About 20%-30% of people who have had symptomatic COVID-19 develop post-COVID syndrome, health experts say. Show What is this exactly? Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases had this to say during a recent interview with The Washington Post's Robert Costa: "Namely, they no longer have the virus in them, they can't infect anybody, but it takes them anywhere from weeks to months – and maybe even beyond – to feel perfectly normal," he said. "They have a constellation of symptoms and signs that seem to be consistent when you talk to different people." The most common symptoms of post-COVID syndrome include extreme fatigue, shortness of breath, difficulty regulating body temperature, sleep disturbances and problems concentrating on daily tasks. These "long-haulers," as they are often dubbed, describe having no energy, aching constantly, and feeling like they are in a constant brain fog. The symptoms are debilitating enough to make even the most basic activities difficult to perform, according to Harvard Health. There is currently an ongoing long-term study to better understand why certain people develop this syndrome and others do not. Previous research has shown that anywhere from 50%-80% of COVID-19 patients can have lingering symptoms up to three months after onset of the infection. Dr. Fauci and other health experts theorize that people who are left with lingering symptoms without any detectable damage in the body may develop myalgic encephalomyelitis/chronic fatigue syndrome. Chronic fatigue syndrome is a disorder that causes extreme fatigue that lasts for at least six months and doesn't improve with rest. People with this disorder often don't have any underlying medical conditions that could otherwise explain the symptoms. Other possible theories for why COVID-19 symptoms cause more long-term symptoms include low level of inflammation in the brain, decreased blood flow to the brain, or an autoimmune condition where the body attacks itself. Penn Medicine has a Post-COVID Assessment and Recovery Clinic to help assess and provide resources for patients recovering from COVID-19. The clinic is open to all patients post-COVID. Find out more information here. COVID-19 symptoms, including fever, can start anywhere from 2 days to 2 weeks after exposure to the virus. Fever is one of the ways your body tries to fight off infection. For that reason, it’s a common symptom of COVID-19, which typically gets reported by those who have it. However, not everyone who gets COVID-19 will develop a fever. According to the CDC, you have a fever if your temperature is 100.4°F (38°C) or greater, no matter what the cause. Read on to find out about fever as a symptom of COVID-19 and other symptoms that require medical care. In addition to being new, COVID-19 has often been unpredictable. As common a symptom as fever is, there is no definitive temperature range for this condition. Some people who test positive never run a fever. Others spike very high fevers. A large review of multiple studies across nine countries observed 24,420 adults with COVID-19, and 78 percent ran a fever at some point during their illness. A later review of studies involving 17,515 adults and children with COVID-19 uncovered similar results. Of all the adult participants, 79.43 percent ran a fever during their illness. Low- and medium-grade fevers were also more likely to occur in this population than high fevers. Researchers also noted that fever was less likely to occur in children, especially during the early days when symptoms begin. They found that 45.86 percent of 373 children in China experienced fever. The authors conclude that over 50 percent of children under 18 years old with COVID-19 presented without fever. Despite the lack of a specific temperature range, it is clear that fever can indicate serious illness. The majority of hospitalized COVID-19 patients have fever as a symptom. However, running a high fever does not mean you will have a serious outcome. A study involving over 7,000 COVID-19 patients in the New York City area found that initial high fever upon hospital admission did not correlate significantly with death. However, persistent high fevers throughout the course of illness were significantly correlated with death due to COVID-19. People whose fevers spiked to 104°F (40°C) or higher had a mortality rate of 42 percent. This same study found that abnormally low body temperatures were associated with the poorest outcomes. Those with a body temperature under 96.8°F (36°C) had the highest death rates. These findings may indicate that problems with body temperature regulation are a marker of serious COVID-19 cases. Fever can be an indication of many illnesses, not just COVID-19. However, if you have any COVID-19 symptoms and may have been exposed to the virus, speak with a health professional immediately. There are medications and treatments that can help reduce the possibility of serious disease. If you run a temperature of 100.4°F (38°C) or greater, get tested. Early testing can help ensure better outcomes. No matter what the possible cause, high fevers such as these should always prompt a call to a health professional:
COVID-19 does not have a temperature range associated with it. People with COVID may spike high fevers or have no fever at all. Very high fever is associated with higher mortality rates among people with COVID-19. Too-low body temperature can also be indication of serious COVID-19 disease. If you had COVID and were double vaccinated you may not need a booster Research suggests COVID infection plus vaccination provides the strongest protection against a wide range of variants, possibly for a long time. Doctors at UT Health Austin have been trying to solve the puzzle of why some COVID-19 patients remain sick for months or now years. Since last July, people who have what some call long COVID or long-haulers COVID have been treated at a post-COVID-19 program at UT Health Austin, the clinical arm of University of Texas Dell Medical School. "Now, we've learned a lot," said Dr. W. Michael Brode, the medical director of the post-COVID-19 program. People who continue to have symptoms from COVID-19 long after the initial infection fall into three categories:
"This third group the medical community doesn't know what to do with," Brode said. More: 'I'm 29 years old and I feel like I'm 70': Long COVID patients continue to struggle for months, years Their common complaints often are fatigue similar to chronic fatigue syndrome and brain fog. They also might have shortness of breath, rapid heart rate, dizziness because of changes in blood pressure, problems with digestion, trouble regulating their body temperature and difficulty sleeping. A common phenomenon is post-exertional malaise, in which they actually get worse after physical or mental activity. People also can experience food allergies or sensitivities that they have not had before, or they might have rashes. Some people also experience heightened anxiety or new anxieties. Brode said that, while long COVID can happen to anyone, there are some definite groups of people that it seems to happen to more often: otherwise healthy women in their 30s and 40s; men in their 40s and 50s; and teenagers. We still don't know how long these symptoms will last, Brode said. "We have people who were sick in March and April of 2020 who are not fully recovered," he said. The program is now seeing about 150 patients. Treating long COVID: For when symptoms don't go away, Dell Medical School sets up clinic for 'long COVID' What happens in long COVID?COVID-19's effects are still being researched, but some clues can be found in previous viral outbreaks, as well as less talked about side effects that can come after any virus. "In some ways, I'm becoming a student of history," Brode said. "This clearly happened after the 1918 Spanish flu and the 1890s flu." Long COVID is the body's reaction to the COVID-19 virus, which is a systemic disease that invades everywhere. COVID-19 is happening in the vasculature — the body's arrangement of blood vessels. Because COVID-19 is new, it's a disease that the body doesn't recognize to know how to handle properly. Researchers have looked at skin biopsies in people with long COVID and found small fiber neuropathy, or damage to the smallest nerves in the body. Those nerves regulate the body's sensory perceptions. These same small nerve cells also are found in the nose, the ears, the heart and lungs, which is why such COVID-19 symptoms as loss of smell, difficulty with balance, rapid heart rate or shortness of breath might continue. Unlike people who had severe COVID-19 and were hospitalized and on ventilators, people with long COVID don't have damaged lungs or damaged hearts, at least not that shows up on tests, Brode said. It could be that current tests aren't good enough to detect the small fiber damage, he said. Instead, the people who have long COVID might not have anything wrong with their lungs or heart, but the autonomic nervous system thinks they do. It's like the body is still sending signals that it's experiencing the virus and needs to react, triggering rapid heart rate and shortness of breath. Choosing the right mask: N95, KN95, KF94, surgical: Know the types of masks and why cloth masks are out for omicron Treating variant by variant for long COVIDRight now, the Austin program is working with people who were infected in the first three waves, through the delta variant. It is too early to treat people who got the omicron variant because the center typically starts working with people who have had symptoms for at least three months. Brode has not seen any difference between people who were infected with the original coronavirus and people infected with the delta variant. He suspects in a few months he won't see a difference in people infected with omicron compared with delta or earlier variants. "It's hard to prognosticate," he said, but the hope is that there might be less long COVID with omicron because of the number of people who have been vaccinated. Vaccination tends to reduce the symptoms of the virus in a breakthrough case. The hope is that, if the COVID-19 virus is a trigger for long COVID, perhaps the vaccine can help protect against that, "but it doesn't bring it to zero," he said. He estimates that right now about 4% of people who have had COVID-19 fall into the third category of people and will have long COVID. His hope is that with omicron, it might get to as low as 1% for people who had that variant. How you can help: 'Scary' need for blood with COVID-19 omicron surge, Austin growth outpacing donations How doctors are treating long COVIDAt first, doctors were treating each symptom to try to ease those. Now, they are leaning on treatments that have worked for chronic fatigue syndrome or dysautonomia — when your body can't regulate its autonomic nervous system. Some antidepressant medications that are more stimulating have been shown to be helpful with fatigue and anxiety. It also helps with inflammation in the brain. Doctors are prescribing physical therapy, but not standard courses in which you push through to build up strength. New protocols have been written to provide physical therapy designed for people with post-exertional malaise. That means slowly getting moving again. "I have not met anyone who pushing through that wall is effective," Brode said. "In all scenarios, it makes it worse." Doctors also can prescribe mental health therapy to help with the long-term effects of having a chronic illness. Much of the other therapies are about treating the symptoms. Melatonin two hours before bedtime is suggested for people who are having difficulty sleeping. For people who lost their sense of smell, nasal steroids and smell therapy can help regain that sense. People with daily headaches are offered medications. There have yet to be targeted therapies specific to long COVID, but Brode is hopeful there will be and that the post-COVID program at UT Health will be able to participate in clinical trials for those. Understand the surge: If the omicron variant is a less severe strain, why are Texas hospitals filling up again? What to do if your COVID-19 symptoms lingerMost lingering COVID-19 symptoms will start to get better within four to 12 weeks after the initial infection. See your primary care physician if they are getting worse, there are new symptoms, or it's been four weeks without improvement. Treat the symptoms by doing such things as using over-the-counter cough medicine for cough or acetaminophen for headache. If you're experiencing gastrointestinal issues, try smaller meals more often and stay hydrated. If you are dizzy when getting up, get up slowly to allow your blood pressure to adjust. Brode said he has seen a lot of people in the hospital after COVID-19 because they have fallen. If it's exhaustion or brain fog, don't try to push through it and do too much; that can make symptoms worsen. Take frequent breaks and slowly build back up to your usual level of activity. "I think this is a time to really listen to the body, give yourself some grace and just rest when your body says so," Brode said. But if you're having trouble getting back to your usual activities, physical therapy from someone who knows how to treat people after COVID-19 is important, Brode said. If things haven't improved by three months, ask for a referral to the post-COVID program. For patient resources and more information about the post-COVID program at UT Health Austin, visit uthealthaustin.org/clinics/services/post-covid-19-program or call 1-833-882-2737. |