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Redefining Covid-19: Months after infection, patients report breathing difficulty, excessive fatigue - CNN
Sep 13, 2020 3 mins, 25 secs
"If doctors just say 'We don't know,' it's better than saying Covid symptoms only last two weeks."

Many hospitalized for Covid-19 at risk to become 'long haulers'

About three-quarters of those hospitalized for Covid-19 could become long haulers, according to a paper uploaded to the pre-print server medRxiv on August 14 without having yet been vetted by outside experts or accepted for publication.

Researchers from the Academic Respiratory Unit of the North Bristol NHS Trust in the UK looked at 110 Covid-19 patients, whose illnesses required hospital stays for a median of five days between March 30 and June 3.

Twelve weeks after patients were released from the hospital, 74% of them reported symptoms, including breathlessness and excessive fatigue.

Despite these symptoms, however, 104 of the 110 patients in the study had normal basic blood test results, with just 12% showing an abnormal chest X-ray and 10% showing restrictive lung function through spirometry tests.

The British Medical Journal released new guidance for health providers in August on how to treat long-haul Covid-19 patients, estimating that up to 10% of all people who have tested positive could develop a prolonged illness.

"For the patients I have followed, many continue to complain of cough, breathing issues and severe fatigue long after their first infection."

Long haulers and dysautonomia

One of the key issues in caring for each long-haul Covid-19 patient is to figure out how many of their symptoms can be chalked up to the heart and lungs and how much of the illness is actually the result of a deeper form of neurological dysfunction the coronavirus has unspooled, according to Noah Greenspan, a New York-based physical therapist and founder of the Pulmonary Wellness Foundation.

Before engaging in physical or respiratory therapy, he asks that all his patients get a full workup from their doctor to rule out a cardiac condition, stroke or pulmonary embolism before starting physical therapy.

Some patients' symptoms are mild and can start a more traditional rehab plan, he said, "but there are others, which are turning into the biggest group of people, which are these long haulers."

The primary trend across the Covid-19 long haulers that Greenspan is working with is a condition called dysautonomia, a condition marked by a miscommunication between the autonomic nervous system and the rest of the body.

The autonomic nervous system regulates automatic body functions such as breathing, sleep and digestion.

"It's a twisted ball of yarn and takes a week to unravel one string."

While shortness of breath and cardiovascular problems do present in his patients, Greenspan said, these are not usually the most common underlying cause of their misery.

Gahan and others with long-haul Covid-19 symptoms face a condition called postural orthostatic tachycardia syndrome, which refers to a sharp rise in heart rate that occurs when moving from a reclining to standing position.

That diagnosis requires at least six months of symptoms, a benchmark most long haulers haven't yet reached.

For many, lung damage not the biggest issue

Many Covid-19 patients feel that the medical system is gaslighting them, telling them there's nothing wrong even though their whole lives have been upended by Covid-19's aftermath.

Corey Coopersmith, a 36-year-old fitness consultant in Las Vegas, hasn't been able to work since first getting sick in late February.

"Your blood work looks like someone about to get AIDS."

A mixed martial arts fighter in his 20s, Coopersmith was in great shape when he contracted Covid-19 in February, boasting of a resting heart rate of 58 beats per minute.

Now though, when he wakes up in the middle of the night to go to the bathroom, POTS can drive his heart rate to 200.

To make it possible to sleep under his new constraints, he bought a continuous positive airway pressure machine, a device with a face mask that pushes oxygen into his lungs.

"I lie there gasping for air, fighting for life," he said.

For many, lung damage not the biggest issue

Coopersmith is one of many Covid survivors trying to grasp why he feels so breathless even though his lung function is excellent.

"I feel like my lungs have recovered quite well," Gahan, the clinical psychologist in the UK, said.

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