20Mar

The latest on treatment and recovery

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RALEIGH, N.C. — For many people, a case of COVID-19 lasts a week or two. For millions of adults, though, symptoms stick around for weeks, months, even years. Long COVID is associated with more than 200 symptoms that return or persist more than four weeks after initial infection, including neurological, respiratory, gastrointestinal and cardiovascular complaints.

“Long COVID remains a major health issue,” says John M. Baratta, MD, founder and co-director of the UNC COVID Recovery Clinic. “We see people who are unable to work at their prior level. They’re unable to do household activities, including caring for their families. Millions of people are kept from the activities they need or want to do because of these persisting symptoms.”
Dr. Baratta says data released from the Centers for Disease Control and Prevention in February 2024 shows that 17 percent of U.S. adults have experienced long COVID at some point, with 7 percent of adults reporting still having symptoms.

In the years since the start of the COVID-19 pandemic, researchers have learned more about long COVID. Dr. Baratta shares some new insights into the condition and best practices for treatment.

Investigating possible causes of long COVID

Long COVID affects people differently, which makes research difficult. Though it’s not always clear what causes symptoms to persist in some people, researchers are continuing to investigate the effect of the virus on the body’s immune system.
“Research has shown that long COVID could be caused by prolonged inflammatory and autoimmune response and lingering presence of the virus,” Dr. Baratta says. “When the UNC COVID Recovery Clinic opened, we primarily treated patients based on their symptoms and offered symptom relief, but now we’re transitioning our approach to treat those underlying causes.”

A low dose of the drug naltrexone, for example, typically used for substance addiction, may reduce the inflammatory responses that cause long COVID symptoms. This treatment previously has been used for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a condition that has significant symptom overlap with long COVID.

“Not everyone with long COVID has ME/CFS, but about a third of the patients we see in our clinic do meet the criteria for ME/CFS,” Dr. Baratta says.

Diagnostic criteria for ME/CFS include significant fatigue for six months, post-exertional malaise (fatigue that worsens after mild activity), poor sleep and cognitive issues such as brain fog.

“The treatment will be similar for these patients,” he says, “but a diagnosis of ME/CFS can have implications for recovery and ability to return to work. A person with ME/CFS will likely have a slower recovery time.”

Risk factors for long COVID include a severe case of COVID-19 and a preexisting health condition, such as heart disease, lung disease, diabetes or autoimmune disease. Women are more likely than men to experience long COVID by a ratio of about 3-to-1, Dr. Baratta says. Still, anyone is at risk for long COVID.

Current treatment for the most common symptoms

People with long COVID may experience a variety of symptoms, including cough, smell and taste issues, headaches, difficulty sleeping and gastrointestinal issues, but Dr. Baratta says the most common symptom is debilitating fatigue.
“We work with patients on energy conservation techniques so that they can limit when they expend energy,” he says. “We’ll usually recommend a physical activity program, like physical therapy, so that they can build endurance. Then, we’ll evaluate whether some medications can help boost their energy levels.”

A similar approach is used for addressing brain fog, or difficulty thinking and focusing.

“There has to be some patient education and guidance on how to make adjustments and manage expectations,” Dr. Baratta says. “Then, there are rehab activities that are similar to what people do after a stroke, such as cognitive rehab with a speech language pathologist. Some medications can help focus attention.”
People also commonly report difficulty breathing after a case of COVID-19.

“We’ll look for other medical problems that might be causing breathing issues, but many people will need a breathing exercises program because their breathing pattern changed while they had COVID,” Dr. Baratta says. “The person may be taking short breaths and hyperventilating without realizing. They can be trained to take slow, deep breaths.”

Dr. Baratta says that with time, many people’s long COVID symptoms can improve or go away.

“The recovery time is variable, and we don’t have a good understanding of why,” Dr. Baratta says. “Some patients recover in a few months; some patients have been treated by our clinic for more than three years and will continue to be seen for the foreseeable future.”

New cases of long COVID are less severe

One piece of good news about long COVID: New cases are less severe than they were in the early years of the pandemic.

“The combination of immunity from vaccines and immunity from prior COVID illness has been helpful,” Dr. Baratta says. “The increased immunity means that we see less-severe acute COVID-19 and less-severe cases of long COVID.”

Although the cases may not be as severe, the combination of new and existing cases indicate long COVID will continue to be a public health concern in the years to come.

“We still see many new cases, including patients who are unable to work,” Dr. Baratta says. “Long COVID is not going away, and many people will need long-term specialized care. This need speaks to the importance of new research happening at UNC and nationally.”

The National Institutes of Health’s Researching COVID to Enhance Recovery (RECOVER) Initiative is conducting research into long COVID through a variety of projects, including several studies at UNC.
“UNC is participating in a study to see if treating patients with an extended course of Paxlovid could cause symptom improvement, based on the suggestion that long COVID is caused by the virus persisting in the body,” Dr. Baratta says. “UNC is also involved in studying the trajectory of long COVID symptoms over time in patients.”

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