David Putrino, PhD, discusses what you need to know about Long COVID.
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Welcome to Mount Sinai live. We stream smart healthcare information that's simple to understand so you can improve your health. I'm dr jimmy McCain, I'm your host today. We're talking about long covid audience. Remember if you have a question or a comment during the livestream, feel free to drop it in the comments below on whatever platform you're watching from, to educate us about Long Covid. Today is the director of rehabilitation innovation and associate professor of rehabilitation of human performance, physical therapist. DR David Petrino, Doctor Doctor Petrino. Welcome to the show. Thanks for having me jenny. It's good to be here educating about Long Covid. David at the abilities Research Center at Mount Sinai where you work, you and your team have been working to understand what happens to the body during and after a covid 19 infection. The term has been dubbed Long Covid and that name came from the people that were suffering from it. Let's start by defining long Covid and its symptoms as we know right now. Yeah, really great question. I think there's a lot of confusion out there as to what long covid is. I think that the simplest and best definition of long covid right now at this moment actually comes from the CDC. As you mentioned, um the patient led population has been really amazing in leading a lot of the learning a lot of the education and a lot of the research around Long Covid and in collaboration with the CDC. The definition of long Covid was that it referred to any new returning or ongoing health problems that someone was having after experiencing an acute covid infection. So let's break that down a little bit. So it's a bit more simple new symptoms. So, you you went through an acute covid infection and after the acute symptoms have passed, you're now experiencing new symptoms. Maybe it's shortness of breath, maybe it's extreme fatigue, maybe it is difficulty with your cognition. All of these are new symptoms that didn't exist before that counts as long covid returning symptoms. So many people may have had a health condition in the past and it hasn't bothered them for years. A really good example of this is a condition like asthma. You had it as a kid, hasn't been a problem for you for a very long time. And now post covid all of a sudden it has returned and you're having significant symptoms as a result, we count that as long covid, finally ongoing health problems. So individuals who had existing health problems that have significantly worsened as a result of their acute covid 19 infection, we consider to be under this umbrella of long Covid. Now, this sounds like a very broad definition, but we think it's necessarily broad because right now, what we're seeing is a large percentage of the population, up to 30% of the population, in fact are experiencing extraordinarily debilitating symptoms as a result of their initial acute covid 19 infection and these long term symptoms are not going away and as a result, what we need to do is we need to make sure it's our responsibility to make sure that every single person experiencing these symptoms are counted so that we can make sure that they get the care they need and they get the support that they need to recover. Asking about the symptoms of long Covid really is longer than we have time for right now. Um, once again, I would actually direct people to a wonderful publication that was um, that was written by the patient led research collaborative, which is a group of people with Long Covid who are conducting research. It was published in a journal affiliated with the Lancer and it showed us that people with Long covid across the world reported over 200 symptoms That spans 10 organ systems. So this is an extraordinarily variable condition in how it presents. Um, and we're still understanding all of the different ways that affects the body. Thank you for that. We have a test to identify COVID-19 infection, but there isn't a test to determine if I have long covid. How does someone know if they have long covid? This is a great question as well. I think that what you just asked here speaks to a lot of inadequacies in the system that we need to address quickly. The first thing that we need to point out in no uncertain terms is that long Covid is diagnosed by a clinician using clinical presentation of symptoms, meaning we don't need a test to diagnose long covid. What we need is for clinicians to listen to their patients to hear the symptoms that are being reported to understand the CDCs. Um, you know, diagnostic guidelines for Long Covid and make the diagnosis on a clinical basis, meaning that because patients are coming to them and saying I have these symptoms and I have a previous history of infection with Covid, I have long covid. So that's a very important piece of what we need to understand. We myself, my team, many other phenomenal researchers around the world are currently conducting research rapidly to search for a biomarker for long Covid. We don't have one right now. We hope that we will have one. We hope that soon you'll be able to get a blood test that will definitively tell you if you have long Covid or not, but we're not there. So, the diagnosis needs to be made on a clinical basis, which means we need clinicians to be listening to their patients when patients are reporting these sorts of symptoms. Um, and you know, we need to start using this diagnosis on a clinical basis to count rates of long covid. This is a very important piece of the puzzle that we don't have under control right now. Um, we have a counter for every single positive pcr test that that occurs in the country. We don't have a counter for every diagnosis of long Covid that's occurring in the country until we have that long covid isn't going to get the attention that it needs. So, um, this is this is how we need to think about it and this is how we need to think about moving forward with diagnosis. Let's talk about demographics who's at risk. Do we know who's at risk more than others for developing long Covid, their demographics that are more likely to suffer from it? This is this is a tricky question as well as such a new condition that it's often hard to understand exactly the demographics and um, and the risk factors associated with long covid at this stage, there have not been any convincing publications that would point us toward precisely who is at risk of developing long covid. Um, we know that you are, you have a slightly higher risk of long covid if you had severe symptoms. Um, however, there are millions of individuals with long covid who were not hospitalized with their acute covid infection and in some cases had mild or asymptomatic cases of covid. So severity does not seem to significantly impact your chances of getting long covid. Similarly, we have not seen too much in the way of other demographics that affect your chances of getting long covid. There is a slight chance that that that there is a, sorry, there is not a slight chance, there there is a a gender bias in long covid indicating that women are slightly more. Um, at risk of developing long covid symptoms. That's something that we don't fully understand right now, but it is certainly emerging in the demographic data. Um, but across the board there does not seem to be any rhyme or reason to who can get affected. We've seen marathon runners coming in and telling us that they are now completely bed bound by long covid and we've seen older adults in their nineties coming to us with with long covid symptoms, it seems to affect everyone, um, slightly lower rates in Children. Um, but we still know that Children are affected by long covid. And I also think that we need to be careful about understanding whether or not it's more or less likely in kids because many of the symptoms are hard for a child to describe. If you think about it, Children don't often have the vocabulary to walk up to their parents and say, you know, I'm feeling more fatigued. Since I had my initial covid infection. That's not really um, something that kids think about a lot and, and they don't really think about how they crash after exercise and how maybe their cognition isn't quite as much as it used to be. These aren't, these aren't things that kids are used to evaluating within themselves. And so reporting maybe lower in kids with long covid, that's a great distinction. Um, let's let's go to a very specific question for persons who are currently covid positive are the things that people who are covid positive currently can do to reduce the risk of developing long covid. Yeah, this is a very important piece. Um The only evidence that we have at present about what one can do to um reduce the risk of developing long covid while you're ill is making sure that you rest appropriately. There is emerging evidence to suggest that those who try to push through their symptoms are at higher risk of developing persistent symptoms. So, ensuring that you take adequate rest, um you allow time for um uh for your body to fully recover from covid before you resume normal activities is very important for um making sure that you reduce the risk of developing persistent symptoms. Um This is, you know, one of the reasons that we're that we're concerned about people returning to work too early um because we fear that there could be an increased risk of developing long covid symptoms based on our available evidence. So the best thing I can say right now is if you develop covid, please take the time to recover properly. Please understand that even if you're feeling as though your symptoms are mild, it's still not advised to push through because of the risk of persistent symptoms sticking with vaccinations. Well, getting vaccinated reduced the severity of long covid symptoms. We we we do want to add that. Getting vaccinated. Something definitely support from the literature as well. But we're getting vaccinated, reduced the severity of long covid symptoms. We know that yes, this is a very important topic that I think there's been significant confusion over. There was a large amount of media ah earlier in the pandemic around this topic where many people were claiming that vaccines were a cure for long covid or significantly eased the symptoms of long covid. Um, and we learned later on as, as that initial sort of media storm faded, that that wasn't the whole story. Um, we certainly know that vaccines appear to modulate and influence symptoms in many people with long covid, but it's not all in one direction. Some people have felt much worse with their long covid symptoms as a result of the vaccine and many have felt much better and many still have have not felt anything at all. They, they felt just what everyone else does. You know, some mild symptoms for a couple of days and then everything resolves. Um, all of the literature that we have seen so far leads us to the point that it leads us to the conclusion that these changes in symptoms are more often than not very transient. So whether you get worse or better as a result of the vaccine, Um, your symptoms will typically bounce back to your baseline, your pre vaccine baseline within 2-3 weeks at a maximum. Um, some some sometimes a little bit longer, sometimes a little bit less, but everyone seems to return to normal. So it seems to be a transient effect of the vaccine that it does in many cases have an influence on long covid symptoms, but it's not permanent and it's not all in one direction that being said. Although we really do acknowledge how frightening it can be to experience a severe change in long covid symptoms and we understand how debilitating these symptoms are. We still strongly recommend vaccination because even if your symptoms are worsened by the vaccine, um, for a short period of time, we know for a fact that sustaining another covid infection, uh, it has a much higher likelihood of producing more severe and more lasting setbacks in long covid symptoms dr david Petrino from the abilities research center here with us at Mount Sinai on Mount Sinai live. Let's get more specific here as well. Are vaccinated. People who contract covid 19 less likely to develop long covid. Very specific question here. So, I think actually the question here is, yes, I I'm sorry, sorry, I completely missed this question. So, if you are vaccinated and you sustain a breakthrough COVID-19 infection um, the available literature tells us that you are much less likely to develop long covid. Um, so, to to put a concrete number on that some emerging literature out of the UK would suggest that pre vaccine, the number of people that were exhibiting signs and symptoms of long covid after an acute covid 19 infection was around 30% which is a staggering number. It's a very, very large number of acute covid 19 infection translating into long Covid post vaccine. We, what we're seeing is the rate of long covid is more like 10%. So that's very encouraging that um making sure that someone gets vaccinated if you are unfortunate enough to sustain a breakthrough infection, your chances of getting long covid are much lower. So that is some encouraging news. But I think we still need to, You know, reiterate that 10% is an extraordinarily high number. That's that's one in 10 cases. And um so I think the strongest case needs to be made for um preventing infection altogether. Thank you for that. Finally, let's talk about some specifics here at Mount Sinai. What's Mount Sinai doing to help people living with Long Covid? Yeah, I feel, you know, incredibly fortunate to be working in a place like Mount Sinai that has been working with the Long covid community from the very beginning to develop services and care for individuals with Long Covid um you know, right right at the beginning of the pandemic. In um in the first few months of the pandemic, Mount Sinai established one of the first centers for Post Covid Care in the country and began to build an interdisciplinary care program for individuals with Long Covid the abilities research center, which is where I worked quickly partnered with the Center for Post Covid care to provide the rehab services for individuals with long covid. So right now Mount Sinai has been at the forefront of delivering very high quality interdisciplinary care, many different specialties, working together to manage the multiple um symptoms and the multiple organ systems that are affected by long Covid and then referring to appropriate rehabilitation for people with long covid. And when I say appropriate rehabilitation, this is a point where I think we really need to stress that although rehabilitation, we call it autonomic rehabilitation, which is rehabilitation of the autonomic nervous system, this is a part of your nervous system that controls many of the things that you don't usually need to think about. So, you know, when your heart should beat, when you should be breathing, body temperature, digestion, all of these little things that ordinarily your body does on autopilot with long covid, it gets knocked out of balance. And autonomic rehabilitation is a specific form of rehabilitation that can help that system return back to normal. It is not aerobic exercise and I think we really need to stress that appropriate rehabilitation does not push aerobic exercise. This is not something that rehabilitation that people need to do because they're de conditioned long covid is not de conditioning, treating it like de conditioning and asking people to push through their symptoms is only going to make them worse. And I think the reason I'm bringing this up very strongly is because I don't think there is enough education on this out there. And if there's anyone take away that people could take from this conversation, it should be that long. Covid isn't de conditioning. Don't ask people to push through their symptoms. Don't ask, don't tell people that all they need is to improve their fitness. That approach will make them worse. Dr Petrino thanks so much for the insight and we'd like to thank all of those involved in the work that you do with the abilities research Center here at Mount Sinai. Follow us at Mount Sinai, Ny C, on all major social platforms. This has been another Mount Sinai live broadcast. We stream smart healthcare information that's simple to understand so you can improve your health and physical therapist. Um McKay, thanks for watching.
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