How Long COVID Impacts Healthcare Workers

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 the AOHP webinar.

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 …read more

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