Coronavirus Long Haulers
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UCSF expert calls BA.5 variant 'a beast with a new
superpower' 7/5/22 COVID-19
'long haulers' need dedicated clinics, experts say
3/23/21 The United States should create multispecialty COVID-19 clinics dedicated to treating patients still experiencing serious multiorgan effects of infection well after recovery from acute illness, say the authors of a comprehensive review of literature on so-called coronavirus "long-haulers" published yesterday in Nature Medicine. The exact number of US long-haul COVID-19 cases is unknown, but the researchers said that many patients struggle in silence or become frustrated when their doctors don't consider that their symptoms could be related to their previous infection. Chest pain, fatigue, shortness of breath The review, led by researchers at New York-Presbyterian/Columbia University Irving Medical Center, found that the cell damage, inflammatory immune response, abnormal blood clotting, and other complications of acute COVID-19 infection can leave in their wake long-term symptoms such as chest pain, shortness of breath, "brain fog," fatigue, joint pain, and posttraumatic stress disorder, all of which can compromise quality of life. The researchers detailed literature from the United States, Europe, and China on high percentages of long-haulers, or those with chronic or post–COVID-19 syndrome, who often have debilitating symptoms for more than 3 months. COVID-19 has been associated with diabetes, strokes, heart rhythm abnormalities, blood clots in the lungs, and other complications. For example, an observational study of 488 COVID-19 patients released from Michigan hospitals after 60 days who completed a phone survey found that 32.6% had lingering symptoms, including 18.9% who reported new or worsening symptoms. The most common issues were shortness of breath while walking up stairs (22.9%), cough (15.4%), and loss of smell or taste (13.1%). Similarly, 87.4% of 143 COVID-19 patients released from a hospital in Italy reported persistent symptoms, including fatigue (53.1%), shortness of breath (43.4%), joint pain (27.3%), and chest pain (21.7%), with 55% still experiencing at least three symptoms a mean of 60 days after symptom onset. And a study from France of 150 survivors of noncritical COVID-19 found that two-thirds reported persistent symptoms at 60 days follow-up, with one-third saying they felt worse than they did when their acute coronavirus symptoms began. In China, 6-month post-acute follow-up of 1,733 COVID-19 patients found at least one lingering symptom in 76%, with fatigue/muscle weakness in 63%, sleep problems in 26%, and anxiety/depression in 23%. About half of 349 patients who underwent high-resolution chest computed tomography showed at least one abnormal pattern. All COVID patients vulnerable While long-haul syndrome often occurs in people with underlying health problems, it also affects previously healthy people, senior study author Elaine Wan, MD, said in a Columbia University news release. "I have seen young patients, weeks even months after COVID-19 infection, and they've suddenly developed new onset of heart racing, palpitations, and chronic fatigue," she said, adding that other patients report new chest discomfort or difficulty with decision making, memory, and concentration. Wan said that COVID-19 is the first infectious disease that she has seen that affects so many organs. "It's changed my clinical practice," she said. "No matter what the patient comes in for, I now ask if they ever had COVID-19 infection. It changes the possible range of diagnoses." Lead author Ani Nalbandian, MD, said in the release that she encourages potential long-haulers to insist on appropriate recognition and treatment. "Get in touch with your doctors even if you're not sure if your symptoms are lingering from your COVID infection," she said. "The situation is still fluid, and we're learning more every month." Physician cooperation with patient advocacy groups, sharing of data, and participation in longitudinal clinical trials are also essential, the authors said in the study. "Necessary active and future research include the identification and characterization of key clinical, serological, imaging and epidemiologic features of COVID-19 in the acute, subacute, and chronic phases of disease, which will help us to better understand the natural history and pathophysiology of this new disease entity," they wrote. Establishing long-haul clinics The researchers called for the creation of dedicated COVID-19 clinics, similar to those popping up in Italy, and prioritization of those at high-risk for long-term symptoms, such as those of advanced age or with severe acute infection requiring intensive care, pre-existing respiratory illness, obesity, diabetes, high blood pressure, chronic cardiovascular disease, chronic kidney disease, organ transplant, or active cancer. "It is clear that care for patients with COVID-19 does not conclude at the time of hospital discharge, and interdisciplinary cooperation is needed for comprehensive care of these patients in the outpatient setting," they wrote. One academic medical center, the Brigham Lung Center, recently opened the COVID Recovery Center for these patients, according to a Dana-Farber Cancer Institute news release. But doing so has been difficult because physicians are still attending to new coronavirus patients, Nalbandian said in the Columbia release. "Clinics could prioritize follow-up care for those at high risk for post-acute COVID-19 and those with the highest burden of persistent symptoms," she said. See also: Months After
Contracting Virus, 2 Women Suffer Crippling Effects Of 'Long
COVID' - NPR 3/21/21 For many Americans, the end of the pandemic feels just within reach. Millions have been vaccinated, and cases are declining nationwide, so it's easy to imagine a return to normal life. But for so-called long COVID patients, there doesn't seem to be a return to life as they knew it, at least not yet. These patients, many of whom are young with no underlying health conditions, contracted COVID and simply never got better. Months after getting sick, some still struggle with persistent fevers, brain fog, extreme fatigue and, at times, with skepticism from the medical community. Many have turned online to find other people going through the same experience. That's how Hannah Davis and Fiona Lowenstein met. They are both long COVID patients and met last year after Lowenstein wrote about her experience. Lowenstein formed a support and advocacy group for those living with long COVID, and Davis is a founding member of a Patient-Led Research Collaborative. They recently co-wrote an op-ed for The New York Times describing what they say could be one of the largest mass disabling events in modern history. And Hannah Davis is with us now. Hannah, welcome. HANNAH DAVIS: Thank you so much. MARTIN: And Fiona Lowenstein is also with us. Welcome to you as well. FIONA LOWENSTEIN: Thank you for having me. MARTIN: So I'm just going to start with your personal experiences with long COVID. I mean, many people have heard about it in the abstract, but they might not have met anybody who's been living with this. So I'm just going to ask each of you to tell us about your experiences. I don't know. Fiona, do you want to start? LOWENSTEIN: Yeah, sure. So I got sick very early on in kind of the pandemic's trajectory of hitting the United States. I live in New York City, and my first symptoms were on Friday, March 13. I believe I was infected by a friend who came over on March 10. And then a few days later, I developed a headache and a fever. For my first couple of days, those were the main symptoms I had. I had a little bit of cough. I had a fever. But, you know, as a young person - I was 26 at the time. I didn't have any serious pre-existing health conditions. I assumed that I would just be able to ride it out at home. And then it became clear that that was not going to be the case. I started to develop pretty severe shortness of breath. By March 16, I was too short of breath to, you know, walk, to talk. So I went to the ER on the 16th. I spent the night there. I was hospitalized the following day. And that's the reason that I was able to get a COVID test. I had tried previously calling, you know, everywhere in the city, and they weren't giving tests to people unless they had been exposed to someone who themselves had a confirmed test, so that was unhelpful. And then I spent just a couple of days in the hospital on supplemental oxygen. And then I was released after my, you know, shortness of breath seemed to be getting better and my fever was gone. And I got home and kind of assumed, OK, it might take - you know, I might be a little fatigued but assumed that recovery would be more or less around the corner. And then I started developing new symptoms. So the first issues were intense GI issues. And then there was the loss of smell. I started to have hives and rashes. I started to get a runny nose and a sinus pain and intense headaches that I think now were migraines. I had eye pain, light sensitivity. Over the course of the next, you know, two months, it was just these cycling symptoms that would come and go, and new ones would pop up. It was unlike anything that I had experienced before and totally unlike what I imagined. MARTIN: And so here we are a year later. Are you still having these things? LOWENSTEIN: So I'm one of the lucky ones in the sense that I have made an almost full recovery. I do still have some long-term symptoms. The most notable is that my menstrual periods have changed entirely, and they're very debilitating now. And I have a return of flu-like symptoms as well as fatigue and migraines and sometimes nausea and vomiting. And that's something I never experienced before COVID, but it is something that we see with a lot of long COVID patients and survivors who menstruate. MARTIN: Wow. LOWENSTEIN: And I also have some circulation issues. And my skin is not the same. It's very sensitive. I have new, you know, skin allergies. MARTIN: And none of that before? LOWENSTEIN: None of that before, no. No. MARTIN: That's crazy. OK. I'm sure there's yet more to say, but Hannah, what about you? DAVIS: So I got sick also in New York City on March 25. My first symptom was actually that I couldn't read a text message. I kind of thought I was tired. But then an hour later, I took my temperature and realized I had a fever. And for me, I had actually a primarily neurological manifestation of COVID. I had extremely intense brain fog. I had really bad memory loss, which I'm still struggling with today. You know, I forgot my partner's name. I just forgot people in my life. I forgot to look both ways when I was crossing the street. I almost got hit by cars multiple times. I, like, forgot how to use the bus... MARTIN: Wow. DAVIS: ...As well as kind of a nonstop low-grade fever just for months, something that continues to happen and come back. I have been diagnosed with post-viral dysautonomia, which includes a very high heart rate. Whenever I stand, my heart rate can go up to 140, 150 just by standing up, which makes activity difficult. And I've had, you know, fatigue, pain in my joints, sensitivity to light and noise, really bad tinnitus, insomnia, temperature regulation. I've had phantom smells, like smelling smoke and smelling, you know, meat. I've had a complete loss of feeling in my arms and various limbs. I've had kind of ongoing tremors and very, very severe headaches that thankfully have lessened in the past couple of months. MARTIN: Wow. DAVIS: But.. MARTIN: And none of that before COVID? DAVIS: None of that before COVID, no. That's the thing I think people don't understand, is, like, it's a very severe set of symptoms to have all of a sudden. MARTIN: So, Hannah, you were - we were saying earlier that you're a founding member of the Patient-Led Research Collaborative, which is a self-organized group of long COVID patients. Do you have a sense of how widespread this could be? DAVIS: Yes. There are a couple of small longitudinal studies. And one thing Fiona and I have been talking about alongside other patients like Nesrin Alan (ph) in the U.K. have - are - you know, we need to really count long COVID at a much larger scale. But the longitudinal studies that have been done point to numbers around 30%. (Editor's note: See Harvard Medical School that says 30-50%) MARTIN: Which is one of the reasons you say this could be one of the largest mass disabling events in history because there could be so many people affected by this. And I'm thinking the effects of this might be somewhat hidden because a lot of people still haven't gone back to offices. But, you know, one of the things you wrote about in the piece - you said one of the biggest issues has been getting doctors and family and friends to take these symptoms seriously. Fiona, why don't you take this one? Why do you think that is? LOWENSTEIN: Well, I think it's something that's actually been going on for people with chronic illnesses and autoimmune diseases and, you know, mysterious-seeming illnesses for a very long time. But I think the fact that COVID itself is new and information is still emerging on it, and initial media coverage really focused on, you know, the idea that there were really only two ways that this virus could manifest, that you would either have a mild case that you would ride out at home like a common flu, or that you would get really sick, and it would be potentially fatal, and you would have to be put on a ventilator. But the reality is that a lot of patients experience something in between. And we also have seen a lot of the early studies that focused on long COVID focused on only hospitalized patients. So there was also this mistaken understanding for a long time that it was only those patients who would have long-term symptoms. And that's part of the reason as well that I think patients are experienced gaslighting from clinicians and employers and family and friends. MARTIN: Well, also - something you said earlier I want to go back to - you said that one - another issue is the fact that some early COVID patients were never able to get tested. LOWENSTEIN: Yeah. MARTIN: How do you think this feeds into this whole question of not being believed? LOWENSTEIN: Well, there's so many issues there. I mean, to start with, even when we're talking about prevalence, we have all of these patients - you know, first wavers - who were not able to access testing because it just - testing capacity was limited, and we were being told to stay home. And so for those patients, they don't have on their record that they had a COVID infection. And by the time, you know, things settled down in the area that they were able to access care, or by the time they realized they really weren't getting better, it was hard to get clinicians to understand that this was a result of an earlier viral infection because we've heard lots of stories from patients who are saying, I went to a doctor, and I told them I have, you know, this, that and the other symptom and that I had COVID earlier. And they said, OK. Well, where's your positive PCR test from having COVID? MARTIN: You make the point in your piece that this health crisis cannot be considered over when people just stop being infected. So just in the time that we have left, could you each just give me a sense of what you think people should be thinking about, about this issue? Hannah, do want to take this first? DAVIS: Sure. I mean, there are a lot of needs. I think, you know, first and foremost, we need an understanding of long COVID. And we need to be counting it, and we need to be incorporating it into policy decisions. And, you know, in one of our surveys we did recently, we found that basically only 7% had recovered. And people who had not recovered in the first three months continued to experience an average of 14 symptoms in month seven. MARTIN: Fiona. LOWENSTEIN: Yeah. So the first thing I would say is, I think it's very important that the general population understand that a mild - an initially mild case of COVID is not necessarily a non-impactful case of COVID. Of course, you know, in terms of widespread awareness raising, we need employers to understand long COVID because the disability benefits system is really not working for a lot of long COVID patients right now because they need to prove 12 months of impaired ability to work. And most of us are only just coming up on that 12-month point right now. I think another conversation that's not happening is looking at long COVID in terms of racial disparities. We have seen - because we've been tracking rates of infections and hospitalizations and deaths, we've seen the disproportionate impact of COVID-19 on Black and Latinx and Indigenous communities. But because we are not tracking long COVID, we really have no idea of the impact in these communities. And then finally, I would just say we need widespread clinician education on long COVID. But I think we can all have some part in helping with that sort of clinician education by just asking about it when we're going to the doctor for our own symptoms. MARTIN: Fiona Lowenstein is the founder of the Body Politic COVID-19 support group, and Hannah Davis is a founding member of Body Politic's research partner, the Patient-Led Research Collaborative. And as we said, they co-wrote an op-ed in The New York Times describing the experience of being long COVID patients. Fiona Lowenstein, Hannah Davis, thank you both so much for joining us. And, gosh, I wish you the best. Hang in there. LOWENSTEIN: Thank you. You, too. DAVIS: Thank you so much. NPR transcripts are created on a rush
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is the audio record. Feeling
fatigued or feverish after your COVID-19 vaccine? Here's why
the CDC wants to know - 3/15/21 The CDC describes V-safe as a "smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccine." The program asks you to report any side effects you experience after the vaccine and, depending on their severity, may prompt someone from the CDC to reach out for more information. This week, the app received criticism for the fact that it's available only on smartphones, excluding the millions of people in the U.S. who do not have one. But for the vast majority who do, says Dr. Carolyn B. Bridges, associate director for adult immunization at the Immunization Action Coalition, it can be an extremely helpful resource. Here's what you need to know. Anyone vaccinated can sign up for V-safe, and your vaccination center should have information about it Bridges says vaccine distribution centers should provide info about V-safe. "When you go get your vaccine, they should be giving you a handout with a QR code on there, which you can use to sign up," she says. "They'll send you questions about the kind of side effects that you're having for a period of time after you get your vaccine ... and if you have a more unusual or severe something to report, then you may get a follow-up call." For those who do not receive a handout, the CDC has directions about the registration process on its website. The info gathered on V-safe is supplemental to VAERS, the Vaccine Adverse Event Reporting System The CDC has long tracked severe reactions to vaccines through VAERS, the Vaccine Adverse Event Reporting System, which requires clinicians to record any concerning clinical reactions. Bridges says that V-safe is not a replacement, but merely an additional way to track side effects through self-reporting. "These vaccine trials have all been large, 40,000 people or so, but that may not pick up something that occurs in one in a million," she says. "So while VAERS is ongoing, V-safe is supplemental and involves you getting a text message you respond to." Since the U.S. vaccination program moved at unprecedented speed, churning out multiple vaccines in less than a year, V-safe helps fill in the gaps, and Bridges says it may even make some feel better about their choice to get one. "I think it's important for people to participate in V-safe if they want to contribute," she says. "I think it will be important for people who maybe were not as comfortable with the vaccination at the beginning, just to give them a little more control and more information." Nearly 4 million Americans have begun reporting on V-safe, recording side effects like headache and fatigue During a meeting on March 1, Dr. Tom Shimabukuro, deputy director of the Immunization Safety Office at the CDC, shared the first data about V-safe, revealing that 3.8 million people had begun using the app by Feb. 16. The number represented just a small fraction of the 55 million individuals who had received one or more doses of the Pfizer or Moderna vaccines (the Johnson & Johnson vaccine was not yet available) by that time, but his publicly available presentation shows valuable insight gained from data. For example, much like volunteers in Pfizer's and Moderna's vaccination studies, those who received the vaccines reported three main symptoms after the shots: fatigue, headache and myalgia (muscle pain). These side effects were followed by other common ones including chills, nausea and fever. Reactions significantly increased after individuals got the second dose of Pfizer. (At the time, information for the second Moderna dose was not available.) More than 16,000 individuals reported getting pregnant after their vaccination Of all the myths circulating about the COVID-19 vaccine, the one suggesting that the vaccines may cause infertility in women seems particularly damaging. But as of mid-January, the V-safe data, according to Shimabukuro's slides, included 30,000 pregnant women, providing data that led the CDC to conclude that "adverse events observed among pregnant women in V-safe did not indicate any safety problem." Bridges says this is one example of
why V-safe is so valuable, especially given that neither
Moderna's nor Pfizer's clinical trials included pregnant
women. "All the pregnancies recorded, that is incredibly
helpful to have that data," she says. "[There has
been] misinformation and what we all want and need is
real data — information that's accurate. So I think
this is a really great way if people are willing to
volunteer." The tragedy of
long COVID - Harvard Medical School - 3/1/21 And then you begin to turn the corner. Every day your worst symptoms — the fever, the terrible cough, the breathlessness — get a little better. You are winning, beating a life-threatening disease, and you no longer wonder if each day might be your last. In another week or two, you’ll be your old self. But weeks pass, and while the worst symptoms are gone, you’re not your old self — not even close. You can’t meet your responsibilities at home or at work: no energy. Even routine physical exertion, like vacuuming, leaves you feeling exhausted. You ache all over. You’re having trouble concentrating on anything, even watching TV; you’re unusually forgetful; you stumble over simple calculations. Your brain feels like it’s in a fog. Your doctor congratulates you: the virus can no longer be detected in your body. That means you should be feeling fine. But you’re not feeling fine. The doctor suggests that maybe the terrible experience of being ill with COVID-19 has left you a little depressed, or experiencing a little PTSD. Maybe some psychiatric treatment would help, since there’s nothing wrong with you physically. You try the treatment, and it doesn’t help. How common are lingering COVID symptoms? Tens of thousands of people in the United States have lingering illness following COVID-19. In the US, we call them post-COVID “long haulers.” Currently, the condition they are suffering from is known as “long COVID,” although other names are being proposed. Published studies (see here and here) and surveys conducted by patient groups indicate that 50% to 80% of patients continue to have bothersome symptoms three months after the onset of COVID-19 — even after tests no longer detect virus in their body. Which lingering symptoms are common? The most common symptoms are fatigue, body aches, shortness of breath, difficulty concentrating, inability to exercise, headache, and difficulty sleeping. Since COVID-19 is a new disease that first appeared in December 2019, we have no information on long-term recovery rates. Moving toward a better definition of long haulers — and a new name Very different chronic illnesses may develop in some people who have had COVID-19. So, the National Institutes of Health (NIH) has proposed a unifying name: post-acute sequelae of SARS-CoV-2 infection, or PASC. (SARS-CoV-2 is the virus that causes COVID-19.) Most people who get COVID-19 recover within weeks or a few months. However, some will likely suffer chronic damage to their lungs, heart, kidneys or brain that the virus inflicted. Others will develop long COVID. We do not yet have a formal definition of long COVID. In my opinion, such a definition should include these three points:
Is long COVID the same as chronic fatigue syndrome (ME/CFS)? Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has speculated that long COVID likely is the same as or very similar to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). ME/CFS can be triggered by other infectious illnesses — such as mononucleosis, Lyme disease, or severe acute respiratory syndrome (SARS), another coronavirus disease. Before the pandemic, the National Academy of Medicine estimated that as many as 2.5 million people in the US are living with ME/CFS. I recently published an article in the journal Frontiers in Medicine indicating that the pandemic could well double that number in the next year. Who is more likely to become a long hauler? Currently, we can’t accurately predict who will become a long hauler. As an article in Science notes, people only mildly affected by COVID-19 still can have lingering symptoms, and people who were severely ill can be back to normal two months later. However, continued symptoms are more likely to occur in people over age 50, people with two or three chronic illnesses, and, possibly, people who became very ill with COVID-19. What might cause the symptoms that plague long haulers? Research is underway to test several theories. People who have ME/CFS, and possibly people with long COVID, may have one or more of these abnormalities:
The bottom line How many people may develop long COVID? We can only guess. By late February, 2021, almost 30 million Americans were confirmed to have been infected by the virus. Probably many more were never diagnosed. Early studies indicate that one in ten people with COVID-19 may develop long COVID that lasts at least a year. Ultimately, how long these illnesses last remains to be determined. For this and many other reasons, the strain on the American health care system and economy from the pandemic will not end soon. Fortunately, the NIH and CDC have committed major support for research on long COVID. In the US and around the world, planning is underway to develop centers dedicated to research into long COVID and caring for those who have it. Virtually every health professional I
know believes that the pandemic in the US could and should
have been better controlled than it has been. Bad mistakes
rarely lead to only temporary damage. When Coronavirus
Symptoms Refuse to Go Away - En
español 9/4/20 En español | When Maryland resident Russell Frisby was discharged from the hospital in late March after a five-day stay for COVID-19, he wasn't “100 percent,” but he was feeling better. The persistent cough that plagued him for weeks had subsided, and the breathing trouble that initially landed him in a hospital bed had improved. About two weeks into his recovery, however, “the bottom dropped out” and the serious symptoms returned. The 69-year-old attorney was suddenly unable to do household chores without getting winded. And his asthma, which had always been mild and under control, seemed to be getting worse. Frisby took a coronavirus test just to be sure he didn't have COVID-19 again. The test was negative. Instead, he learned that his initial battle with the illness was far from over. Recovery is not immediate for many COVID-19 patients Frisby is what a growing number of doctors and researchers refer to as a “long-hauler,” or a person who experiences persisting symptoms of COVID-19 long after the infection is defeated. In addition to shortness of breath, long-haulers report extreme fatigue, tachycardia (a racing heart) and cognitive complications such as memory loss and brain fog that interfere with everyday tasks. For some, these symptoms can last weeks. A July report from the Centers for Disease Control and Prevention (CDC) found that 35 percent of adults who had mild cases of COVID-19 still weren't back to their usual state of health two to three weeks after testing positive for the coronavirus. (By comparison, more than 90 percent of people with the flu recover within two weeks of having a positive test result, the report's authors write.) For others, the syndrome can drag on for months. An Italian study published in JAMA found 87 percent of hospitalized COVID-19 patients had at least one symptom continue two months after the onset of the disease. It's been nearly six months since Frisby's diagnosis, and he is still receiving care for issues related to his coronavirus infection and the lung scarring it caused. His current regimen involves “a more intense asthma treatment” with daily inhalers, weekly allergy shots and lots of rest. It's hard to know exactly how many people experience prolonged effects of COVID-19, but Sarath Raju, M.D., an instructor of medicine at the Johns Hopkins University School of Medicine and a pulmonary specialist who has been treating Frisby for the last several months, says the number is “higher than we initially thought." "I think when people first came in with COVID-19, we were very focused on what the acute effects are and how we save lives or lower the severity of illness. We really didn't have a great sense of how long we expect people to be sick for,” Raju says. "The benefit of time has given us a better sense of that.” Young, healthy people can be long-haulers, too At first, it was the sickest patients who were still showing signs of illness after overcoming COVID-19, which is not unusual, says Sean Smith, M.D., an assistant professor of physical medicine and rehabilitation at the University of Michigan Medical School. People who have been in the hospital for an extended period or on a ventilator in intensive care commonly experience weakness, delirium and anxiety or depression after treatment. What's more, COVID-19 attacks the entire body — many patients who have been admitted to the hospital for one symptom leave with damage to their hearts, kidneys, lungs and more. But it's not just critically ill patients who are feeling the lingering effects of COVID-19. In the CDC report that looked at recovery rates for people with mild illness, 1 in 5 young and healthy adults reported prolonged problems. And in his Baltimore clinic, Raju has seen a handful of patients in their 20s and 30s seeking treatment for ongoing COVID-19-related symptoms. Smith describes the same: “Now, we're also seeing more outpatients [people who were never admitted to the hospital] who are able to walk, but they need oxygen long term” to help relieve shortness of breath, he says. And even with oxygen therapy “they still get winded very easily, can't climb stairs like they used to, that sort of thing.” Doctors don't know for sure what's causing these drawn-out symptoms, but many point to an inflammatory response as the likely culprit. “It's the body reacting to the virus that was there, and then the body reacting to the damage caused by the inflammation from before. And basically, it's this ongoing vicious cycle,” Smith says. Other viral illnesses can also result in chronic symptoms, including SARS and RSV (respiratory syncytial virus). “But what is different is that [the lasting symptoms] seem to be more common and more magnified with COVID,” says Gerard Francisco, M.D., professor and chair of the Department of Physical Medicine and Rehabilitation at McGovern Medical School at UTHealth in Houston. “I've never quite seen anything like this,” Smith adds. The good news: Rehabilitation therapies can help Frisby, who says he is “pretty much back to normal now,” considers himself fortunate for the care he has received for his longer-term COVID-19 symptoms, adding that he was “far luckier than some people” who were dismissed by their doctors or didn't feel empowered to seek follow-up care. His advice: Be aggressive. “You can't just sit back,” he says. Though no single pill can cure what's being dubbed “long COVID,” doctors can help with “non-medication, nonsurgical rehabilitation approaches,” UTHealth's Francisco says. For example, individuals experiencing lingering fatigue can benefit from a reconditioning program. And people with cognitive issues can recover with the help of a neuropsychologist. "Those who are having trouble getting back to work, we can even help with a work reintegration program,” Francisco says. “These are not the typical treatments that you would think of for someone recovering from a viral infection, but I think they may help some of our patients experiencing these problems.” Johns Hopkins’ Raju says medical professionals are becoming more aware of COVID-19's long-term effects and can help patients devise a plan of treatment or refer them to a specialist who can help. Some hospitals and universities have established post-COVID-19 teams and centers to help long-haulers recover. All the while, researchers are conducting studies in search of more answers and effective interventions. "The more we learn about the long-term
effects of COVID, the better prepared we will be” for
any future coronavirus surges, Francisco says. “We were
really initially in the dark as to how to help these
individuals. But now that we know better, we will be better
prepared.” CDC-funded study
launches to look at COVID-19
long-haulers
2/22/21 Carlos Olvera had to be hospitalized three times during his bout with COVID-19. “It had been already over a month and it was part of protocol to get me tested again, and it turned out that I was positive on that third hospitalization,” he recalled. Three months later, breathing is still a struggle for Olvera. “Yeah, unfortunately, it’s kind of back," he said. It may take years to truly understand the long-term impact COVID-19 has had on survivors like Olvera, but a major effort to gain that understanding has begun. “Some of the estimates we've seen is 30 percent of people who have this infection with COVID-19 can have some sort of long-term findings,” said Dr. Bala Hota, chief analytics officer and infectious disease expert at Rush University Medical Center in Chicago. Dr. Hota's team is taking the lead on a national study to assess the long-term complications experienced by COVID-19 survivors. “It's crucial we document what's the average duration, what's the burden of this” said Dr. Hota. “Is it reversible?” Over the next two years, the study will track 3,600 people with new COVID-19 symptoms and 1,200 people without. Enrollment is underway, or beginning soon, across eight health systems in Washington, Illinois, Texas, Connecticut, California and Pennsylvania. Dr. Monnie Wasse leads the post-COVID clinic at Rush University Medical Center, where COVID long-haulers are receiving follow-up treatment with a team of specialists. “There are a myriad of symptoms that continued on that patients are continuing to experience six, seven, eight months, following their diagnosis,” she explained. Some of those lingering symptoms that have been documented include organ damage in the heart, lungs and brain, blood clots, chronic fatigue syndrome, depression and anxiety, as well as impacts on neurocognitive function. “It's patients that have not been hospitalized who tend to have more of a moderate to mild case of COVID that actually are the ones that end up with longer-term symptoms that are smoldering symptoms,” said Dr. Wasse. For survivors like Olvera, three months after being hospitalized and recently vaccinated, he still gets headaches, brain fog and shortness of breath. “Patients like myself that are called ‘long haulers,’ we want to get better,” he said. This study could provide crucial insights into what the rest of his life could look like. “We have hope that, one day,
we'll kind of return to that normality, but it is a bit of a
struggle every day," he said. Long haulers:
Why some people experience long-term coronavirus
symptoms 2/8/21 Researchers estimate about 10% of COVID-19 patients become long haulers, according to a recent article from The Journal of the American Medical Association and a study done by British scientists. That’s in line with what UC Davis Health is seeing. This condition can effect anyone – old and young, otherwise healthy people and those battling other conditions. It has been seen in those who were hospitalized with COVID-19 and patients with very mild symptoms. What are common COVID-19 symptoms of long haulers? The list of long hauler symptoms is long, wide and inconsistent. For some people, the lasting coronavirus symptoms are nothing like the original symptoms when they were first infected with COVID-19. The most common long hauler symptoms include:
Brain fog is among the most confusing symptoms for long haulers. Patients report being unusually forgetful, confused or unable to concentrate even enough to watch TV. This can happen to people who were in an intensive care unit for a while, but it’s relatively rare. However, it is happening to a variety of patients, including those who weren’t hospitalized. Some people have reported feeling better for days or even weeks then relapsing. For others, it’s a case of just not feeling like themselves. Why do long haulers continue to experience long-term COVID-19 symptoms? There's not a lot of information on long haulers, who only recently received attention from experts because it’s also so new. The vast majority of long haulers test negative for COVID-19. There’s nothing specific to test for lasting coronavirus symptoms. One common theory about patients with long-term COVID-19 symptoms is that the virus possibly remains in their bodies in some small form. Another theory is their immune systems continue to overreact even though the infection has passed. What is being done to help COVID-19 long haulers? As with many other COVID-19 issues, it’s hard to identify why something is occurring when the disease was discovered less than a year ago. Learning how to treat long haulers also requires time. Also, because the disease is so new, much of the information about COVID-19 cases and care is anecdotal. However, that is changing. UC Davis Health launched the region’s first Post-COVID-19 Clinic to provide streamlined, comprehensive specialty care for long haulers. We are one of only a handful of health systems in the U.S. to create a clinic that cares for these patients. Can COVID-19 long-haul symptoms cause permanent damage? The answer to this is not clear. Health care providers don't know how many of these symptoms are permanent, or if there is permanent damage being done. Some patients who have been seriously ill from COVID-19 develop acute respiratory distress syndrome (ARDS), which can permanently scar their lungs. But it’s not clear if there is any scarring for long-haulers who have respiratory issues but not at the severe level of ARDS. Other patients with long-term loss of smell and taste worry about permanent damage, too. Experts believe that the loss of smell and taste won't be permanent. For most people, there will likely be resolution, but there isn't a clear answer as to how long this will take. Learn about the frightening uncertainty for long-haul COVID-19 patients As a COVID long hauler, should I get a COVID-19 vaccine? Researchers still don't know much about what causes long hauler symptoms and why they experience such long-term effects. Our infectious disease experts say you should ask your physician before scheduling an appointment to get a COVID-19 vaccine. I'm a COVID long hauler. Can UC Davis Health help me? If you wish to set up an appointment with our Post-COVID-19 Clinic, you can call our referral center at 1-800-4-UCDAVIS (1-800-482-3284). Select option #3. Please note that an in-person evaluation is required. If I live outside of the Sacramento region, can I get care at the Post-COVID-19 Clinic? UC Davis Health's Post-COVID-19 Clinic requires an in-person visit in order to ensure a full medical evaluation and care. If you are unable to travel for care, we recommend seeking care at the academic medical center nearest you for their post-COVID-19 treatment options. These types of medical centers – like ours – are often the best at addressing complex health conditions.
Source: health.ucdavis.edu/coronavirus/covid-19-information/covid-19-long-haulers.html
Overview When the COVID-19 pandemic began, initial descriptions of the symptomology focused on the clinical presentations of patients in the acute, inpatient setting. In the months since, information on how patients with mild disease present has become available (Gandhi, April 2020), along with information on the fairly common occurrence of asymptomatic disease More recently, data have emerged that some patients continue to experience symptoms related to COVID-19 after the acute phase of infection. There is currently no clearly delineated consensus definition for the condition: terminology has included “long COVID,” “post-COVID syndrome” and “post-acute COVID-19 syndrome.” Among the lay public, the phrase “long haulers” is also being used. Here we review the current literature on post-acute symptoms in patients with COVID-19, using the term “post-acute COVID-19 syndrome.” Key Literature In summary: Preliminary reports indicate some patients may develop a so-called “post-acute COVID-19 syndrome,” in which they experience persistent symptoms after recovering from their initial illness. The syndrome appears to affect those with mild as well as moderate-to-severe disease. The incidence, natural history and etiology of these symptoms is currently unknown. Additional Literature Post-acute COVID-19 Syndrome incidence and risk factors: a Mediterranean cohort study (Moreno-Perez, January 2021). Prospective cohort study to analyze the incidence of post-acute COVID-19 syndrome and its components. 277 adult patients who had recovered from COVID-19 (February 27-April 29, 2020) confirmed by PCR or subsequent seroconversion, with a systematic assessment 10-14 weeks after disease onset, and were evaluated 77 days (IQR 72-85) after disease onset. 34.3% patients had mild SARS-CoV-2 and 65.7% had severe SARS-CoV-2. Post-acute COVID-19 syndrome was detected in 141 patients (50.9%; 95% CI 45.0-56.7%). The cumulative incidence was 58.2% (95%CI 51.0-65.2), 36.6% (95% CI 23.5-51.8) and 37.0% (95% CI 25.4-50.3) in patients with severe pneumonia, mild pneumonia and without pneumonia, respectively (p=0.003). The most frequent symptoms were dyspnea and fatigue. Symptoms were mostly mild. Alterations in spirometry were noted in 25/269 (9.3%), while in radiographs in 51/277 (18.9%). No baseline clinical features behaved as independent predictors of post-acute COVID-19 syndrome development. Resources SARS-CoV-2 Recovery Cohort Studies Research Opportunity Announcement NIH calls for applications in line with the goals of its Post-Acute Sequelae of SARS-CoV-2 Infection Initiative and Investigator Consortium. Management of Post-Acute COVID-19 in Primary Care This BMJ “practice pointer” includes a one-page visual summary of assessment and initial management of patients with persistent symptoms following acute SARS-CoV-2 infection. Scientific overview developed by the CDC. Long-Term Neurological Complications of COVID-19 This short Society of Critical Care Medicine video presentation details long-term neurolgical complication seen in COVID-19 patients. Webinar Recording: Rehabilitation After COVID-19 Disease A recording of a webinar jointly hosted by the European Respiratory Society and the American Thoracic Society. Management of post-COVID Symptoms: Experiences from the Center for Post-COVID Care in NYC An American Thoracic Society COVID-19 Critical Care Training Forum discussion with physicians who helped organize Mt. Sinai's Center for Post-COVID Care about the most common and uncommon symptoms they have encountered. Managing Patients Post-COVID-19: From Symptoms to Lasting Complications Drs. Robin Trotman of Cox Health and Inessa Gendlina of Montefiore Medical Center discuss the long-term effects of COVID-19 and how to manage recovered patients. COVID-19 Podcast: Survivors of COVID-19 (June 13, 2020) “There was no sense of what was
coming next.” Drs. Buddy Creech & Anna Person of
Vanderbilt University & Michael Saag of the University
of Alabama share their experiences as physicians infected
with COVID-19. COVID Long
Haulers: Symptoms and Connections to Post Viral Fatigue and
Organ Damage 12/22/20 Defining Long COVID: 3 Distinct Patient Groups The terms “COVID long haulers,” “long COVID,” and “Post COVID Syndrome,” have all been used interchangeably in recent months to describe individuals who have been infected with the SARS-CoV-2 and continue to experience symptoms after “recovery.” However, these terms may be misleading to healthcare providers, patients, and even the media as they represent three different patient subsets with prolonged symptoms, usually defined as greater than 1 month after COVID-19 infection. As described in the fast-tracked book by PPM Editorial Board Advisor Don L. Goldenberg, How the COVID-19 Pandemic is Affecting You and Your Healthcare (Armin Lear Press), these subsets include: 1. Critically-ill patients, almost all who have been admitted to intensive care, who, are expected to have a lengthy recovery period (often months) and may have permanent organ damage, particularly in the lung. 2. An undetermined number of patients, following mild or severe infection, who have organ damage/dysfunction, such as myocarditis or an encephalopathy. The long-range consequences are unclear. (More on cardiovascular risks in COVID long haulers) 3. Many patients, in some series estimated up to 10%,1 have prolonged, multisystem symptoms with no evidence of organ damage or dysfunction. These patients most often have severe exhaustion, headaches, myalgias, and mood and cognitive disturbances with normal physical and laboratory findings. This is the subset experiencing symptoms most similar to post-viral fatigue syndrome (PVFS), chronic fatigue syndrome (CFS) – also termed benign myalgic encephalomyelitis (BME) in the UK, fibromyalgia and other related, poorly understood disorders associated with chronic fatigue and pain. In these conditions, there has been no strong evidence for organ damage or persistent and significant immune/inflammatory abnormalities. The confusion and controversy playing out online and among support groups for the third subset of patients mirrors the misunderstandings of CFS over the past 40 years in both the United States and the United Kingdom.2,3 COVID long haulers may be broken into three patient groups depending on organ damage and other key symptoms. (iStock) What we do know, so far, is that this broad group of COVID-19 survivors does not seem to fully recover and that there are significant differences between those who experience organ damage and those who do not. We also know that, while COVID-19 has killed more men than women, long haulers seem to be predominantly female. Physicians at a Paris Hospital recently reported that among the long hauler patients they treated between mid-May and late July 2020, women outnumbered men 4:1 – the same rate by which women outnumber men in CFS.1 As the medical community works to understand the acute stage of COVID-19, long-term consequences pose a further challenge for understanding how this virus persists. Here, we look at what clinicians and researchers are finding in COVID-19 patients with regard to potential organ damage following COVID-19 infection and how chronic post-viral fatigue is playing out. Severe Post COVID Syndrome and Organ Damage As noted above, some patients with mild or moderate COVID infection do develop organ damage (subsets 1 and 2), most notably myocarditis or an encephalopathy. In some patients with sustained organ damage or dysfunction, there may be a vascular connection, according to William Li, MD, founder of the Angiogenesis Foundation (AF), which is currently dedicated to research on the novel coronavirus, particularly its long-term consequences.4 Dr. Li and an international team of researchers noticed something atypical for a respiratory virus - it was infecting vascular endothelial cells and damaging the endothelium. The team compared autopsies on the lungs of patients who died from COVID-19 with those of patients who died from influenza. The COVID-19 lungs had nine times as many microthrombi as the influenza lungs. Dr. Li believes there may be three main components at play: microvascular damage, persistent inflammation, which may have an autoimmune component, and neuropathy. It is important to note Dr. Li's findings are based on patients who died of COVID-infection, not those living with long COVID. Long COVID and Post Viral Fatigue As noted, up to 10% of patients recovering from COVID infection1 seem to experience prolonged symptoms that appear to resemble PVFS or CFS (subset 3). Clinicians may recall that both fatigue syndromes have connections to prior infectious disease outbreaks. For example: 2003 SARS o Doctors observed PVFS in patients after the 2003 SARS outbreak (also a coronavirus), which affected 8,096 people worldwide.5 1918 Spanish Influenza o There was evidence of high rates of PVFS/CFS after the 1918 influenza A (H1N1) pandemic, with fatigue being the most common long-term symptom.7 2009 Influenza A (H1N1) o Researchers in Norway studying the lasting symptoms of this influenza pandemic and found that the infection was associated with a greater than wo-fold increased risk of CFS. The researchers did not observe an increased risk for CFS following vaccination.8 There have also been reports of post viral fatigue in Ebola virus patients. A cross-sectional study estimated that 28% of people who recovered from the Ebola virus experienced unusual fatigue post recovery. Symptoms of Post-Ebola Syndrome also included joint pain, muscle pain, headaches, eye problems, and sleep disturbances. Finally, there have been some reports attempting to associate Epstein-Barr virus (EBV), the human herpes virus that can lead to infectious mononucleosis, with the novel coronavirus and autoimmune response but conclusive data is still needed.9-11 Overlapping Symptoms: Post COVID Syndrome and Post Viral Fatigue Syndrome Many clinicians and researchers are comparing the post-acute effects of today’s coronavirus with PVFS and CFS. Natalie Lambert, PhD, associate professor and director of the Lambert Lab at the Indiana University School of Medicine, has published in collaboration with Survivor Corps, a long-hauler support group, a Long-Hauler Symptom Survey. The survey includes reports from more than 4,000 COVID-19 patients.12 The most common symptoms her team uncovered were exhaustion (both physical and mental), other cognitive disturbances, headaches, myalgias, dyspnea, gastrointestinal, sleep and mood disturbances.12 These symptoms are similar to those reported in PVFS or CFS. However, dyspnea and loss of taste and smell appear to be much more common in Post COVID Syndrome patients. Practical Takeaways While PVFS is not new to the medical community, there is no clear path to treatment. More important, there is still not enough knowledge about the exact causes or repercussions of post-viral fatigue in recovering COVID-19 patients. Ongoing symptoms reported by those recovering from COVID-19 infection should be taken seriously and addressed accordingly. As stated by Dr. Anthony Fauci in July 2020, “Anecdotally, there’s no question that there are a considerable number of individuals who have a post viral syndrome that really, in many respects, can incapacitate them for weeks and weeks following so-called recovery and clearing of the virus, highly suggestive of myalgic encephalomyelitis/chronic fatigue syndrome.”1 John Brooks, MD, chief medical officer
of the CDC’s COVID response team, predicted that
“long COVID would affect on the order of tens of
thousands in the United States and possibly hundreds of
thousands.”13 Some long-haul
covid-19 patients say their symptoms are subsiding after
getting vaccines 3/16/21 But Eisenberg’s tale has a happy ending that neither she nor current medical science can explain. Thirty-six hours after her second shot of coronavirus vaccine last month, her symptoms were gone, and they haven’t returned. “I really felt back to myself,” the 34-year-old Brooklyn therapist said, “to a way that I didn’t think was possible when I was really sick.” Some people who have spent months suffering from long-haul covid-19 are taking to social media to report their delight at seeing their symptoms disappear after their vaccinations, leaving experts chasing yet another puzzling clinical development surrounding the disease caused by the coronavirus. How to deal with 3 lasting symptoms of 'long covid' - A video Some people experience “long covid” months after their battle with covid-19. While cures remain unknown, there are some practical steps you can take. (Allie Caren/The Washington Post) “The only thing that we can safely assume is that an unknown proportion of people who acquire SARS-CoV-2 have long-term symptoms,” said Steven Deeks, an infectious-disease physician at the University of California at San Francisco. “We know the questions. We have no answers. Hard stop.” Those questions include: If long-haulers are suffering from immune systems that went awry and never reset, why would vaccines — which rev up the immune system — help some of them? Are reservoirs of coronavirus hiding in the body? Are some long-haulers experiencing a placebo effect from the vaccine? Or does the disease simply take longer to run its course in some people? U.S. clinicians and researchers have yet to come to a consensus on even a definition for long-haul covid-19. They do not know how many people have it, what all the symptoms may be or who tends to develop problems that persist or begin after the virus is cleared. Dismissed by doctors, covid-19 ‘long haulers’ find comfort in each other - A Video A December workshop held by the National Institutes of Health that began grappling with those issues suggested that 10 percent to 30 percent of people infected with the coronavirus suffer some long-term symptoms. And on Feb. 23, NIH announced that it would spend more than $1.1 billion over four years to study the effects of long-term covid-19.
But there is little guidance about vaccination for people suffering through extended battles with the disease, other than medical authorities’ instruction that everyone in the United States should be immunized. Diana Berrent, founder of Survivor Corps, an online organization of people with long-term covid-19 symptoms, said many members of the group were initially hesitant to comply for fear that the vaccine would create more havoc with their immune systems. One tiny study released Monday but not yet submitted for peer review concluded that people with long-term symptoms who get vaccinated are more likely to see their problems resolve or not worsen than people who have not been vaccinated. But the research out of the University of Bristol in England compared only 44 vaccinated patients against 22 unvaccinated ones and was designed to determine whether the vaccines were safe for people with long-haul covid-19. The authors said it is possible that the act of getting the vaccine influenced the patients’ recall of symptoms, what they described as a “a placebo/nocebo effect.” When Survivor Corps informally surveyed its members recently, 216 people said they felt no different after vaccination, 171 said their conditions improved and 63 reported that they felt worse, Berrent said. Eisenberg, who said she had a mild case of covid-19 last summer, doesn’t believe the placebo theory fits because she had no expectation that the vaccine would help with her debilitating symptoms. She was immunized because tests did not detect antibodies to the virus in her blood and she was terrified that she could be reinfected. She received her second shot of the Moderna vaccine on Feb. 5. “I didn’t expect the vaccine to do this,” she said. “It is possible. The mind is a very powerful thing.” Rebecca Neff, 61, an information technology manager at a mortgage company, thinks she caught a fairly severe case of covid-19 last March in Los Angeles and has been paying the price ever since. Although she was never tested and never hospitalized, she has experienced chronic gastrointestinal problems, shortness of breath, fatigue and brain fog. Her hair fell out and her teeth loosened, she said. Neff, who recently moved to Frisco, Tex., said she consistently measured the oxygen level in her blood with a fingertip pulse-oximeter and found it to be two or three points below normal for many months. Stress would trigger flare-ups, she said, as would wine and some foods. Her dreams were “more bizarre” than she has ever experienced. One shot of Pfizer’s vaccine on March 8 has changed all that, she said. “My head is clearer in the last week than it’s been the whole entire year,” she said. “So even though I felt better, I didn’t realize how much I was off.” Akiko Iwasaki, an immunologist at Yale University, said that immunization is likely to reduce the chances of long-term covid-19, based on evidence that shows that vaccines help prevent the disease. “Vaccines will generate good antibody and T-cell responses. They have been already shown to significantly reduce infection, both symptomatic and asymptomatic,” she said. Iwasaki said she understands that it can be “a bit scary to get the vaccine when you are already feeling ill from long covid. However, more people appear to benefit from the vaccine than get worse with the vaccine.” She stressed that the benefit of vaccination outweighs the risks, and that vaccines also “will greatly reduce the risk of reinfection.” Michael S. Saag, a professor of medicine and infectious disease at the University of Alabama at Birmingham who took part in the NIH workshop, said he, too, is trying to make sense of the conflicting signals. “I’m looking at that disorder as a potential overreaction to the SARS-Cov-2 virus, and stimulating [patients’ immune systems] further could make them worse,” he said. “I’m intrigued and puzzled by the reports and curious to see whether this pans out to be real and, if so, why is it happening.” Several theories have emerged, although researchers have barely begun to explore them. Deeks noted that people who are infected with varicella zoster, the virus that causes chickenpox and shingles, may harbor the pathogen in their nervous systems for years. The Centers for Disease Control recommends that people in their 50s be vaccinated against it. That offers a potential comparison with the coronavirus vaccine; the varicella zoster immunization “doesn’t prevent new infections but takes care of the infection that’s there,” he said. The coronavirus vaccine could be triggering an immune response sufficient to eliminate any viral holdouts. “You put one and one together and you can say, ‘Okay, you know, this is plausible,’ ” Deeks said. Saurabh Mehandru, a gastroenterologist at New York’s Mount Sinai Hospital who studies the immune system, and colleagues found that coronavirus cells infected the lining of the small intestine, according to studies they published in the journals Nature in January and Gastroenterology in March. In a few cases, the virus persisted in small intestine cells at low levels for weeks or even months. Mehandru said he does not know whether a lingering infection in the intestine could contribute to long-term symptoms. He emphasized that more work needs to be done, such as determining whether people who have long-term symptoms also have infected intestinal cells. All of the biopsied patients in the study who had virus in their cells at four months were asymptomatic. But he said it is plausible that viral remnants in the gut could lead to a “low degree of inflammation, which could drive some of the features associated with persistence of symptoms. This is the speculation.” In a post on the blog Elemental, Iwasaki proposed three reasons vaccines might improve people’s symptoms: T cells, boosted by the vaccine, could eliminate a viral reservoir; a heightened immune response could clear any lingering virus fragments; or the vaccine may “divert autoimmune cells,” if long-lasting symptoms are the result of an inappropriate autoimmune response. These are all working hypotheses. “We will try some animal models to test this,” she said, “but my hope is that more and more people will be engaged in this research.” Saag said the clues remind him most of long-term Lyme disease, “because there we know the infectious organism .?.?. is long gone, and the organism seems to have triggered a persistent hyperactive immune syndrome.” Eisenberg is confident that her health is returning to normal. She is taking on more clients, working out and cleaning her house again. She still feels occasional nerve pain in her feet, but is seeing a doctor to resolve it. Best of all, she can fall asleep without medication. “Even the brain fog has gone away
to a point where I didn’t know how bad I had brain
fog,” she said. If you've been
exposed to the coronavirus 3/12/21 As COVID-19 continues to spread, the chances that you will be exposed and get sick continue to increase. If you've been exposed to someone with COVID-19 or begin to experience symptoms of the disease, you may be asked to self-quarantine or self-isolate. What does that entail, and what can you do to prepare yourself for an extended stay at home? How soon after you're infected will you start to be contagious? And what can you do to prevent others in your household from getting sick? What are the symptoms of COVID-19? Some people infected with the virus have no symptoms. When the virus does cause symptoms, common ones include fever, body ache, dry cough, fatigue, chills, headache, sore throat, loss of appetite, and loss of smell. In some people, COVID-19 causes more severe symptoms like high fever, severe cough, and shortness of breath, which often indicates pneumonia. People with COVID-19 may also experience neurological symptoms, gastrointestinal (GI) symptoms, or both. These may occur with or without respiratory symptoms. For example, COVID-19 affects brain function in some people. Specific neurological symptoms seen in people with COVID-19 include loss of smell, inability to taste, muscle weakness, tingling or numbness in the hands and feet, dizziness, confusion, delirium, seizures, and stroke. In addition, some people have gastrointestinal (GI) symptoms, such as loss of appetite, nausea, vomiting, diarrhea, and abdominal pain or discomfort associated with COVID-19. The virus that causes COVID-19 has also been detected in stool, which reinforces the importance of hand washing after every visit to the bathroom and regularly disinfecting bathroom fixtures. What should I do if I think I or my child may have a COVID-19 infection? First, call your doctor or pediatrician for advice. If you do not have a doctor and you are concerned that you or your child may have COVID-19, contact your local board of health. They can direct you to the best place for testing and treatment in your area. If you have a high or very low body temperature, shortness of breath, confusion, or feeling you might pass out, you need to seek immediate medical evaluation. Call the urgent care center or emergency department ahead of time to let the staff know that you are coming, so they can be prepared for your arrival. How do I know if I have COVID-19 or the regular flu? COVID-19 often causes symptoms similar to those a person with a bad cold or the flu would experience. And like the flu, the symptoms can progress and become life-threatening. So far there has been much less than the usual number of cases of influenza, likely due to the enhanced public health measures to prevent the spread of COVID. Therefore, at the current time, people with "flulike" symptoms should assume they have COVID. That means isolating and contacting your doctor or local board of health to arrange testing. How is someone tested for COVID-19? A specialized diagnostic test must be done to confirm that a person has an active coronavirus infection. Most often a clinician takes a swab of your nose (or both your nose and throat). Some tests may be done using a saliva sample. The sample is then checked for the virus's genetic material (PCR test) or for specific viral proteins (antigen test). Antibody tests can tell if someone has been infected with COVID-19. But the infected person doesn't begin producing antibodies immediately. It can take as long as three weeks for a blood antibody test to turn positive. That's why it is not useful as a diagnostic test for someone with new symptoms. Are there at-home tests for COVID-19? Available over the counter, without a doctor's prescription The FDA has granted emergency use authorization (EUA) to the first COVID-19 test that can be obtained without a doctor's prescription and fully performed at home. The Ellume COVID-19 Home Test is approved for use in adults and in children age 2 and older, with or without COVID-19 symptoms. To take the test, you collect a nasal swab, stir it in a vial of processing fluid, then place a drop of the fluid in an analyzer. The device, which detects coronavirus antigens, delivers a positive or negative test result to your smartphone within 20 minutes. Like other antigen tests, this test is less accurate than "gold standard" PCR tests, but initial studies suggest the accuracy comes close to PCR testing. Until there is much more real-world experience with this home test, the FDA recommends interpreting any result with caution. If you have COVID-like symptoms, you should self-isolate and contact your doctor whether your test is positive or negative. Your doctor will likely suggest a PCR test for confirmation. You should also self-isolate and call your doctor if you get a positive test result, even if you don't have symptoms. A negative test if you don't have symptoms makes it very unlikely that you are infected. However, you should continue to follow the standard prevention strategies of physical distancing, avoiding crowds, wearing a mask, and hand washing. This test will be available in drugstores and is expected to cost about $30. Available with a doctor's presctiption The FDA has approved a diagnostic test for COVID-19 that can be completed entirely at home, from sample collection to receiving the results. Other FDA-approved COVID-19 tests allow at-home sample collection, but still have to be shipped to a laboratory for processing. The Lucira COVID-19 All-In-One Test Kit is approved for people ages 14 and older who are suspected of having COVID-19. It requires a doctor's prescription. The company does not expect the test to be widely available until the spring of 2021. To perform the test, you swirl a swab in both nostrils, then stir the swab in a vial of chemicals. The vial is then plugged into a battery-powered test unit, which returns a positive or negative test result within 30 minutes. The test works by making copies of the virus's genetic material (if present) until it reaches detectable levels. It does this using a technique called loop-mediated isothermal amplification (LAMP). The method is similar to PCR, the gold standard of COVID-19 diagnostic testing. The LAMP test provides much faster results, but it is less accurate. In a head-to-head comparison, the Lucira test missed 6% of people who tested positive for COVID by PCR. Because a person can be infected and have a negative LAMP test, you should always self-quarantine if you have symptoms consistent with COVID, or have had recent contact with someone who has the infection, until you can get a PCR test. The FDA has granted emergency use authorization to a rapid antigen test for COVID-19. How is it different from other tests on the market? The BinaxNOW COVID-19 Ag Card, as the test is known, detects antigen proteins on the surface of SARS-CoV-2, the virus that causes COVID-19. Unlike other diagnostic tests for COVID-19, BinaxNOW does not require a laboratory or other equipment to process or analyze the test results. This makes it portable and fast — results are available within 15 minutes. This test is approved for use in people who are suspected of having COVID-19, and must be done within seven days of when their symptoms began. A prescription is needed to get this test, which can be performed in authorized locations including doctor's offices and emergency rooms. To perform the test, a sample obtained using a nasal swab is inserted into the BinaxNOW test card. The test is a lateral flow immunoassay, which works like a pregnancy test. The appearance of colored lines on the test strip indicates whether or not you have tested positive for COVID-19. The test comes with a smartphone app that can be used to share test results. Positive test results are highly specific, meaning that if you test positive you are very likely to be infected, particularly if you are tested during the first week of infection when you are experiencing symptoms. False negatives are a bigger concern. As with other antigen tests, BinaxNOW can miss infections, producing negative test results in people who are actually infected. Still, this test could have an important role during this pandemic. It offers a quick, easy, and inexpensive way to test more people, more quickly. What is the difference between a PCR test and an antigen test for COVID-19? PCR tests and antigen tests are both diagnostic tests, which means that they can be used to determine whether you currently have an active coronavirus infection. However, there are important differences between these two types of tests. PCR tests detect the presence of the virus's genetic material using a technique called reverse transcriptase polymerase chain reaction, or RT-PCR. For this test, a sample may be collected through a nasal or throat swab, or a saliva sample may be used. The sample is typically sent to a laboratory where coronavirus RNA (if present) is extracted from the sample and converted into DNA. The DNA is then amplified, meaning that many of copies of the viral DNA are made, in order to produce a measurable result. The accuracy of any diagnostic test depends on many factors, including whether the sample was collected properly, when during the course of illness the testing was done, and whether the sample was maintained in appropriate conditions while it was shipped to the laboratory. Generally speaking, PCR tests are highly accurate. However, it can take days to over a week to get the results of a PCR test. Antigen tests detect specific proteins on the surface of the coronavirus. They are sometimes referred to as rapid diagnostic tests because it can take less than an hour to get the test results. Positive antigen test results are highly specific, meaning that if you test positive you are very likely to be infected. However, there is a higher chance of false negatives with antigen tests, which means that a negative result cannot definitively rule out an active infection. If you have a negative result on an antigen test, your doctor may order a PCR test to confirm the result. It may be helpful to think of a COVID antigen test as you would think of a rapid strep test or a rapid flu test. A positive result for any of these tests is likely to be accurate, and allows diagnosis and treatment to begin quickly, while a negative result often results in further testing to confirm or overturn the initial result. How do saliva tests compare to nasal swab tests for diagnosing COVID-19? Samples for COVID-19 tests may be collected through a long swab that is inserted into the nose and sometimes down to the throat, or from a saliva sample. The saliva test is easier to perform — spitting into a cup versus submitting to a swab — and more comfortable. Because a person can independently spit into a cup, the saliva test does not require interaction with a healthcare worker. This cuts down on the need for masks, gowns, gloves, and other protective equipment. Either saliva or swab samples may be used for PCR tests, which detect genetic material from the coronavirus. Swab or saliva samples can also be used for antigen tests, which detect specific proteins on the surface of the coronavirus. A systematic review and meta-analysis published in JAMA Internal Medicine found that saliva- and nasal swab-based tests that used a technique similar to PCR were similarly accurate. A positive result on either test meant that it was accurate at diagnosing the infection 99% of the time. However, approximately 16 out of 100 people who are infected will be missed. These results are very similar to prior studies, reinforcing that a single negative swab or saliva test does not mean you don't have COVID. If you have symptoms suggestive of COVID, presume you may still be infected to avoid transmitting the virus to others. How reliable are the tests for COVID-19? Two types of diagnostic tests are currently available in the US. PCR tests detect viral RNA. Antigen tests, also called rapid diagnostic tests, detect specific proteins on the surface of the coronavirus. Antigen test results may come back in as little as 15 to 45 minutes; you may wait several days or longer for PCR test results. The accuracy of any diagnostic test depends on many factors, including whether the sample was collected properly. For PCR tests, which are typically analyzed in a laboratory, test results may be affected by the conditions in which the test was shipped to the laboratory. Results may also be affected by the timing of the test. For example, if you are tested on the day you were infected, your test result is almost guaranteed to come back negative, because there are not yet enough viral particles in your nose or saliva to detect. The chance of getting a false negative test result decreases if you are tested a few days after you were infected, or a few days after you develop symptoms. Generally speaking, if a test result comes back positive, it is almost certain that the person is infected. A negative test result is less definite. There is a higher chance of false negatives with antigen tests. If you have a negative result on an antigen test, your doctor may order a PCR test to confirm the result. If you experience COVID-like symptoms and get a negative PCR test result, there is no reason to repeat the test unless your symptoms get worse. If your symptoms do worsen, call your doctor or local or state healthcare department for guidance on further testing. You should also self-isolate at home. Wear a mask when interacting with members of your household. And practice physical distancing. I've heard that the immune system produces different types of antibodies when a person is infected with the COVID-19 coronavirus. How do they differ? Why is this important? When a person gets a viral or bacterial infection, a healthy immune system makes antibodies against one or more components of the virus or bacterium. The COVID-19 coronavirus contains ribonucleic acid (RNA) surrounded by a protective layer, which has spike proteins on the outer surface that can latch on to certain human cells. Once inside the cells, the viral RNA starts to replicate and also turns on the production of proteins, both of which allow the virus to infect more cells and spread throughout the body, especially to the lungs. While the immune system could potentially respond to different parts of the virus, it's the spike proteins that get the most attention. Immune cells recognize the spike proteins as a foreign substance and begin producing antibodies in response. There are two main categories of antibodies: Binding antibodies. These antibodies can bind to either the spike protein or a different protein known as the nucleocapsid protein. Binding antibodies can be detected with blood tests starting about one week after the initial infection. If antibodies are found, it's extremely likely that the person has been infected with the COVID-19 coronavirus. The antibody level declines over time after an infection, sometimes to an undetectable level. Binding antibodies help fight the infection, but they might not offer protection against getting reinfected in the future. It depends on whether they are also neutralizing antibodies. Neutralizing antibodies. The body makes these antibodies specifically against the spike protein. In the laboratory, scientists have observed that neutralizing antibodies block the virus from getting into live cells. And human studies have shown that neutralizing antibodies made against other coronaviruses help prevent re-infection. Scientists are optimistic that the same will be true for the COVID-19 coronavirus, and that neutralizing antibodies will block cell-to-cell transmission of this virus in humans, and offer protection against reinfection, at least for two to three months. In November 2020, the FDA authorized emergency use of a test for COVID-19 neutralizing antibodies. People who have completely recovered from a COVID-19 infection and have neutralizing antibodies in their blood can potentially donate plasma, the component of blood that contains antibodies, to help COVID-19 patients recover from their illness. Can a person who has been infected with coronavirus get infected again? Natural immunity to COVID-19 is the protection that results from having been sick. But we don't know how long natural immunity lasts, or how strong it is. So can we count on natural immunity to protect us from reinfection? If so, for how long? Unfortunately, we don't know the answer to either of those questions. There have been some confirmed cases of reinfection with COVID-19. In other words, a person got sick with COVID-19, recovered, and then became infected again. This is rare, but it can happen. The CDC states that people who have gotten sick with COVID-19 may still benefit from getting vaccinated. For now, people are eligible to get the COVID-19 vaccine whether or not they were previously infected. Vaccination criteria may change in the future as scientists learn more about natural immunity after COVID illness. It's also worth noting that someone who has been re-infected — even someone with no symptoms — has the potential to spread the virus to others. That means that everyone, even those who have recovered from coronavirus infection, and those who have been vaccinated, should continue to wear masks, practice physical distancing, and avoid crowds. What is serologic (antibody) testing for COVID-19? What can it be used for? A serologic test is a blood test that looks for antibodies created by your immune system. There are many reasons you might make antibodies, the most important of which is to help fight infections. The serologic test for COVID-19 specifically looks for antibodies against the COVID-19 virus. Your body takes one to three weeks after you have acquired the infection to develop antibodies to this virus. For this reason, serologic tests are not sensitive enough to accurately diagnose an active COVID-19 infection, even in people with symptoms. However, serologic tests can help identify anyone who has recovered from coronavirus. This may include people who were not initially identified as having COVID-19 because they had no symptoms, had mild symptoms, chose not to get tested, had a false-negative test, or could not get tested for any reason. Serologic tests will provide a more accurate picture of how many people have been infected with, and recovered from, coronavirus, as well as the true fatality rate. Serologic tests may also provide information about whether people become immune to coronavirus once they've recovered and, if so, how long that immunity lasts. The accuracy of serologic tests varies depending on the test and when in the course of infection the test is performed. How soon after I'm infected with the new coronavirus will I start to be contagious? The time from exposure to symptom onset (known as the incubation period) is thought to be two to 14 days, though symptoms typically appear within four or five days after exposure. We know that a person with COVID-19 may be contagious 48 hours before starting to experience symptoms. Emerging research suggests that people may actually be most likely to spread the virus to others during the 48 hours before they start to experience symptoms. This strengthens the case for face masks, physical distancing, and contact tracing, all of which can help reduce the risk that someone who is infected but not yet experiencing symptoms may unknowingly infect others. Can people without symptoms spread the virus to others? "Without symptoms" can refer to two groups of people: those who eventually do have symptoms (pre-symptomatic) and those who never go on to have symptoms (asymptomatic). During this pandemic, we have seen that people without symptoms can spread the coronavirus infection to others. A person with COVID-19 may be contagious 48 hours before starting to experience symptoms. In fact, people without symptoms may be more likely to spread the illness, because they are unlikely to be isolating and may not adopt behaviors designed to prevent spread. But what about people who never go on to develop symptoms? A published in JAMA Network Open found that almost one out of every four infections may be transmitted by individuals with asymptomatic infections. This study provides yet another reason to wear face masks and observe physical distancing. Both measures can help reduce the risk that someone who does not have symptoms will infect others. For how long after I am infected will I continue to be contagious? At what point in my illness will I be most contagious? People are thought to be most contagious early in the course of their illness, when they are beginning to experience symptoms, especially if they are coughing and sneezing. But people with no symptoms can also spread the coronavirus to other people. In fact, people who are infected may be more likely to spread the illness if they are asymptomatic, or in the days before they develop symptoms, because they are less likely to be isolating or adopting behaviors designed to prevent spread. By the 10th day after COVID symptoms begin, most people will no longer be contagious, as long as their symptoms have continued to improve and their fever has resolved. People who test positive for the virus but never develop symptoms over the following 10 days after testing are probably no longer contagious, but again there are documented exceptions. A full, 14-day quarantine remains the best way to avoid spreading the virus to others after you've been exposed to someone with COVID-19. However, according to CDC guidelines, you may discontinue quarantine after a minimum of 10 days if you do not have any symptoms, or after a minimum of seven days if you have a negative COVID test within 48 hours of when you plan to end quarantine. People who are fully vaccinated do not need to quarantine or get tested after exposure, because their risk of infection is low. But they should be alert for symptoms, and should isolate and get tested if they develop symptoms after exposure. One of the main problems with general rules regarding contagion and transmission of this coronavirus is the marked differences in how it behaves in different individuals. That's why everyone needs to wear a mask and keep a physical distance of at least six feet. If I get sick with COVID-19, how long until I will feel better? It varies. Most people with mild cases appear to recover within one to two weeks. However, recent surveys conducted by the CDC found that recovery may take longer than previously thought, even for adults with milder cases who do not require hospitalization. The CDC survey found that one-third of these adults had not returned to normal health within two to three weeks of testing positive for COVID-19. Among younger adults (ages 18 to 34) who did not require hospitalization and who did not have any underlying health conditions, nearly one in five had not returned to normal health within two to three weeks after testing positive for COVID-19. With severe cases, recovery can take six weeks or more. Some people may experience longer-term physical, cognitive, and psychological problems. Their symptoms may alternately improve and worsen over time, and can include a variety of difficulties, from fatigue and trouble concentrating to anxiety, muscle weakness, and continuing shortness of breath. Who are long haulers? And what is post-viral syndrome? Long haulers are people who have not fully recovered from COVID-19 weeks or even months after first experiencing symptoms. Some long haulers experience continuous symptoms for weeks or months, while others feel better for weeks, then relapse with old or new symptoms. The constellation of symptoms long haulers experience, sometimes called post-COVID-19 syndrome or post-acute sequelae of SARS-CoV-2 infection (PASC), is not unique to this infection. Other infections, such as Lyme disease, can cause similar long-lasting symptoms. Emerging research may help predict who will become a long hauler. One study found that COVID-19 patients who experienced more than five symptoms during their first week of illness were significantly more likely to become long haulers. Certain symptoms — fatigue, headache, difficulty breathing, a hoarse voice, and muscle or body aches — experienced alone or in combination during the first week of illness also increased the chances of becoming a long hauler, as did increasing age and higher body mass index (BMI). Though these factors may increase the likelihood of long-term symptoms, anyone can become a long hauler. Many long haulers initially have mild to moderate symptoms — or no symptoms at all — and do not require hospitalization. Previously healthy young adults, not just older adults with coexisting medical conditions, are also experiencing post-COVID-19 syndrome. Symptoms of post-COVID-19 syndrome, like symptoms of COVID-19 itself, can vary widely. Some of the more common lasting symptoms include fatigue, worsening of symptoms after physical or mental activity, brain fog, shortness of breath, chills, body ache, headache, joint pain, chest pain, cough, and lingering loss of taste or smell. Many long haulers report cognitive dysfunction or memory loss that affects their day-to-day ability to do things like make decisions, have conversations, follow instructions, and drive. The common thread is that long haulers haven't returned to their pre-COVID health, and ongoing symptoms are negatively affecting their quality of life. There's already some speculation, but no definite answers, about what is causing these ongoing symptoms. Some researchers suspect that SARS-CoV-2 infection triggers long-lasting changes in the immune system. Others propose that it triggers autonomic nervous system dysregulation, which can impact heart rate, blood pressure, and sweating, among other things. In February 2021, the National Institutes of Health announced a $1.15 billion initiative to support research into the causes and ultimately the prevention and treatment of long-haul COVID. Many long haulers never had laboratory confirmation of COVID-19, which can make it tricky to diagnose post-COVID-19 syndrome. Early on in the pandemic, tests were scarce. Many people who suspected they had COVID-19 self-isolated without getting a test, or were refused a COVID test when they requested one. And the tests themselves have not been entirely reliable; both diagnostic tests and antibody tests may return false negative results if taken too early or too late in the course of illness. How long after I start to feel better will be it be safe for me to go back out in public again? The most recent CDC guidance states that someone who has had COVID-19 can discontinue isolation once they have met the following criteria: 1. It has been more than 10 days since your symptoms began. 2. You have been fever-free for more than 24 hours without the use of fever-reducing medications. 3. Other symptoms have improved. The CDC is no longer recommending a negative COVID-19 test before going back out in public. Anyone who tested positive for COVID-19 but never experienced symptoms may discontinue isolation 10 days after they first tested positive for COVID-19. Even after discontinuing isolation, you should still take all precautions when you go out in public, including wearing a mask, minimizing touching surfaces, and keeping at least six feet of distance away from other people. What's the difference between self-isolation and self-quarantine, and who should consider them? Self-isolation is voluntary isolation at home by those who have or are likely to have COVID-19 and are experiencing mild symptoms of the disease (in contrast to those who are severely ill and may require hospitalization). The purpose of self-isolation is to prevent spread of infection from an infected person to others who are not infected. If possible, the decision to isolate should be based on physician recommendation. If you have tested positive for COVID-19, you should self-isolate. You should strongly consider self-isolation if you
You may also consider self-isolation if you have symptoms consistent with COVID-19 (fever, cough, difficulty breathing) but have not had known exposure to the new coronavirus and have not been tested for it. In this case, it may be reasonable to isolate yourself for a minimum of 10 days from when you begin to experience symptoms. Self-quarantine is advised for anyone who has been exposed to the COVID-19 virus, regardless of whether you are experiencing symptoms. The purpose of self-quarantine (as with self-isolation) is to prevent the possible spread of COVID-19. A full, 14-day quarantine remains the best way to ensure that you don't spread the virus to others. However, according to CDC guidelines, you may discontinue quarantine after a minimum of 10 days if you do not have any symptoms, or after a minimum of seven days if you have a negative COVID test within 48 hours of when you plan to end quarantine. According to CDC guidelines released in March 2021, people who are fully vaccinated do not need to quarantine or get tested after exposure, because their risk of infection is low. But they should be alert for symptoms, and should isolate and get tested if they develop symptoms after exposure. What does it really mean to self-isolate or self-quarantine? What should or shouldn't I do? If you are sick with COVID-19 or think you may be infected with the COVID-19 virus, it is important not to spread the infection to others while you recover. While home-isolation or home-quarantine may sound like a staycation, you should be prepared for a long period during which you might feel disconnected from others and anxious about your health and the health of your loved ones. Staying in touch with others by phone or online can be helpful to maintain social connections, ask for help, and update others on your condition. Here's what the CDC recommends to minimize the risk of spreading the infection to others in your home and community. Stay home except to get medical care
Call ahead before visiting your doctor
Separate yourself from other people and animals in your home
Wear a face mask if you are sick
Cover your coughs and sneezes
Clean your hands often
Don't share personal household items
Clean all "high-touch" surfaces every day High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables.
Monitor your symptoms
What types of medications and health supplies should I have on hand for an extended stay at home? Try to stock at least a 30-day supply of any needed prescriptions. If your insurance permits 90-day refills, that's even better. Make sure you also have over-the-counter medications and other health supplies on hand. Medical and health supplies
When can I discontinue my self-quarantine? A full, 14-day quarantine remains the best way to ensure that you don't spread the virus to others after you've been exposed to someone with COVID-19. However, according to CDC guidelines, you may discontinue quarantine after a minimum of 10 days if you do not have any symptoms, or after a minimum of 7 days if you have a negative COVID test within 48 hours of when you plan to end quarantine. How can I protect myself while caring for someone that may have COVID-19? You should take many of the same precautions as you would if you were caring for someone with the flu:
My parents are older, which puts them at higher risk for COVID-19, and they don't live nearby. How can I help them if they get sick? Caring from a distance can be stressful. Start by talking to your parents about what they would need if they were to get sick. Put together a single list of emergency contacts for their (and your) reference, including doctors, family members, neighbors, and friends. Include contact information for their local public health department. You can also help them to plan ahead. For example, ask your parents to give their neighbors or friends a set of house keys. Have them stock up on prescription and over-the counter medications, health and emergency medical supplies, and nonperishable food and household supplies. Check in regularly by phone, Skype, or however you like to stay in touch. Can people infect pets with the COVID-19 virus? The virus that causes COVID-19 does appear to spread from people to pets, according to the FDA, though this is uncommon. Research has found that cats and ferrets are more likely to become infected than dogs. If you have a pet, do the following to reduce their risk of infection:
If you become sick with COVID-19, restrict contact with your pets, just like you would around other people. This means you should forgo petting, snuggling, being kissed or licked, and sharing food or bedding with your pet until you are feeling better. When possible, have another member of your household care for your pets while you are sick. If you must care for your pet while you are sick, wash your hands before and after you interact with your pets and wear a face mask. At present, it is considered unlikely that pets can spread the COVID-19 virus to humans. However, pets can spread other infections that cause illness, including E. coli and Salmonella, so wash your hands thoroughly with soap and water after interacting with your animal companions. Blog posts: What
is COVID-19 brain fog — and how can you clear
it? Podcast: You think you've got COVID-19. Here's what you need to do (recorded 4/10/20) We asked Dr.
Mallika Marshall, medical
reporter for CBS-affiliate WBZ TV in Boston and an
instructor at Harvard Medical School, how we should react
when we start to experience a dry cough or perhaps spike a
fever. Who do you call? How do you protect your family? When
does it make sense to move toward an emergency department,
and how should we prepare? Dr. Marshall is the host of
Harvard Health Publishing's online
course series, and an urgent
care physician at Mass General Hospital. Which test
is best for COVID-19? 1/15/21 So, which tests to use? Start here: There are tests that diagnose current infection and tests that show whether you previously had SARS-CoV-2, the virus that causes COVID-19. The FDA has granted emergency use authorization (EUA) for hundreds of COVID-19 diagnostic tests. This allows makers to market tests without receiving formal FDA approval because there is a public health emergency. Because this novel coronavirus is indeed novel, and COVID-19 is a new disease, information about available tests is incomplete and testing options keep changing. Tests vary in terms of accuracy, cost, recommended use for people of various ages, and convenience. This blog post reviews features of the major types of tests. For more detailed information on individual tests, check the FDA’s updated list of authorized tests, which has links to the test makers’ websites. Diagnostic tests for current infection If you want to know whether or not you have the virus, there are two types of tests: molecular tests and antigen testing. Molecular tests (also called PCR tests, viral RNA tests, nucleic acid tests) How is it done? Nasal swabs, throat swabs, and tests of saliva or other bodily fluids. Where can you get this test? At a hospital, in a medical office, in your car, or even at home. The FDA has authorized a home molecular test that requires no prescription. What does the test look for? Molecular tests look for genetic material that comes only from the virus. How long does it take to get results? It depends on lab capacity. Results may be ready within hours, but often take at least a day or two. Much longer turnaround times are reported in many places. What about accuracy? The rate of false negatives — a test that says you don’t have the virus when you actually do have the virus — varies depending on how long infection has been present: in one study, the false-negative rate was 20% when testing was performed five days after symptoms began, but much higher (up to 100%) earlier in infection. The false positive rate — that is, how often the test says you have the virus when you actually do not — should be close to zero. Most false-positive results are thought to be due to lab contamination or other problems with how the lab has performed the test, not limitations of the test itself. A molecular test using a nasal swab is usually the best option, because it will have fewer false negative results than other diagnostic tests or samples from throat swabs or saliva. People who are in the hospital, though, may have other types of samples taken. Antigen tests How is it done? A nasal or throat swab. Where can you get these tests? At a hospital, a doctor’s office or at home (the FDA has authorized a home antigen test that requires no prescription). What does the test look for? This test identifies protein fragments (antigens) from the virus. How long does it take to get results? The technology involved is similar to a pregnancy test or a rapid strep test, with results available in minutes. What about accuracy? False negative results tend to occur more often with antigen tests than with molecular tests. This is why antigen tests are not favored by the FDA as a single test for active infection. Because antigen testing is quicker, less expensive, and requires less complex technology to perform than molecular testing, some experts recommend repeated antigen testing as a reasonable strategy. As with the molecular test, the false positive rate of antigen testing should be close to zero. Tests for past infection An antibody test can show if you have previously been infected with the COVID-19 virus. Antibody tests (also called serologic testing) How is it done? A sample of blood is taken. Where can you get these tests? At a doctor’s office, blood testing lab, or hospital. What does the test look for? These blood tests identify antibodies that the body’s immune system has produced in response to the infection. While a serologic test cannot tell you if you have an infection now, it can accurately identify past infection. How long does it take to get results? Results are usually available within a few days. What about accuracy? Having an antibody test too early can lead to false negative results. That’s because it takes a week or two after infection for your immune system to produce antibodies. The reported rate of false negatives is 20%. However, the range of false negatives is from 0% to 30%, depending on the study and when in the course of infection the test is performed. Research suggests antibody levels may wane over just a few months. And while a positive antibody test proves you’ve been exposed to the virus, it’s not yet known whether such results indicate a lack of contagiousness or long-lasting, protective immunity. The true accuracy of tests for COVID-19 is uncertain Unfortunately, it’s not clear exactly how accurate any of these tests are. There are several reasons for this:
How much does testing cost? Cost varies widely, from under $10 to hundreds of dollars, depending on whether your health insurance will cover the test, or if you’ll be paying out of pocket. It also depends on which test you get and where it’s done. It’s important to ask about cost ahead of time, especially if you are told to go to the ER or a private testing facility. Some communities offer free tests. Go online or call your town or city government to find out about this. The bottom line If we had fast, highly accurate, and inexpensive home testing, we could repeatedly test ourselves before going to work, heading off to school, or otherwise spending time near others. If the tests were more accurate, we could more confidently rely on testing to know when it’s safe to relax distancing, masking, and other protective measures. But we aren’t there yet. While we’re lucky to have reasonably accurate tests available so early in the course of a newly identified virus, we need better tests and easy access to them. All tests should undergo rigorous vetting by the FDA as soon as possible. Ideally, they should be covered by health insurance or offered free of charge to those who are uninsured. Lastly, widely available tests and short turnaround times for results are essential for effective contact tracing and getting this virus under control while awaitingwidespread vaccination. For more information about coronavirus
and COVID-19, see the Harvard
Health Publishing Coronavirus Resource
Center. Darkest
Days In Pandemic Lie Ahead, Expert Warns Oregon
Lawmakers Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota and a member of President Joe Biden’s COVID-19 transition team, told the House COVID-19 Subcommittee on Monday that the B.1.1.7 variant from Britain poses a major threat. “The darkest days are just coming upon us,” said Osterholm, who said he has reversed his prior stance that schools should reopen this spring. A similar tone was also struck on Monday by Dr. Rochelle Walensky, the head of the Centers for Disease Control and Prevention, during a White House briefing, according to press reports. She warned of "impending doom." "We have so much to look forward to, so much promise and potential of where we are and so much reason for hope," Walensky said. "But right now, I'm scared." Their stark prognoses came the same week that Oregon elementary schools for students in kindergarten through fifth grade can no longer offer exclusively online instruction. Starting this week, Oregon elementary schools must provide in-person or hybrid models that combine in-person and online instruction, due to an executive order from Gov. Kate Brown. Those schools can no longer exclusively offer online instruction, though they can still provide that mode to families who request it. Osterholm told lawmakers that the B.1.1.7 variant is “now readily infecting kids in levels I can’t believe.” For example, there was an outbreak of COVID-19 cases, some with the variant, that infected about 100 children in a daycare in Omaha. “We are seeing it jump like lightning,” Osterholm said. The CDC warned in January when the variant emerged in the United States that it would become the dominant strain by March. The B.1.1.7 variant quickly spread in Britain where it was first identified. Scientists say it is 50 to 70% more infectious than many other strains and perhaps 30% more deadly. Osterholm said he originally was a strong proponent for reopening schools due to the lack of evidence of infection in children. He’s since changed his stance on that, he said, calling at a “180-degree flip.” The B.1.1.7 variant underscores the need to vaccinate the population, said Osterholm, who is well-known in epidemiology circles for warning about the lack of preparation in the United States for a pandemic years before COVID-19. “I think B.1.1.7 has a chance to really cause us real damage in the country before we get out of the woods,” he said. Besides the British variant, health officials are watching variants from Brazil and South African although they have not spread so quickly. Experts believe the vaccines that have been approved for emergency use in the United States are effective against these variants. That’s why public health officials are racing to vaccinate as much of the population as possible to slow their spread. Osterholm said the United States is the only high-income nation to open everything up, even as overall COVID-19 case numbers increase. This pattern, he said, aids the spread of B.1.1.7. Osterholm said the situation should serve as a “tremendous motivator” for vaccine acceptance. The good news is that the U.S. has vaccines, but the problem is that the vaccine doses are not getting out quickly enough. Osterholm criticized moves by states to offer vaccines to more categories of people while some seniors wait. That's “not a victory, that’s a defeat,” he said, because it means that providers are “not necessarily vaccinating the people who need it most.” In Oregon, Brown delayed vaccinating senior citizens to give doses to public school teachers and early childhood instructors to allow schools to reopen sooner. Currently, about 66% of Oregonians age 65 and older have received at least one dose. Manufacturers are researching vaccines that will work for children under 16. Currently, only Pfizer vaccines are approved for children 16 and older. People have to be at least 18 to receive the Moderna or Johnson & Johnson vaccines. Osterhold said vaccines for younger children probably will not be available until sometime in the fall. Oregon has 16 cases with the B.1.1.7 variant, according to federal Centers for Disease Control and Prevention data. That doesn’t reflect the full picture because testing for the variant requires additional genomic sequencing beyond COVID-19 tests. The Oregon State Public Health Laboratory, part of the health authority, has announced it will start to perform genomic sequencing for specimens of public health significance starting Monday. Local public health agencies can submit a request for sequencing in cases that meet certain criteria, such as an individual who traveled, a person who tested positive in a “break through” case after receiving the vaccine and clusters of unusual size or severity. Labs at Oregon Health & Science University, Oregon State University and the University of Oregon are also performing the sequencing on samples. Washington state has 152 cases of the B.1.1.7 variant, federal data show. Nationwide, there are nearly 11,000 cases with the variant, with most hard-hit states in the East Coast and in the Midwest. However, the Northwest region could be just a month beyond those parts of the nation, Osterholm said. Study Shows Vaccines 90% Effective Even as the variant spreads, more evidence emerged Monday that the vaccines are effective. Oregon health care professionals, first responders and frontline workers participated in a federal study that found that the Pfizer and Moderna vaccines are 90% effective in preventing COVID-19 infections and illnesses. The Centers for Disease Control and Prevention study tested nearly 4,000 people who took the vaccine every week for a 13-week period. Nearly 12 percent of the participants were Oregonians. The other participants were in Arizona, Florida, Minnesota, Texas and Utah. “This study demonstrated that in real-world use, the mRNA vaccines are marvelously effective – 90% – in preventing SARS-CoV-2 infection as well as COVID-19 illness in frontline workers,” said Dr. Paul Cieslak, a senior health advisor, with the health authority. “These vaccines will keep people out of the hospital and also reduce spread of the virus. ” COVID-19 Cases Increase Slightly In Oregon, the rolling seven-day average of new COVID-19 cases increased slightly last week. Oregon had 349 new daily cases last week, up from 281 the prior week. Hospitalizations also increased, said Dr. Dean Sidelinger, state epidemiologist, adding that it’s too soon to know whether this is the start of a new trend.Sidelinger said Oregon schools are offering on-site testing for students and staff who develop symptoms or who are exposed to the virus. Sidelinger called school staff a key partner in curtailing infections because they have closer relationships with families and students than public health officials. Besides addressing elementary schools, Brown’s March 12 executive order calls for secondary schools to offer in-person instruction starting the week of April 19. The order requires schools to offer online instruction to families who want it through the end of the school year. Colt Gill, director of the Oregon Department of Education, said the state changed protocols to require only three feet of distancing at the elementary school level instead of six feet due following CDC guidance. During the hearing, Rep. Cedric Hayden, R-Roseburg, asked whether vaccines will be added to the vaccination list required by schools in the fall. Sidelinger said he “would not anticipate a quick process” of adding the vaccine to the required school schedules because they first need to be tested in clinical trials that are now underway. House Floor Session Canceled The Oregon House canceled its Monday floor session because a second person tied to that chamber tested positive for COVID-19, one week after a positive case shut down proceedings. The Legislature’s human resources office notified lawmakers about the positive case. In a memo, Lindsey O’Brien, chief of staff for House Speaker Tina Kotek, D-Portland, wrote that the floor session was canceled “out of an abundance of caution” as some people get tested. The House plans to have its next floor session Tuesday, unless additional cases emerge. “We haven’t received notice of any positive tests so far,” Danny Moran, spokesman for Kotek, said Monday in an email. Due to medical privacy rules, officials did not say whether the person was a lawmaker, staffer or other individual. House lawmakers spent last week in quarantine, the time needed to self isolate after potential exposure to the first person, who was on the House floor March 15 and 16. House legislative committees continued to meet virtually, as they have done throughout the session to prevent the virus’ spread. You can reach Ben Botkin at
ben@thelundreport.org
or via Twitter @BenBotkin1. Can the
vaccinated develop long Covid? That’s good news. But it doesn’t answer one big question: What’s the risk of so-called long Covid after a breakthrough infection? While most people recover from mild to moderate Covid-19 in a few weeks, long Covid is a perplexing set of symptoms — brain fog, fatigue and muscle pain, to name a few — that can persist for weeks or months after the active infection has ended. And it doesn’t happen only to people who had serious illness; sometimes long Covid affects people who had mild illness or no symptoms at all. And while many viruses, like influenza, also can lead to long-term fatigue and other symptoms, long Covid appears to be more common, although more data is needed. Several studies suggest that 10 percent to 30 percent of adults who catch the virus may experience long Covid. But most of what we know about long Covid comes from people who were infected before vaccines became available. What we know Much of what we know about long Covid in fully vaccinated people comes from a single study of antibody levels in Israeli health care workers who had breakthrough infections. Among 36 health workers with breakthrough infections, seven (19 percent) had lingering symptoms after six weeks, including loss of smell, cough, fatigue or trouble breathing. But even the study’s own authors say the study wasn’t designed to assess the risk of long Covid. “It was not the scope of this paper,” said Dr. Gili Regev-Yochay, the study’s senior author and the director of the infection prevention and control unit at Sheba Medical Center in Israel. While we can’t draw conclusions about the risk of long Covid from the experiences of seven patients, the finding confirms that long Covid can occur after a breakthrough infection. It isn’t clear, though, how common it might be or when those who have it might recover. What we don’t know Several physicians and scientists have told me they are frustrated that we don’t have more data about the risk of breakthrough infections and the course of illness that follows. “If mild breakthrough infection is turning into long Covid, we don’t have a grasp of that number,” Akiko Iwasaki, an immunologist at the Yale School of Medicine, told me. One of the reasons we know so little is that the C.D.C. collected nationwide data on all breakthrough infections for just four months before ending the practice in May. Now the agency tracks only breakthrough cases that result in hospitalization or death. The C.D.C. director, Dr. Rochelle Walensky, defended the decision last month, noting that the agency was collecting additional data from more than 20 cohorts, including groups of medical workers and people in long-term-care facilities. “We are absolutely studying and evaluating breakthrough infections in many different sites, many different people across the country,” Dr. Walensky said. “We are looking at those data on a weekly to biweekly basis, and we will be reporting on those soon.” The bottom line In some ways, the fact that we know so little about long Covid after breakthrough infection is good news. The fact that doctors haven’t seen large numbers of post-vaccination cases of long Covid suggests that breakthrough infections are still relatively uncommon, and long Covid after vaccination remains a relatively low risk. We may learn more in the near future, as the Delta variant causes new infections, including, presumably, more breakthrough cases. If some of those breakthrough patients develop symptoms of long Covid, they’ll start showing up in doctor’s offices in the coming months, said Zijian Chen, medical director of post-Covid care at Mount Sinai Health System in New York. Of course, the best way to avoid long
Covid is to avoid getting Covid in the first place: get
vaccinated, wear a mask and avoid spending time in enclosed
public spaces when you don’t know the vaccination
status of others. “The fewer infections we have in the
general population, the fewer cases of long Covid we’re
going to have,” Chen said. Feeling fatigued or feverish after
your COVID-19 vaccine? Here's why the CDC wants to know The CDC describes V-safe as a "smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccine." The program asks you to report any side effects you experience after the vaccine and, depending on their severity, may prompt someone from the CDC to reach out for more information. This week, the app received criticism for the fact that it's available only on smartphones, excluding the millions of people in the U.S. who do not have one. But for the vast majority who do, says Dr. Carolyn B. Bridges, associate director for adult immunization at the Immunization Action Coalition, it can be an extremely helpful resource. Here's what you need to know. Anyone vaccinated can sign up for V-safe, and your vaccination center should have information about it Bridges says vaccine distribution centers should provide info about V-safe. "When you go get your vaccine, they should be giving you a handout with a QR code on there, which you can use to sign up," she says. "They'll send you questions about the kind of side effects that you're having for a period of time after you get your vaccine ... and if you have a more unusual or severe something to report, then you may get a follow-up call." For those who do not receive a handout, the CDC has directions about the registration process on its website. The info gathered on V-safe is supplemental to VAERS, the Vaccine Adverse Event Reporting System The CDC has long tracked severe reactions to vaccines through VAERS, the Vaccine Adverse Event Reporting System, which requires clinicians to record any concerning clinical reactions. Bridges says that V-safe is not a replacement, but merely an additional way to track side effects through self-reporting. "These vaccine trials have all been large, 40,000 people or so, but that may not pick up something that occurs in one in a million," she says. "So while VAERS is ongoing, V-safe is supplemental and involves you getting a text message you respond to." Since the U.S. vaccination program moved at unprecedented speed, churning out multiple vaccines in less than a year, V-safe helps fill in the gaps, and Bridges says it may even make some feel better about their choice to get one. "I think it's important for people to participate in V-safe if they want to contribute," she says. "I think it will be important for people who maybe were not as comfortable with the vaccination at the beginning, just to give them a little more control and more information." Nearly 4 million Americans have begun reporting on V-safe, recording side effects like headache and fatigue During a meeting on March 1, Dr. Tom Shimabukuro, deputy director of the Immunization Safety Office at the CDC, shared the first data about V-safe, revealing that 3.8 million people had begun using the app by Feb. 16. The number represented just a small fraction of the 55 million individuals who had received one or more doses of the Pfizer or Moderna vaccines (the Johnson & Johnson vaccine was not yet available) by that time, but his publicly available presentation shows valuable insight gained from data. For example, much like volunteers in Pfizer's and Moderna's vaccination studies, those who received the vaccines reported three main symptoms after the shots: fatigue, headache and myalgia (muscle pain). These side effects were followed by other common ones including chills, nausea and fever. Reactions significantly increased after individuals got the second dose of Pfizer. (At the time, information for the second Moderna dose was not available.) More than 16,000 individuals reported getting pregnant after their vaccination Of all the myths circulating about the COVID-19 vaccine, the one suggesting that the vaccines may cause infertility in women seems particularly damaging. But as of mid-January, the V-safe data, according to Shimabukuro's slides, included 30,000 pregnant women, providing data that led the CDC to conclude that "adverse events observed among pregnant women in V-safe did not indicate any safety problem." Bridges says this is one example of
why V-safe is so valuable, especially given that neither
Moderna's nor Pfizer's clinical trials included pregnant
women. "All the pregnancies recorded, that is incredibly
helpful to have that data," she says. "[There has
been] misinformation and what we all want and need is
real data — information that's accurate. So I think
this is a really great way if people are willing to
volunteer." If you've been exposed to the
coronavirus As COVID-19 continues to spread, the chances that you will be exposed and get sick continue to increase. If you've been exposed to someone with COVID-19 or begin to experience symptoms of the disease, you may be asked to self-quarantine or self-isolate. What does that entail, and what can you do to prepare yourself for an extended stay at home? How soon after you're infected will you start to be contagious? And what can you do to prevent others in your household from getting sick? What are the symptoms of COVID-19? Some people infected with the virus have no symptoms. When the virus does cause symptoms, common ones include fever, body ache, dry cough, fatigue, chills, headache, sore throat, loss of appetite, and loss of smell. In some people, COVID-19 causes more severe symptoms like high fever, severe cough, and shortness of breath, which often indicates pneumonia. People with COVID-19 may also experience neurological symptoms, gastrointestinal (GI) symptoms, or both. These may occur with or without respiratory symptoms. For example, COVID-19 affects brain function in some people. Specific neurological symptoms seen in people with COVID-19 include loss of smell, inability to taste, muscle weakness, tingling or numbness in the hands and feet, dizziness, confusion, delirium, seizures, and stroke. In addition, some people have gastrointestinal (GI) symptoms, such as loss of appetite, nausea, vomiting, diarrhea, and abdominal pain or discomfort associated with COVID-19. The virus that causes COVID-19 has also been detected in stool, which reinforces the importance of hand washing after every visit to the bathroom and regularly disinfecting bathroom fixtures. What should I do if I think I or my child may have a COVID-19 infection? First, call your doctor or pediatrician for advice. If you do not have a doctor and you are concerned that you or your child may have COVID-19, contact your local board of health. They can direct you to the best place for testing and treatment in your area. If you have a high or very low body temperature, shortness of breath, confusion, or feeling you might pass out, you need to seek immediate medical evaluation. Call the urgent care center or emergency department ahead of time to let the staff know that you are coming, so they can be prepared for your arrival. How do I know if I have COVID-19 or the regular flu? COVID-19 often causes symptoms similar to those a person with a bad cold or the flu would experience. And like the flu, the symptoms can progress and become life-threatening. So far there has been much less than the usual number of cases of influenza, likely due to the enhanced public health measures to prevent the spread of COVID. Therefore, at the current time, people with "flulike" symptoms should assume they have COVID. That means isolating and contacting your doctor or local board of health to arrange testing. How is someone tested for COVID-19? A specialized diagnostic test must be done to confirm that a person has an active coronavirus infection. Most often a clinician takes a swab of your nose (or both your nose and throat). Some tests may be done using a saliva sample. The sample is then checked for the virus's genetic material (PCR test) or for specific viral proteins (antigen test). Antibody tests can tell if someone has been infected with COVID-19. But the infected person doesn't begin producing antibodies immediately. It can take as long as three weeks for a blood antibody test to turn positive. That's why it is not useful as a diagnostic test for someone with new symptoms. Are there at-home tests for COVID-19? Available over the counter, without a doctor's prescription The FDA has granted emergency use authorization (EUA) to the first COVID-19 test that can be obtained without a doctor's prescription and fully performed at home. The Ellume COVID-19 Home Test is approved for use in adults and in children age 2 and older, with or without COVID-19 symptoms. To take the test, you collect a nasal swab, stir it in a vial of processing fluid, then place a drop of the fluid in an analyzer. The device, which detects coronavirus antigens, delivers a positive or negative test result to your smartphone within 20 minutes. Like other antigen tests, this test is less accurate than "gold standard" PCR tests, but initial studies suggest the accuracy comes close to PCR testing. Until there is much more real-world experience with this home test, the FDA recommends interpreting any result with caution. If you have COVID-like symptoms, you should self-isolate and contact your doctor whether your test is positive or negative. Your doctor will likely suggest a PCR test for confirmation. You should also self-isolate and call your doctor if you get a positive test result, even if you don't have symptoms. A negative test if you don't have symptoms makes it very unlikely that you are infected. However, you should continue to follow the standard prevention strategies of physical distancing, avoiding crowds, wearing a mask, and hand washing. This test will be available in drugstores and is expected to cost about $30. Available with a doctor's presctiption The FDA has approved a diagnostic test for COVID-19 that can be completed entirely at home, from sample collection to receiving the results. Other FDA-approved COVID-19 tests allow at-home sample collection, but still have to be shipped to a laboratory for processing. The Lucira COVID-19 All-In-One Test Kit is approved for people ages 14 and older who are suspected of having COVID-19. It requires a doctor's prescription. The company does not expect the test to be widely available until the spring of 2021. To perform the test, you swirl a swab in both nostrils, then stir the swab in a vial of chemicals. The vial is then plugged into a battery-powered test unit, which returns a positive or negative test result within 30 minutes. The test works by making copies of the virus's genetic material (if present) until it reaches detectable levels. It does this using a technique called loop-mediated isothermal amplification (LAMP). The method is similar to PCR, the gold standard of COVID-19 diagnostic testing. The LAMP test provides much faster results, but it is less accurate. In a head-to-head comparison, the Lucira test missed 6% of people who tested positive for COVID by PCR. Because a person can be infected and have a negative LAMP test, you should always self-quarantine if you have symptoms consistent with COVID, or have had recent contact with someone who has the infection, until you can get a PCR test. The FDA has granted emergency use authorization to a rapid antigen test for COVID-19. How is it different from other tests on the market? The BinaxNOW COVID-19 Ag Card, as the test is known, detects antigen proteins on the surface of SARS-CoV-2, the virus that causes COVID-19. Unlike other diagnostic tests for COVID-19, BinaxNOW does not require a laboratory or other equipment to process or analyze the test results. This makes it portable and fast — results are available within 15 minutes. This test is approved for use in people who are suspected of having COVID-19, and must be done within seven days of when their symptoms began. A prescription is needed to get this test, which can be performed in authorized locations including doctor's offices and emergency rooms. To perform the test, a sample obtained using a nasal swab is inserted into the BinaxNOW test card. The test is a lateral flow immunoassay, which works like a pregnancy test. The appearance of colored lines on the test strip indicates whether or not you have tested positive for COVID-19. The test comes with a smartphone app that can be used to share test results. Positive test results are highly specific, meaning that if you test positive you are very likely to be infected, particularly if you are tested during the first week of infection when you are experiencing symptoms. False negatives are a bigger concern. As with other antigen tests, BinaxNOW can miss infections, producing negative test results in people who are actually infected. Still, this test could have an important role during this pandemic. It offers a quick, easy, and inexpensive way to test more people, more quickly. What is the difference between a PCR test and an antigen test for COVID-19? PCR tests and antigen tests are both diagnostic tests, which means that they can be used to determine whether you currently have an active coronavirus infection. However, there are important differences between these two types of tests. PCR tests detect the presence of the virus's genetic material using a technique called reverse transcriptase polymerase chain reaction, or RT-PCR. For this test, a sample may be collected through a nasal or throat swab, or a saliva sample may be used. The sample is typically sent to a laboratory where coronavirus RNA (if present) is extracted from the sample and converted into DNA. The DNA is then amplified, meaning that many of copies of the viral DNA are made, in order to produce a measurable result. The accuracy of any diagnostic test depends on many factors, including whether the sample was collected properly, when during the course of illness the testing was done, and whether the sample was maintained in appropriate conditions while it was shipped to the laboratory. Generally speaking, PCR tests are highly accurate. However, it can take days to over a week to get the results of a PCR test. Antigen tests detect specific proteins on the surface of the coronavirus. They are sometimes referred to as rapid diagnostic tests because it can take less than an hour to get the test results. Positive antigen test results are highly specific, meaning that if you test positive you are very likely to be infected. However, there is a higher chance of false negatives with antigen tests, which means that a negative result cannot definitively rule out an active infection. If you have a negative result on an antigen test, your doctor may order a PCR test to confirm the result. It may be helpful to think of a COVID antigen test as you would think of a rapid strep test or a rapid flu test. A positive result for any of these tests is likely to be accurate, and allows diagnosis and treatment to begin quickly, while a negative result often results in further testing to confirm or overturn the initial result. How do saliva tests compare to nasal swab tests for diagnosing COVID-19? Samples for COVID-19 tests may be collected through a long swab that is inserted into the nose and sometimes down to the throat, or from a saliva sample. The saliva test is easier to perform — spitting into a cup versus submitting to a swab — and more comfortable. Because a person can independently spit into a cup, the saliva test does not require interaction with a healthcare worker. This cuts down on the need for masks, gowns, gloves, and other protective equipment. Either saliva or swab samples may be used for PCR tests, which detect genetic material from the coronavirus. Swab or saliva samples can also be used for antigen tests, which detect specific proteins on the surface of the coronavirus. A systematic review and meta-analysis published in JAMA Internal Medicine found that saliva- and nasal swab-based tests that used a technique similar to PCR were similarly accurate. A positive result on either test meant that it was accurate at diagnosing the infection 99% of the time. However, approximately 16 out of 100 people who are infected will be missed. These results are very similar to prior studies, reinforcing that a single negative swab or saliva test does not mean you don't have COVID. If you have symptoms suggestive of COVID, presume you may still be infected to avoid transmitting the virus to others. How reliable are the tests for COVID-19? Two types of diagnostic tests are currently available in the US. PCR tests detect viral RNA. Antigen tests, also called rapid diagnostic tests, detect specific proteins on the surface of the coronavirus. Antigen test results may come back in as little as 15 to 45 minutes; you may wait several days or longer for PCR test results. The accuracy of any diagnostic test depends on many factors, including whether the sample was collected properly. For PCR tests, which are typically analyzed in a laboratory, test results may be affected by the conditions in which the test was shipped to the laboratory. Results may also be affected by the timing of the test. For example, if you are tested on the day you were infected, your test result is almost guaranteed to come back negative, because there are not yet enough viral particles in your nose or saliva to detect. The chance of getting a false negative test result decreases if you are tested a few days after you were infected, or a few days after you develop symptoms. Generally speaking, if a test result comes back positive, it is almost certain that the person is infected. A negative test result is less definite. There is a higher chance of false negatives with antigen tests. If you have a negative result on an antigen test, your doctor may order a PCR test to confirm the result. If you experience COVID-like symptoms and get a negative PCR test result, there is no reason to repeat the test unless your symptoms get worse. If your symptoms do worsen, call your doctor or local or state healthcare department for guidance on further testing. You should also self-isolate at home. Wear a mask when interacting with members of your household. And practice physical distancing. I've heard that the immune system produces different types of antibodies when a person is infected with the COVID-19 coronavirus. How do they differ? Why is this important? When a person gets a viral or bacterial infection, a healthy immune system makes antibodies against one or more components of the virus or bacterium. The COVID-19 coronavirus contains ribonucleic acid (RNA) surrounded by a protective layer, which has spike proteins on the outer surface that can latch on to certain human cells. Once inside the cells, the viral RNA starts to replicate and also turns on the production of proteins, both of which allow the virus to infect more cells and spread throughout the body, especially to the lungs. While the immune system could potentially respond to different parts of the virus, it's the spike proteins that get the most attention. Immune cells recognize the spike proteins as a foreign substance and begin producing antibodies in response. There are two main categories of antibodies: Binding antibodies. These antibodies can bind to either the spike protein or a different protein known as the nucleocapsid protein. Binding antibodies can be detected with blood tests starting about one week after the initial infection. If antibodies are found, it's extremely likely that the person has been infected with the COVID-19 coronavirus. The antibody level declines over time after an infection, sometimes to an undetectable level. Binding antibodies help fight the infection, but they might not offer protection against getting reinfected in the future. It depends on whether they are also neutralizing antibodies. Neutralizing antibodies. The body makes these antibodies specifically against the spike protein. In the laboratory, scientists have observed that neutralizing antibodies block the virus from getting into live cells. And human studies have shown that neutralizing antibodies made against other coronaviruses help prevent re-infection. Scientists are optimistic that the same will be true for the COVID-19 coronavirus, and that neutralizing antibodies will block cell-to-cell transmission of this virus in humans, and offer protection against reinfection, at least for two to three months. In November 2020, the FDA authorized emergency use of a test for COVID-19 neutralizing antibodies. People who have completely recovered from a COVID-19 infection and have neutralizing antibodies in their blood can potentially donate plasma, the component of blood that contains antibodies, to help COVID-19 patients recover from their illness. Can a person who has been infected with coronavirus get infected again? Natural immunity to COVID-19 is the protection that results from having been sick. But we don't know how long natural immunity lasts, or how strong it is. So can we count on natural immunity to protect us from reinfection? If so, for how long? Unfortunately, we don't know the answer to either of those questions. There have been some confirmed cases of reinfection with COVID-19. In other words, a person got sick with COVID-19, recovered, and then became infected again. This is rare, but it can happen. The CDC states that people who have gotten sick with COVID-19 may still benefit from getting vaccinated. For now, people are eligible to get the COVID-19 vaccine whether or not they were previously infected. Vaccination criteria may change in the future as scientists learn more about natural immunity after COVID illness. It's also worth noting that someone who has been re-infected — even someone with no symptoms — has the potential to spread the virus to others. That means that everyone, even those who have recovered from coronavirus infection, and those who have been vaccinated, should continue to wear masks, practice physical distancing, and avoid crowds. What is serologic (antibody) testing for COVID-19? What can it be used for? A serologic test is a blood test that looks for antibodies created by your immune system. There are many reasons you might make antibodies, the most important of which is to help fight infections. The serologic test for COVID-19 specifically looks for antibodies against the COVID-19 virus. Your body takes one to three weeks after you have acquired the infection to develop antibodies to this virus. For this reason, serologic tests are not sensitive enough to accurately diagnose an active COVID-19 infection, even in people with symptoms. However, serologic tests can help identify anyone who has recovered from coronavirus. This may include people who were not initially identified as having COVID-19 because they had no symptoms, had mild symptoms, chose not to get tested, had a false-negative test, or could not get tested for any reason. Serologic tests will provide a more accurate picture of how many people have been infected with, and recovered from, coronavirus, as well as the true fatality rate. Serologic tests may also provide information about whether people become immune to coronavirus once they've recovered and, if so, how long that immunity lasts. The accuracy of serologic tests varies depending on the test and when in the course of infection the test is performed. How soon after I'm infected with the new coronavirus will I start to be contagious? The time from exposure to symptom onset (known as the incubation period) is thought to be two to 14 days, though symptoms typically appear within four or five days after exposure. We know that a person with COVID-19 may be contagious 48 hours before starting to experience symptoms. Emerging research suggests that people may actually be most likely to spread the virus to others during the 48 hours before they start to experience symptoms. This strengthens the case for face masks, physical distancing, and contact tracing, all of which can help reduce the risk that someone who is infected but not yet experiencing symptoms may unknowingly infect others. Can people without symptoms spread the virus to others? "Without symptoms" can refer to two groups of people: those who eventually do have symptoms (pre-symptomatic) and those who never go on to have symptoms (asymptomatic). During this pandemic, we have seen that people without symptoms can spread the coronavirus infection to others. A person with COVID-19 may be contagious 48 hours before starting to experience symptoms. In fact, people without symptoms may be more likely to spread the illness, because they are unlikely to be isolating and may not adopt behaviors designed to prevent spread. But what about people who never go on to develop symptoms? A published in JAMA Network Open found that almost one out of every four infections may be transmitted by individuals with asymptomatic infections. This study provides yet another reason to wear face masks and observe physical distancing. Both measures can help reduce the risk that someone who does not have symptoms will infect others. For how long after I am infected will I continue to be contagious? At what point in my illness will I be most contagious? People are thought to be most contagious early in the course of their illness, when they are beginning to experience symptoms, especially if they are coughing and sneezing. But people with no symptoms can also spread the coronavirus to other people. In fact, people who are infected may be more likely to spread the illness if they are asymptomatic, or in the days before they develop symptoms, because they are less likely to be isolating or adopting behaviors designed to prevent spread. By the 10th day after COVID symptoms begin, most people will no longer be contagious, as long as their symptoms have continued to improve and their fever has resolved. People who test positive for the virus but never develop symptoms over the following 10 days after testing are probably no longer contagious, but again there are documented exceptions. A full, 14-day quarantine remains the best way to avoid spreading the virus to others after you've been exposed to someone with COVID-19. However, according to CDC guidelines, you may discontinue quarantine after a minimum of 10 days if you do not have any symptoms, or after a minimum of seven days if you have a negative COVID test within 48 hours of when you plan to end quarantine. People who are fully vaccinated do not need to quarantine or get tested after exposure, because their risk of infection is low. But they should be alert for symptoms, and should isolate and get tested if they develop symptoms after exposure. One of the main problems with general rules regarding contagion and transmission of this coronavirus is the marked differences in how it behaves in different individuals. That's why everyone needs to wear a mask and keep a physical distance of at least six feet. If I get sick with COVID-19, how long until I will feel better? It varies. Most people with mild cases appear to recover within one to two weeks. However, recent surveys conducted by the CDC found that recovery may take longer than previously thought, even for adults with milder cases who do not require hospitalization. The CDC survey found that one-third of these adults had not returned to normal health within two to three weeks of testing positive for COVID-19. Among younger adults (ages 18 to 34) who did not require hospitalization and who did not have any underlying health conditions, nearly one in five had not returned to normal health within two to three weeks after testing positive for COVID-19. With severe cases, recovery can take six weeks or more. Some people may experience longer-term physical, cognitive, and psychological problems. Their symptoms may alternately improve and worsen over time, and can include a variety of difficulties, from fatigue and trouble concentrating to anxiety, muscle weakness, and continuing shortness of breath. Who are long haulers? And what is post-viral syndrome? Long haulers are people who have not fully recovered from COVID-19 weeks or even months after first experiencing symptoms. Some long haulers experience continuous symptoms for weeks or months, while others feel better for weeks, then relapse with old or new symptoms. The constellation of symptoms long haulers experience, sometimes called post-COVID-19 syndrome or post-acute sequelae of SARS-CoV-2 infection (PASC), is not unique to this infection. Other infections, such as Lyme disease, can cause similar long-lasting symptoms. Emerging research may help predict who will become a long hauler. One study found that COVID-19 patients who experienced more than five symptoms during their first week of illness were significantly more likely to become long haulers. Certain symptoms — fatigue, headache, difficulty breathing, a hoarse voice, and muscle or body aches — experienced alone or in combination during the first week of illness also increased the chances of becoming a long hauler, as did increasing age and higher body mass index (BMI). Though these factors may increase the likelihood of long-term symptoms, anyone can become a long hauler. Many long haulers initially have mild to moderate symptoms — or no symptoms at all — and do not require hospitalization. Previously healthy young adults, not just older adults with coexisting medical conditions, are also experiencing post-COVID-19 syndrome. Symptoms of post-COVID-19 syndrome, like symptoms of COVID-19 itself, can vary widely. Some of the more common lasting symptoms include fatigue, worsening of symptoms after physical or mental activity, brain fog, shortness of breath, chills, body ache, headache, joint pain, chest pain, cough, and lingering loss of taste or smell. Many long haulers report cognitive dysfunction or memory loss that affects their day-to-day ability to do things like make decisions, have conversations, follow instructions, and drive. The common thread is that long haulers haven't returned to their pre-COVID health, and ongoing symptoms are negatively affecting their quality of life. There's already some speculation, but no definite answers, about what is causing these ongoing symptoms. Some researchers suspect that SARS-CoV-2 infection triggers long-lasting changes in the immune system. Others propose that it triggers autonomic nervous system dysregulation, which can impact heart rate, blood pressure, and sweating, among other things. In February 2021, the National Institutes of Health announced a $1.15 billion initiative to support research into the causes and ultimately the prevention and treatment of long-haul COVID. Many long haulers never had laboratory confirmation of COVID-19, which can make it tricky to diagnose post-COVID-19 syndrome. Early on in the pandemic, tests were scarce. Many people who suspected they had COVID-19 self-isolated without getting a test, or were refused a COVID test when they requested one. And the tests themselves have not been entirely reliable; both diagnostic tests and antibody tests may return false negative results if taken too early or too late in the course of illness. How long after I start to feel better will be it be safe for me to go back out in public again? The most recent CDC guidance states that someone who has had COVID-19 can discontinue isolation once they have met the following criteria: 1. It has been more than 10 days since your symptoms began. 2. You have been fever-free for more than 24 hours without the use of fever-reducing medications. 3. Other symptoms have improved. The CDC is no longer recommending a negative COVID-19 test before going back out in public. Anyone who tested positive for COVID-19 but never experienced symptoms may discontinue isolation 10 days after they first tested positive for COVID-19. Even after discontinuing isolation, you should still take all precautions when you go out in public, including wearing a mask, minimizing touching surfaces, and keeping at least six feet of distance away from other people. What's the difference between self-isolation and self-quarantine, and who should consider them? Self-isolation is voluntary isolation at home by those who have or are likely to have COVID-19 and are experiencing mild symptoms of the disease (in contrast to those who are severely ill and may require hospitalization). The purpose of self-isolation is to prevent spread of infection from an infected person to others who are not infected. If possible, the decision to isolate should be based on physician recommendation. If you have tested positive for COVID-19, you should self-isolate. You should strongly consider self-isolation if you
You may also consider self-isolation if you have symptoms consistent with COVID-19 (fever, cough, difficulty breathing) but have not had known exposure to the new coronavirus and have not been tested for it. In this case, it may be reasonable to isolate yourself for a minimum of 10 days from when you begin to experience symptoms. Self-quarantine is advised for anyone who has been exposed to the COVID-19 virus, regardless of whether you are experiencing symptoms. The purpose of self-quarantine (as with self-isolation) is to prevent the possible spread of COVID-19. A full, 14-day quarantine remains the best way to ensure that you don't spread the virus to others. However, according to CDC guidelines, you may discontinue quarantine after a minimum of 10 days if you do not have any symptoms, or after a minimum of seven days if you have a negative COVID test within 48 hours of when you plan to end quarantine. According to CDC guidelines released in March 2021, people who are fully vaccinated do not need to quarantine or get tested after exposure, because their risk of infection is low. But they should be alert for symptoms, and should isolate and get tested if they develop symptoms after exposure. What does it really mean to self-isolate or self-quarantine? What should or shouldn't I do? If you are sick with COVID-19 or think you may be infected with the COVID-19 virus, it is important not to spread the infection to others while you recover. While home-isolation or home-quarantine may sound like a staycation, you should be prepared for a long period during which you might feel disconnected from others and anxious about your health and the health of your loved ones. Staying in touch with others by phone or online can be helpful to maintain social connections, ask for help, and update others on your condition. Here's what the CDC recommends to minimize the risk of spreading the infection to others in your home and community. Stay home except to get medical care
Call ahead before visiting your doctor
Separate yourself from other people and animals in your home
Wear a face mask if you are sick
Cover your coughs and sneezes
Clean your hands often
Don't share personal household items
Clean all "high-touch" surfaces every day High touch surfaces include counters, tabletops, doorknobs, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables.
Monitor your symptoms
What types of medications and health supplies should I have on hand for an extended stay at home? Try to stock at least a 30-day supply of any needed prescriptions. If your insurance permits 90-day refills, that's even better. Make sure you also have over-the-counter medications and other health supplies on hand. Medical and health supplies
When can I discontinue my self-quarantine? A full, 14-day quarantine remains the best way to ensure that you don't spread the virus to others after you've been exposed to someone with COVID-19. However, according to CDC guidelines, you may discontinue quarantine after a minimum of 10 days if you do not have any symptoms, or after a minimum of 7 days if you have a negative COVID test within 48 hours of when you plan to end quarantine. How can I protect myself while caring for someone that may have COVID-19? You should take many of the same precautions as you would if you were caring for someone with the flu:
My parents are older, which puts them at higher risk for COVID-19, and they don't live nearby. How can I help them if they get sick? Caring from a distance can be stressful. Start by talking to your parents about what they would need if they were to get sick. Put together a single list of emergency contacts for their (and your) reference, including doctors, family members, neighbors, and friends. Include contact information for their local public health department. You can also help them to plan ahead. For example, ask your parents to give their neighbors or friends a set of house keys. Have them stock up on prescription and over-the counter medications, health and emergency medical supplies, and nonperishable food and household supplies. Check in regularly by phone, Skype, or however you like to stay in touch. Can people infect pets with the COVID-19 virus? The virus that causes COVID-19 does appear to spread from people to pets, according to the FDA, though this is uncommon. Research has found that cats and ferrets are more likely to become infected than dogs. If you have a pet, do the following to reduce their risk of infection:
If you become sick with COVID-19, restrict contact with your pets, just like you would around other people. This means you should forgo petting, snuggling, being kissed or licked, and sharing food or bedding with your pet until you are feeling better. When possible, have another member of your household care for your pets while you are sick. If you must care for your pet while you are sick, wash your hands before and after you interact with your pets and wear a face mask. At present, it is considered unlikely that pets can spread the COVID-19 virus to humans. However, pets can spread other infections that cause illness, including E. coli and Salmonella, so wash your hands thoroughly with soap and water after interacting with your animal companions. Blog posts: What
is COVID-19 brain fog — and how can you clear
it? Podcast: You think you've got COVID-19. Here's what you need to do We asked Dr.
Mallika Marshall, medical
reporter for CBS-affiliate WBZ TV in Boston and an
instructor at Harvard Medical School, how we should react
when we start to experience a dry cough or perhaps spike a
fever. Who do you call? How do you protect your family? When
does it make sense to move toward an emergency department,
and how should we prepare? Dr. Marshall is the host of
Harvard Health Publishing's online
course series, and an urgent
care physician at Mass General Hospital. Which test is best for
COVID-19? So, which tests to use? Start here: There are tests that diagnose current infection and tests that show whether you previously had SARS-CoV-2, the virus that causes COVID-19. The FDA has granted emergency use authorization (EUA) for hundreds of COVID-19 diagnostic tests. This allows makers to market tests without receiving formal FDA approval because there is a public health emergency. Because this novel coronavirus is indeed novel, and COVID-19 is a new disease, information about available tests is incomplete and testing options keep changing. Tests vary in terms of accuracy, cost, recommended use for people of various ages, and convenience. This blog post reviews features of the major types of tests. For more detailed information on individual tests, check the FDA’s updated list of authorized tests, which has links to the test makers’ websites. Diagnostic tests for current infection If you want to know whether or not you have the virus, there are two types of tests: molecular tests and antigen testing. Molecular tests (also called PCR tests, viral RNA tests, nucleic acid tests) How is it done? Nasal swabs, throat swabs, and tests of saliva or other bodily fluids. Where can you get this test? At a hospital, in a medical office, in your car, or even at home. The FDA has authorized a home molecular test that requires no prescription. What does the test look for? Molecular tests look for genetic material that comes only from the virus. How long does it take to get results? It depends on lab capacity. Results may be ready within hours, but often take at least a day or two. Much longer turnaround times are reported in many places. What about accuracy? The rate of false negatives — a test that says you don’t have the virus when you actually do have the virus — varies depending on how long infection has been present: in one study, the false-negative rate was 20% when testing was performed five days after symptoms began, but much higher (up to 100%) earlier in infection. The false positive rate — that is, how often the test says you have the virus when you actually do not — should be close to zero. Most false-positive results are thought to be due to lab contamination or other problems with how the lab has performed the test, not limitations of the test itself. A molecular test using a nasal swab is usually the best option, because it will have fewer false negative results than other diagnostic tests or samples from throat swabs or saliva. People who are in the hospital, though, may have other types of samples taken. Antigen tests How is it done? A nasal or throat swab. Where can you get these tests? At a hospital, a doctor’s office or at home (the FDA has authorized a home antigen test that requires no prescription). What does the test look for? This test identifies protein fragments (antigens) from the virus. How long does it take to get results? The technology involved is similar to a pregnancy test or a rapid strep test, with results available in minutes. What about accuracy? False negative results tend to occur more often with antigen tests than with molecular tests. This is why antigen tests are not favored by the FDA as a single test for active infection. Because antigen testing is quicker, less expensive, and requires less complex technology to perform than molecular testing, some experts recommend repeated antigen testing as a reasonable strategy. As with the molecular test, the false positive rate of antigen testing should be close to zero. Tests for past infection An antibody test can show if you have previously been infected with the COVID-19 virus. Antibody tests (also called serologic testing) How is it done? A sample of blood is taken. Where can you get these tests? At a doctor’s office, blood testing lab, or hospital. What does the test look for? These blood tests identify antibodies that the body’s immune system has produced in response to the infection. While a serologic test cannot tell you if you have an infection now, it can accurately identify past infection. How long does it take to get results? Results are usually available within a few days. What about accuracy? Having an antibody test too early can lead to false negative results. That’s because it takes a week or two after infection for your immune system to produce antibodies. The reported rate of false negatives is 20%. However, the range of false negatives is from 0% to 30%, depending on the study and when in the course of infection the test is performed. Research suggests antibody levels may wane over just a few months. And while a positive antibody test proves you’ve been exposed to the virus, it’s not yet known whether such results indicate a lack of contagiousness or long-lasting, protective immunity. The true accuracy of tests for COVID-19 is uncertain Unfortunately, it’s not clear exactly how accurate any of these tests are. There are several reasons for this:
How much does testing cost? Cost varies widely, from under $10 to hundreds of dollars, depending on whether your health insurance will cover the test, or if you’ll be paying out of pocket. It also depends on which test you get and where it’s done. It’s important to ask about cost ahead of time, especially if you are told to go to the ER or a private testing facility. Some communities offer free tests. Go online or call your town or city government to find out about this. The bottom line If we had fast, highly accurate, and inexpensive home testing, we could repeatedly test ourselves before going to work, heading off to school, or otherwise spending time near others. If the tests were more accurate, we could more confidently rely on testing to know when it’s safe to relax distancing, masking, and other protective measures. But we aren’t there yet. While we’re lucky to have reasonably accurate tests available so early in the course of a newly identified virus, we need better tests and easy access to them. All tests should undergo rigorous vetting by the FDA as soon as possible. Ideally, they should be covered by health insurance or offered free of charge to those who are uninsured. Lastly, widely available tests and short turnaround times for results are essential for effective contact tracing and getting this virus under control while awaitingwidespread vaccination. For more information about coronavirus
and COVID-19, see the Harvard
Health Publishing Coronavirus Resource
Center. Memory
loss and 'brain fog' may be side effects of COVID-19, new
study shows - 10/25/21 The study, which was published Friday in the peer-reviewed medical journal JAMA Network Open, analyzed patients who contracted COVID-19, not people who only received the COVID-19 vaccine. The most common cognitive deficits the study identified were memory encoding and memory recall, which showed up in 24% and 23% of the participants, respectively. Memory encoding is the process of storing sensory input as a memory, such as storing a phone number in your head by repeating it out loud a few times. Memory recall refers to accessing memories that are stored already and retrieving them for use. The study used the Hopkins Verbal Learning Test to show participants a series of words in different categories and see how many they could recall. Another test, called the Number Span test, would see how many digits someone could recall from memory after seeing the numbers on a screen. Other common side effects included processing speed (the time it takes someone to perform a mental task), executive functioning (associated with setting and completing goals), and phonemic and category fluency (the ability to come up with words based on certain criteria). An example of phonemic fluency is asking participants to come up with as many words that start with a "C" as possible, and category fluency involves asking them to list words related to a category, such as animals, according to Oxford's Archives of Clinical Neuropsychology. Hospitalized patients were much more likely than non-hospitalized patients to struggle with attention, executive functioning, category fluency, memory encoding and memory recall. Another study that documented "brain fog" was published by Oxford University and the National Institute for Health Research study earlier in October. Cognitive symptoms were seen in about 8% of patients and were more common among the elderly. The study also found common lingering
symptoms, such as trouble breathing, abdominal ailments,
fatigue, pain, anxiety and depression. Men. Don't get
Covid or else. Erectile dysfunction, anosmia and long
Covid - 3/6/22 Let’s start with anosmia. A new study examined golden hamsters that had been infected with the coronavirus and tracked the damage to their olfactory systems over time. (How could you know if golden hamsters could smell? Researchers didn’t feed them for several hours and then buried Cocoa Puffs in their bedding to see if they could find the cereal.) The research, which also examined tissue specimens from infected humans, seems to have settled the debate over whether the coronavirus infects the nerve cells that detect odors: It does not. But the researchers found that the virus did attack other supporting cells that line the nasal cavity. Immune cells then flood the region to fight the virus. The subsequent inflammation wreaks havoc on smell receptors, essentially short-circuiting them, the researchers reported. The paper significantly advances the understanding of how cells critical to the sense of smell are affected by the virus, despite the fact that they are not directly infected. And now onto genitals: A group of researchers in Louisiana who were scanning the bodies of three infected rhesus macaque monkeys were surprised to find the virus within the male genital tract. The researchers discovered that the virus infected the prostate, penis, testicles and surrounding blood vessels in the monkeys. The finding suggests that symptoms like erectile dysfunction — reported by about 10 to 20 percent of men with Covid — may be caused directly by the virus, not by inflammation or fever. Men infected with the virus are three to six times as likely as others to develop erectile dysfunction, which is believed to be an indicator of long Covid. Patients have also reported symptoms such as testicular pain, reduced sperm counts and decreased fertility. The paper’s senior author said he
next planned to determine whether the testicles were a
reservoir for the coronavirus, as had been hypothesized by
some scientists. He will also look at whether the virus
infects tissue in the female reproductive system. FULL
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