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Opinion The Checkup With Dr. Wen: Three important studies shed light on long covid

A cardiologist talks to a patient with long covid during an appointment at Vital Heart & Vein in Humble, Tex., on March 7. (Mark Felix for The Washington Post)

You’re reading The Checkup With Dr. Wen, a newsletter on how to navigate covid-19 and other public health challenges. Click here to get it in your inbox.

One of the most puzzling and concerning aspects of the coronavirus has been the large number of cases in which symptoms persist for months or even years. Three years into the pandemic, we still have lots of questions about the condition known as long covid: What is it? What causes it? And how common is it really?

Three recent studies are helping provide answers.

A recent paper published in Nature Medicine attempts to divide the spectrum of symptoms into four groups: cardiac and renal abnormalities; sleep and anxiety problems; musculoskeletal and nervous system concerns; and digestive and respiratory system consequences.

Based on medical record reviews of long covid patients, researchers found patterns in these groups. For example, those with heart, kidney and other circulatory problems were more likely to be male, to have had severe covid requiring hospitalization and to have been infected during the first wave of covid in 2020. On the other hand, those with muscular pain and headaches were more likely to be female and had a higher rate of preexisting autoimmune conditions such as rheumatoid arthritis.

Given the many ways in which long covid can manifest, I think there is a benefit to this categorization. More research along these lines can better help us understand what predisposes some people to long-term consequences and which treatments would best support patients with different symptoms.

I also think long covid should be classified based on severity of symptoms. A persistent cough and intermittent headache should not be in the same category as debilitating fatigue and shortness of breath so severe that a previously active person can no longer walk a block. Some post-covid symptoms are a minor inconvenience; others have life-altering consequences.

Having standardized criteria for what constitutes mild, moderate and severe long covid could reduce the discrepancy in reports of vastly different rates of this condition. At the moment, the range is wide, from around 20 percent, as estimated by the Centers for Disease Control and Prevention, to around 3 percent, according to a large British study.

It’s also important to investigate the trends in long covid over time. A second paper, published in the Lancet, shows the incidence of long covid was lower during the omicron surge than in the delta surge. The difference was striking: People who contracted the coronavirus in the omicron wave were about half as likely to develop post-covid symptoms compared with those in the delta wave.

One possible explanation is that omicron, in addition to being less lethal than delta, results in a lower likelihood of developing long covid. Another possibility is that the incidence of long covid is reduced in people with prior exposure to the coronavirus through vaccination or prior infection. Either, or both, would be welcome news.

I’ve saved the most illuminating study for last: A nationwide study from Israel, published a few weeks ago in the British Medical Journal, found that among both children and adults who had post-covid symptoms, most were resolved within a year of diagnosis.

The researchers discovered this by comparing patients infected with the coronavirus with a matching group of individuals who shared their demographic characteristics but did not have covid. They found that those who recently recovered from covid reported more symptoms such as loss of taste and smell, cough, shortness of breath, palpitations, muscle aches and concentration problems.

Those differences between the two groups were prominent over the first six months, affirming the existence of post-covid symptoms. But by 12 months after diagnosis, the differences were mostly gone — meaning that most people who developed post-covid symptoms were back to their pre-covid health within a year.

To be sure, there are many patients who are suffering consequences from long covid years after their initial diagnosis. Often, these individuals have found little relief. Far more must be done to identify treatments — and, one day, a cure.

But just as we need to understand who exactly is dying from covid and not just with covid, it’s also crucial to get an accurate accounting of how many people have severe long covid. Resources should be concentrated on helping these individuals.

In the meantime, these severe and persistent outcomes should be categorized separately from the far more frequent occurrences of mild and temporary post-covid symptoms. Such information helps people decide the degree to which they continue to alter their lives to avoid the coronavirus.

Ask Dr. Wen

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“We are in our 70s and healthy. We are current on all vaccines. We’ve just started to venture out again as we’ve lost three years to accomplish our bucket list, which is significant at our age. I’m worried about getting access to Paxlovid if the need arises when we are out of the country. Our primary care physicians have declined to prescribe it just in case. I’ve found nothing by Googling that says this is prohibited. Why won’t doctors issue ‘just in case’ prescriptions for Paxlovid in circumstances such as these?” — Sharon from North Carolina

Physicians have different comfort levels when it comes to prescribing “just in case” medications. For example, some doctors will give antibiotics in case you develop bacterial strep or pneumonia; others want to wait until they can officially make the diagnosis.

The same goes for Paxlovid. If your doctor won’t prescribe the antiviral pill in advance of contracting covid, you should ask them what to do if you were to become ill while traveling out of the country. Would your doctor contact a local pharmacy? Will pharmacies where you are traveling carry Paxlovid, and will they honor your physician’s prescription? If not, is there an urgent care clinic you could go to in that country that could quickly prescribe it for you?

“I want to teach yoga and stress reduction and am not sure how safe it is to gather with a group and encourage breathing and stretching or breathing and meditation. I’m 73 and fully vaccinated and boosted. Should I ask members of my class to show proof of being vaccinated or take a test before entering a classroom? Or confine myself to only Zoom classes?” — Debra from California

The risk of covid transmission depends on your classroom. Is it large enough for students to spread out? Can you open the windows and doors and use an air purifier? These steps will reduce risk.

Also, are you primarily concerned about your students contracting covid, or do you want avoid infection yourself? If it’s the latter, you could wear an N95 mask during the class and stay distanced from the students. That, and improved ventilation, will protect you well.

If it’s the former, and some students are saying they won’t come unless the risk is reduced, then you could consider asking everyone to test the day of the class. Those concerned about getting covid should also wear a mask themselves. (At this point in the pandemic, proof of vaccination will not do much to reduce risk of infection.)

“How can I keep safe in a medical facility waiting room when others are taking their masks off? I recently decided to change test sites and even doctors to avoid medical facilities that allow maskless people in waiting rooms.” — Cynthia from California

Medical facilities should, ideally, continue to require masks in public spaces such as waiting rooms. If your medical office does not, there are three things you could do:

First, you could switch providers, as you mentioned. If that’s not an option, consider asking in advance when the office will be the least busy and try to schedule your appointment during the time where you have the best chance of being spaced apart from others in the waiting area. Most important, make sure to wear an N95 or equivalent mask whenever you are in public spaces. Consistently wearing a high-quality, well-fitting mask will protect you well, even if others around you are unmasked.

The Post has also compiled Q&As from my previous newsletters. You can read them here.

What I’m reading

Modeling research by the CDC forecasts that in the next 40 years there could be a nearly 700 percent increase in the number of young people diagnosed with diabetes. About 213,000 people under 20 had diabetes in the United States in 2017. The CDC projects this could increase to an “alarming” 526,000 young people by 2060. As CDC official Debra Houry said in a news release, “This study further highlights the importance of continuing efforts to prevent and manage chronic diseases, not only for our current population but also for generations to come.”

I liked this thoughtful study published in JAMA Internal Medicine that highlights the importance of sound, educational vaccine messaging. Researchers enrolled unvaccinated patients who presented at seven emergency departments in four cities. They used a three-pronged covid messaging strategy that included a four-minute video, a one-page informational flier and a brief scripted message by a physician or nurse. Those who received the three-part intervention were more than twice as likely to get the coronavirus vaccine compared with those who did not.

An analysis by the Commonwealth Fund found that the 26 states with abortion bans or restrictions had higher maternal mortality compared with states that did not. States with bans or restrictions had fewer maternity care resources, including birthing centers and OB/GYNs. In 2020, maternal deaths were 62 percent higher in abortion-restriction states than abortion-access states. The maternal mortality rate also increased nearly twice as fast in states with abortion restrictions across the three years of the analysis.