Talking long COVID with U of M
It’s been three years since the World Health Organization declared COVID-19 a global pandemic. While many aspects of life have returned to normal, some people are dealing with ongoing effects from their COVID infection — called "long COVID." According to the latest estimates from the Centers for Disease Control and Prevention, nearly 15% of all adults in the United States have experienced long COVID.
Farha Ikramuddin, MD, with the University of Minnesota Medical School and M Health Fairview, discusses the impact, treatments and current research on long COVID.
Q: What is long COVID?
Dr. Ikramuddin: Long COVID is a term used to reflect a group of symptoms which either persist or emerge following a COVID-19 infection. It’s unclear if this is unique to the COVID-19 virus. For example, chronic fatigue or other physical symptoms are known to follow influenza or other viral illness.
The most common symptoms are fatigue, headaches, shortness of breath and cognitive dysfunction. So far, no unifying mechanism has been identified to explain the emergence of the disease. Evidence does point to inflammation within the body.
Q: How does long COVID impact a person's daily life?
Dr. Ikramuddin: Long COVID impacts life to varying degrees, depending on the symptoms experienced and pre existing medical conditions. Long COVID patients experience debilitating fatigue that negatively affects their sense of well-being and quality of life. It affects a person's energy, motivation and concentration. Ultimately, this can lead to poor quality of life, inability to return to work or perform daily activities of life and compromised mental health.
Q: What treatments are available for long COVID?
Dr. Ikramuddin: The therapies to treat long COVID remain elusive. While many anecdotal treatments such as low dose naltrexone and Paxlovid remain without much evidence, the treatment of long COVID is based on ruling out other alternate diagnoses which may be exacerbating or contributing to the symptoms. Therapeutic options vary depending on the symptoms and should be customized based on history, comorbidities and treatment response to date.
Some dietary recommendations have been made for individuals with chronic fatigue syndrome, and similar dietary recommendations may be beneficial for long COVID-related fatigue. These include eating small portions every three to four hours, eating foods with more complex carbohydrates in order to support stable energy levels and eating a balanced diet including fruit, vegetables, fish, meat, dairy, nuts and beans. There is currently not sufficient evidence to support the use of specific nutritional supplements to help CFS including multivitamins, B vitamins, magnesium, essential fatty acids, carnitine or coenzyme Q10. Graded exercises while closely monitoring fatigue is important to prevent a vicious cycle of deconditioning.
Q: What work are you doing to advance research in this area?
Dr. Ikramuddin: I am currently in the process of recruiting patients to a “Diaphragmatic Dysfunction” study. The purpose of this study is to address diaphragmatic dysfunctional breathing seen in patients with long COVID, which results in shortness of breath, chest tightness and subsequent fatigue. Targeting shortness of breath and subsequent fatigue as a central symptom of long COVID will alleviate long term sequelae — or a condition which is the consequence of a previous disease or injury — for the patients. We have created a very unique intervention of physical therapy focusing on myofascial stretching and release of the diaphragm and other respiratory muscles. We will also be studying diaphragmatic excursion and quality of function.
Another study in the works would study the impact of Qigong as a treatment option for long COVID. Qigong is a part of traditional Chinese medicine and involves using exercises to optimize energy within the body, mind and spirit. We are driven by the fact that many long COVID patients are unable to participate in traditional physical therapy due to the severe fatigue and specifically ‘post exertional malaise’, the slow and purposeful movements of the Qigong exercise and the respiratory breathing will help alleviate these symptoms. We are utilizing the services of a local Qigong master here in the Twin Cities.
Q: What has surprised you the most clinically and from your research?
Dr. Ikramuddin: Long COVID can be disabling, however, the most surprising part is the resilience I see in my patients and their commitment to improve their lives. I am inspired by their advocacy to improve their health and others with long COVID symptoms. I am also surprised at how much patients have studied about the disease prior to meeting with the providers. Based on my own outcomes, patients with long COVID do get better and return to their previous lifestyles. Another element is that those who treat their mental health optimally tend to have better outcomes. I have never discharged anyone from my clinic who scored high in the scales indicating depression and anxiety. It is also important to mention that long COVID symptoms cause significant disability that it impacts the mental health of the patients. In our long COVID clinic at the University of Minnesota, we closely monitor the function and mental health concerns quantitatively, which I think is an important outcome to monitor.
In terms of our research at the university, the results of the neuropsychological testing in this population has always returned surprisingly negative. In another study, molecular analysis of the SARS-CoV-2 diseased autopsy of the pituitary showed presence of viral mRNA. These are important findings in our work against SARS-CoV-2 virus.
Farha Ikramuddin, MD, is an assistant professor at the University of Minnesota Medical School and M Health Fairview. Her clinical interests include stroke rehabilitation, neuro rehabilitation and spasticity management. Since the start of the pandemic, she helps lead the Long COVID clinic at the University of Minnesota and M Health Fairview. She is a member of the guiding council to the Minnesota Department of Health for Long COVID, and also member of the Long COVID collaborative for AAPMR.
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