Speaker 1: (00:00)
One of the biggest mysteries of the COVID-19 pandemic has been the phenomenon of long COVID months after infection people with lingering COVID symptoms known as long haulers have struggled to regain their health and while patients and doctors alike were initially baffled by these long-term symptoms. A lot has been learned since they were first recorded in patients early in the pandemic. Dr. Lucy Horton is an infectious disease specialist at UCLA. Who's seen the toll long COVID can take on the body. She runs a clinic that specializes in post COVID care and joins us now, Dr. Horton.
Speaker 2: (00:36)
Welcome. Thanks so much for having me,
Speaker 1: (00:38)
Do we know now why some people are afflicted with long COVID as opposed to others?
Speaker 2: (00:43)
It's really a great question. And I think it's one of the biggest challenges that we're facing is we still don't have a great sense of what predisposes some people to developing long. COVID. What we do know is that people who tend to have more symptoms during their acute infection tend to go on to develop long COVID, but there's so much left to be learned.
Speaker 1: (01:07)
Um, have you been seeing with your patients? I mean, what kinds of treatments work really?
Speaker 2: (01:12)
The treatments that work best are those that targets specific symptoms that patients are having. Um, for example, patients who may have developed asthma, like symptoms respond well to asthma medications, patients who have difficulty with their heart rate and blood pressure also known as autonomic dysfunction, they may respond well to medications, specifically targeting that symptom in general, what we think really works best. And what we've seen in our patient cohort is rehabilitation is really kind of the bus, um, that can take the form of pulmonary rehab, physical therapy, even cognitive retraining.
Speaker 1: (01:55)
Is there any kind of consensus as to what factors lead to long-term COVID symptoms?
Speaker 2: (02:00)
That is really such a great question. And it's an active area of research right now, the underlying pathophysiology or mechanisms driving along COVID are still unknown, but we do know that people with long COBIT tend to have ongoing abnormalities in some of their immune and inflammatory responses, similar to what may be seen and chronic viral infections. Um, we know that there is what we call endothelial dysfunction or disruption of the barrier of blood vessels, and that probably contributes to many of the symptoms as well. But I think the majority of us think that it's probably multifactorial and that there's many different things at play leading to all of these different symptoms, how
Speaker 1: (02:49)
Patients emotionally processed having to deal with these symptoms for an extended period of time.
Speaker 2: (02:55)
It's really challenging. Many of the patients are facing a lot of emotional distress. Many of them have almost PTSD like symptoms because they've really had a traumatic experience dealing with the chronic illness and the way that it's really impacted their lives. So caring for a patient with long COVID, it's really important to understand kind of their psychosocial stressors and offer them, um, that type of therapy and emotional support resources.
Speaker 1: (03:28)
Is there any sense that long haul COVID symptoms will one day go away
Speaker 2: (03:32)
Optimistic that the majority of patients will have a meaningful recovery based on what we know of other kind of chronic post viral syndromes from other types of viruses, but in reality, we just don't know for sure. And we know that some patients have had symptoms now for the better part of a year and a half with not a lot of recovery. And so there probably will be some who continue to have symptoms for the rest of their life, but since this is such a new virus, and we've only known it for less than two years, it's really hard to say,
Speaker 1: (04:08)
Do we know what percentage of patients infected with COVID end up suffering from long-term symptoms?
Speaker 2: (04:13)
It's roughly 10 to 30%. And it tends to be more in patients who actually had milder COVID, who were not hospitalized, who are not in the ICU.
Speaker 1: (04:26)
Does vaccination lower the chance of long haul symptoms at all
Speaker 2: (04:30)
Really wonderful question. And there's some emerging research that vaccination may help prevent long COVID. There was recently a study published in the Lancet journal of infectious diseases, uh, where they were actually looking at, um, how vaccine would prevent, uh, breakthrough infections. But what's interesting is, um, in monitoring the patient cohort, they track them out to a month after their infection. And they did find that those who were fully vaccinated, so had received both doses of the MRNs vaccine, uh, were less likely to still have symptoms after a month. So that's suggestive that the vaccine does in fact help prevent development of long COVID.
Speaker 1: (05:16)
Okay. Does it have any role in the treatment of long haul COVID
Speaker 2: (05:20)
This is again something that we're just getting kind of preliminary, um, evidence of now, um, there's some emerging, um, studies coming out, um, showing that, um, those who receive vaccination that had a higher chance of having complete remission of their symptoms about almost twice, that, of those who are unvaccinated,
Speaker 1: (05:45)
How has our, our understanding of how COVID can affect the body longterm, uh, changed since the beginning of the pandemic,
Speaker 2: (05:54)
He knows so much more about the, of symptoms. I think, um, we're better able to diagnose it better able to understand who may benefit from specific therapies. Um, we're learning that COVID seems to unmask, um, other conditions. And so we're seeing a lot of our patients now being diagnosed with things like asthma or reflux or apnea. So we're able to, um, look for and ask the right questions to understand, um, the whole range of symptoms that patients are having. Um, and I think we know a lot more too about, um, the role that rehab and therapy can play, um, in this condition. But honestly, I still think we're at the tip of the iceberg in terms of, um, the full knowledge and understanding of long COVID.
Speaker 1: (06:47)
I've been speaking with Dr. Lucy Horton and infectious disease specialist at UCLA health. Dr. Horton. Thank you very much for joining us.
Speaker 2: (06:55)
Thank you so much.
