What Happens When You Still Have Long COVID Symptoms? – Yale Medicine

It depends on the symptoms. Because there is currently no cure for Long COVID, doctors aim to treat the symptoms associated with the condition.

As many as 200 Long COVID symptoms were identified in an international study published in 2021 in EClinicalMedicine (a Lancet journal) that surveyed more than 3,700 people with Long COVID. Many symptoms are sorted into categories by specialty, where treatments are similar to what they would be for non-COVID patients with similar symptoms.

The specialists you may need to see for Long COVID include:

Pulmonologists: These doctors have played a central role in treating both COVID and Long COVID since the early days of the pandemic, when many patients went to the hospital with urgent symptoms, such as low oxygen levels and lung issues. They treat breathing difficulties, sometimes prescribing treatments like an inhaler (a handheld device that delivers a puff of medicine into the lungs). For some of my Long COVID patients with asthma-type symptoms, biologic treatments are making a difference, Dr. Lutchmansingh says.

Exercise may also be beneficial for some patients, she adds. It's just a different way of exercising than we're accustomed to, she says. While rehabilitation for non-COVID pulmonary patients may involve a push to build muscle and strength, that type of exercise method can worsen symptoms for some Long COVID patients. So, we have to figure out a way to get them to exercise that targets their needs but isn't detrimental to them, she says.

Neurologists: "Long COVID can cause a variety of neurological symptoms, and one patient can have multiple types," Dr. McAlpine says. There can be a constellation of symptoms. She has treated patients for headaches, including new or worsening migraine symptoms. Some have developed neuropathy, a disease of the peripheral nerves that causes numbness or weakness.

But the most common neurological symptoms Dr. McAlpine sees are cognitive difficulties, including issues with attention and memory recall, and language and executive functioning. Patients will say, I can't find my words. I lose track of my thoughts in the middle of my sentences. I have to write everything down. I can't multitask anymore, she says. With the Alpha and Delta variants, the cognitive impairment was quite severe around the acute illness. Then, it would very slowly get better.

Gastroenterologists: Some patients report bloating, constipation, diarrhea, vomiting, and other signs of stomach distress. In March 2023, a study in Nature Communications reported that people who had COVID experienced significantly more gastrointestinal symptoms a year after their infection than people who had not had the virus. The study compared almost 150,000 people who were infected in the early days of the pandemic with 5.6 million similar patients who had not had the virus. In the first group, conditions, including GERD (gastroesophageal reflux disease) and peptic ulcer disease, were among the most commonly reported symptoms.

Cardiologists: Cardiovascular symptoms are less common than some in other specialties, accounting for about 5% to 10% of Long COVID issues, explains Dr. Spatz. Acute COVID can lead to myocarditis, which causes significant inflammation of the heart muscle, she adds. It also can cause other cardiovascular problems, including thrombosis and acute stress to the heart, resulting in cardiomyopathy or arrhythmia. We are learning to look for the potential for any of those issues to have occurred and their residual effects, she says.

Heart specialists also care for Long COVID patients who develop chest pain, palpitations, or exercise intolerance, or those who may have a cardiovascular syndrome, such as postural orthostatic tachycardia syndrome (POTS), a blood circulation disorder that causes lightheadedness or fainting when standing up from a lying down position.

Another potential concern is heart rate fluctuation, which can be caused by tachycardia (a fast heart rate) and bradycardia (a slow heart rate). Yet another issue is a chest pain syndrome that may be related to endothelial dysfunction, in which the arteries become narrow even though there is no blockage.

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What Happens When You Still Have Long COVID Symptoms? - Yale Medicine