and mount an excessive inflammatory response to the virus. This response has been called a ‘Cytokine Storm’. The vagus nerve tells the immune system’s T-cells to make the cytokines to respond to the invading Covid-19. But if the cytokines overreact, their unchecked production can cause many of the problems related to inflammation, blood clots and organ damage.

The vagus nerve is also responsible for regulating the heart rate, breathing rate and digestion, which explains how the brain, lungs, heart and gut can be affected along this superhighway. The problem seems to be an inflammatory response that is too big and goes on for too long, turning from helpful to hurtful.

Vagus nerve stimulators have been implanted in patients for the treatment of epilepsy.

Stimulation of the vagus nerve can also tell the T-cells to stop making cytokines. Fewer cytokines means less inflammation. 

 

How does this work?

Dr. Staats told Medical Daily t hat patients can use a handheld device to stimulate the vagus nerve. The device is rechargeable and portable, designed to stimulate the vagus nerve on either side of the neck to improve airflow to the lungs and improve shortness of breath. It also could improve difficulty breathing related to asthma and reduced airflow due to COVID-19 infection. His research has demonstrated the effectiveness of the device to stimulate the vagus nerve which reduces the amount of cytokines leading to reduced inflammation .

 

How can we stimulate the vagus nerve?

Although there are several handheld vagus nerve stimulators on the market this particular handheld device, called gammaCore Sapphire CV, has received emergency use authorization from the FDA. It has received EUA to help treat patients who have difficulty breathing due to Covid-19. 

Yvonne Stolworthy MSN, RN graduated from nursing school in 1984 and has spent many years in critical care and as an educator in a variety of settings, including clinical trials.  Currently she is applying her nursing knowledge to health care journalism.

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