Dr. David L. Katz
March 22, 2021
Updated: March 22, 2021 10:14 a.m.
Our collective, pandemic focus continues to vacillate with the news of the day, but if it has settled anywhere, it has settled of late on the toll of so-called “long COVID,” now known medically as PASC: Post Acute Sequelae of SARS-CoV-2. That topic is of interest to me for many reasons, not the least of which being: I have it.
To be fair, my version of “long COVID,” like my COVID infection itself, is seemingly mild. So while I can say I have PASC, it is an entry-level case. I am now about 2 months post infection, with IgG to corroborate my past bout and immunity — and still subject to waxing and waning fatigue, and recurrent headaches of a unique (and rather creepy) character. My olfaction, which I lost completely, is at best about 50 percent back now, and also waxes and wanes.
I am trying to be patient, not one of my best attributes. I am hopeful that the single-dose vaccine I eventually receive (only one dose of any COVID vaccine is recommended post-infection) may help banish residual symptoms; there are some early indications of that effect. For now, we are unsure of the remedies, but know for sure that long COVID is real; what are the major implications?
First, while PASC is garnering a unique level of attention as all things associated with the pandemic do, this syndrome is not unique to COVID. Many illnesses, and most injuries, engender their own suite of “post acute sequelae.”
In my nearly 30 years rendering patient care, it was more norm than exception to see persistent symptoms months out from any moderately severe infection. Community acquired pneumonia, for instance, is deemed mild when it does not require hospitalization — but that doesn’t mean it disappears when the course of antibiotics end. Patients routinely take months to feel back to baseline.
So, too, for any of the other infections that assault a vital organ, from pyelonephritis to septic arthritis to prostatitis, and perhaps even to cellulitis — infection of the skin. I am not aware of a national survey exploring residual symptoms, local or systemic, following these and various other infections, but my clinical experience says they are common.
As for viruses, many are notoriously “long.” Varicella, the virus that gives us chickenpox, resides within for decades, emerging to cause shingles. Herpes simplex never goes away, and can cause recurrent cold sores for a lifetime. These and other common viral exposures may even cause a long-form illness much like PASC, which we call by other names: chronic fatigue syndrome, or fibromyalgia. I have treated many patients with these conditions over the years, and at a frequency that makes coincidence unlikely, symptom onset followed some acute viral illness.
And then there is a notorious “long” infection that has itself attracted considerable attention, if altogether too little respect: chronic Lyme Disease. This is not at all likely to be chronic “infection” any more than PASC is, but rather a chronic symptom complex that all too often follows infection with the agent of Lyme disease, Borrelia burgdorferi.
My hope, then, is this: the population impact of PASC will cause the medical establishment to revisit a generally dismissive attitude toward other “long” post-infectious syndromes, including the possible inclusion of chronic fatigue and fibromyalgia among them.
There is another relevant consideration. We routinely say “illness and injury” as if the two are mutually exclusive. They are not. Many illnesses, SARS-CoV-2 clearly among them, cause tissue injury. Injured tissue takes time to heal. Thinking about the “injury” model, involving acute phase, repair, and then a long bout of physical therapy and rehabilitation, is helping me be patient with my own PASC symptoms, and also making me wish we knew more about the underlying mechanisms. Is PASC about tissue injury, and if so — what tissues are involved? We don’t have these answers yet — and need them both to understand PASC, and know best how to overcome it. The distinction between illness and injury is far from absolute, and perhaps much of the reason for lengthy recovery is when the former causes the latter.
To sum up, then: long COVID is, of course, real and important, but like so much else in the pandemic, presented to us in a manner that maximizes drama, and minimizes context. The relevant context is that many other illnesses have comparably long tails, and almost all injuries do. If the medical community learns to be more uniformly compassionate and respectful when patients complain of symptoms long after the “disease” is over, that will be a welcome advance — and the COVID19 pandemic will have done us at least this one favor.
Dr. David L. Katz is a board-certified specialist in preventive medicine/public health