Managing COVID-19 Long-Haulers in Barrie, What’s Our Plan?
"You might want to read this,” my wife Michelle offered over our morning coffee last weekend.
“What is it?” I asked.
"There’s an interesting article in the CBC on the post-COVID symptoms that you’ve been talking about. According to the article, 1 in 3 people with COVID can go on to develop post COVID symptoms. They’re calling themselves, “Long Haulers”. Haven’t you been looking into this?”
I had been -especially in the aftermath of a wide-spread outbreak at Roberta Place and the increased risk for community spread with the new B117 variant.
I suspected that our clinic would be a likely target for those suffering from persistent post-COVID symptoms, especially for those looking for targeted IV therapies. Sure enough, this past week, we saw our first post-COVID patient, shortly after she was cleared from public health.
In communicating with the Simcoe-Muskoka District Health Unit (SMDHU), it’s clear that we will need a coordinated effort in order to manage these patients.
A recent study published in the Annals of Internal Medicine found that one-third of patients with COVID-19 continued to suffer persistent symptoms. (1) Symptoms can include cognitive impairments described as persistent ‘brain fog’ (similar to the patient in the CBC exposé), headaches, severe fatigue, muscle and joint pain, paresthesias or tingling, shortness of breath, exercise intolerance, chest pain, anxiety, depression, elevated heart rate (tachycardia) and other cardiovascular issues. (2)
The patient I saw this week started developing tachycardia (heart rate >100 bpm) after the acute phase had subsided, in addition to severe fatigue, persistent headaches, nausea, and anxiety.
What’s concerning is that this constellation of multisystem disease symptoms can arise even after a relatively mild acute exposure. (3)
As confirmed cases of COVID-19 reach 100 million globally (4), the aftermath of this post-COVID disease will be catastrophic to already overburdened healthcare systems. These consequences are further magnified when the number of mild undiagnosed cases are also considered.
At the present time, there is no community support for “Long-haulers”.
So what’s our plan?
I reached out to Mayor Jeff Lehman early this week. No response, thus far. I’ll be reaching out to MPP Andrea Khanjin next.
In the meantime, we’ll continue to push forward with treatment and research in an effort to help alleviate pain and suffering.
The good news is the patient we saw this week has thus far, responded favourably to care. Of note was a significant reduction in her elevated heart rate by the time her IV had completed. Fatigue is slowly lifting and mood is improving. All good signs.
There are certainly more questions than answers at this point, but we’ve got to start somewhere.
Onwards and upwards Barrie -we can do this!
(1) Nehme M, Braillard O, Alcoba G, Aebischer Perone S, Courvoisier D, Chappuis F, Guessous I. COVID-19 Symptoms: Longitudinal Evolution and Persistence in Outpatient Settings. Ann Intern Med. 2020 Dec 8:M20-5926. doi: 10.7326/M20-5926. Epub ahead of print. PMID: 33284676; PMCID: PMC7741180.
(3) BMJ 2020;370:m3026