Some health care providers in Arkansas are starting to offer services tailored to patients struggling to recover weeks or months after being diagnosed with covid-19.
An estimated one in five covid-19 survivors between 18 and 64 years old and one in four survivors 65 and older have a health condition related to their illness, according to a study released this year by the federal Centers for Disease Control and Prevention, which included 63.4 million individuals.
Another 2022 study published in the Journal of Infectious Diseases estimated millions of Americans -- about 1.7% to 3.8% of the U.S. population -- experienced new, long-term symptoms that limited daily activities one month or longer after covid-19 infection.
"Because the coronavirus can attack the lungs, heart, brain and other organs, there can be lasting internal damage," said Sheena CarlLee, director of the University of Arkansas for Medical Sciences' Long Covid Clinic, which opened Aug. 25 in Fayetteville.
Damage to vital organs can exacerbate long-term health problems such as heart disease, diabetes, kidney disease, blood disorders, neurological conditions and mental health disorders.
The new UAMS clinic brings together specialists in order to treat patients across the breadth of symptoms.
"We are seeing patients with a wide variety of symptoms that require a unique treatment regimen," CarlLee said. "Our long covid clinic offers extensive evaluation from a team of students and trained health care providers from the disciplines of medicine, pharmacy, nursing, physical therapy, occupational therapy and radiation sciences."
Some of the most successful long covid clinics in the country are team-based clinics, which can dive into a variety of symptoms and devise a detailed plan, according to CarlLee.
The clinic team also works closely with researchers at the UAMS campus in Little Rock, and patients may opt in to participate in that research, she said.
UAMS bills through insurance, and the cost for patients at the long covid clinic will be the same as a primary care clinic visit, according to CarlLee.
CarlLee, a UAMS internal medicine doctor, and other doctors at various UAMS campuses have seen former covid-19 patients with prolonged symptoms related to the infection, she said.
Sometimes long covid symptoms develop for people who had little or no symptoms upon their initial positive test, but long covid tends to affect those who had a more complicated initial infection, she said.
Based on recent research, people who stayed in the ICU, were put on a ventilator, are unvaccinated or have underlying medical conditions all seem more likely to develop long covid, according to CarlLee. Women also may be disproportionately affected, she said.
Long covid is still being defined by the scientific community, according to health officials, but it generally signifies new or lingering symptoms of the virus occurring at least three or four weeks after a positive covid-19 test.
Because the term has yet to be precisely defined, data varies on the condition's prevalence, said Jennifer Dillaha, director of the Arkansas Department of Health.
The symptoms and conditions associated with long covid, which will likely affect many people in the coming years, are consistent throughout the scientific literature, Rachel Levine, U.S. assistant secretary for health, wrote last month in the Journal of the American Medical Association.
Symptoms such as shortness of breath, muscle aches, cough, fatigue, loss of taste or smell and problems with memory and concentration are among the more common symptoms. Heart palpitations, dizziness, diarrhea, stomach pain, rashes and joint or muscle pain have also been experienced post-covid, according to the federal Centers for Disease Control and Prevention.
Long covid isn't a singular case of long-term symptoms developing from viral infections, according to Dr. Marti Sharkey, Fayetteville's city health officer. Epstein-Barr virus is the cause of infectious mononucleosis, more commonly known as mono, she noted.
"It's not unusual to see prolonged systems. It's not surprising with a virus that has infected so many people," she said.
PATIENTS YOUNG AND OLD
In Central Arkansas, the Strong Hearts Rehabilitation Center by Arkansas Heart Hospital offers a rehab program for long covid patients at facilities in Little Rock, Russellville, Conway and Bryant.
The center enrolled its first post-covid patients in January shortly after the U.S. Centers for Medicare and Medicaid Services issued guidance allowing programs to treat lingering symptoms of the disease, said Amanda Xaysuda, director of the center.
"We had all of that planned before then but once Medicare was paying for that and more research was coming out that it was beneficial in this patient population, that's when we decided to go for it," she said.
Strong Hearts Rehabilitation Center's program focuses on pulmonary rehabilitation. Health care providers with the center help patients build their exercise tolerance and work on breathing exercises.
"Everything else we do is focused around the patient and what symptoms they are coming in with," said Xaysuda.
The program has helped post-covid patients dealing with postural orthostatic tachycardia syndrome, an abnormal spike in heart rate that occurs after sitting up or standing.
While the program's oldest patients have been in their 90s, the youngest was 16. Many patients are in their 30s and 40s, a demographic the Strong Hearts Rehabilitation Center isn't used to seeing.
"What we've always done is traditional cardiac rehab. Typically, our patients are Medicare age. They're 65 and older," said Xaysuda. "This is a whole new population of people."
Although Medicare and some private insurance companies cover pulmonary rehab for post-covid diagnoses, Xaysuda said Arkansas Blue Cross Blue Shield does not.
Other large Arkansas health care providers do not offer specialized clinics like the ones provided by UAMS and Arkansas Heart Hospital.
In a statement Thursday, spokesman Joshua Cook said CHI St. Vincent does not have a clinic dedicated to long covid treatment.
At Baptist Health, the prevalence of long covid is not high enough to warrant a specialty clinic, said Dr. Amanda Novack, medical director of infectious diseases in a statement Friday. Primary care physicians with Baptist Health nevertheless work with long covid patients to create personal care plans.
"These treatments might include specialized treatments such as physical therapy, nutritional support, cardiac or pulmonary rehabilitation," said Novack in the statement.
Sharkey, the Fayetteville city health officer, said preventing transmission should still be a goal of the community.
"Every time we get infected with this virus, there's another risk for long covid. Just because you haven't had long covid doesn't mean you won't," she said. "We have people who got covid on the first wave in winter of 2020 that are still suffering.
"We're definitely a lot better than where we were a year ago, but we're not at the end yet," she said.
Sharkey recommends people experiencing long-term covid symptoms visit a clinic with a team-based multidisciplinary approach, like the UAMS clinic.
"You need a team approach to assess multiple organ systems and have a very tailored approach to the symptoms of the person," she said.
Getting vaccinated will help fight transmission of the virus, Dillaha said.
"I'd encourage people to get primary vaccination doses, followed by at least one booster dose. Take reasonable steps to avoid getting infected. Especially if you're at high risk for severe illness," Dillaha said.
Dillaha worries people, especially parents, are not informed about long covid and do not consider the risks of infection when deciding whether to get themselves or their children vaccinated.
Even with mild symptoms, people should still get tested for covid-19, because they may be eligible for treatment with Pfizer's anti-viral drug Paxlovid and be able to minimize the risks of infection, according to Dillaha.
Arkansas' death toll from covid-19 topped 12,000 Tuesday. Nationally, more than 1 million people have died as a result of covid-19 infection, according to the centers.