Post-COVID “Long-Haulers” Syndrome in a Female Recreational Athlete
Blair DF, Blakney LK, Duke NC, Long EM, Russ AM, Roberts JM: Wenatchee High School, Wenatchee, Washington
Background: Our subject is a 33 y/o recreational athlete who contracted COVID-19 in March of 2020. Her initial COVID-19 symptoms were quite severe. She “toughed” out the acute phase of the illness in her apartment due to hospital overcrowding. However, even weeks later when the acute phase had passed, she was left with several lingering issues. The patient developed new symptoms as well as worsening residual symptoms. These included: food intolerances (foods that trigger a histamine reaction- dairy, gluten, caffeine, alcohol, legumes, acidic foods, processed foods, etc.), gait disturbances, paresthesias, vestibular issues, anxiety, depression, brain fog/memory/cognitive issues, insomnia, chronic pain/fatigue, hypotension, weight loss, among others.
Differential Diagnosis: There are many sub-diagnosis for Post-COVID “Long-haulers” syndrome because it is a multi-system condition. Several additional tests have ruled out other pathologies including: multiple sclerosis, lyme disease, lupus, sleep apnea, and COPD.
Treatment: Her team consists of a coordinating family practice physician, physiatrist, psychiatrist, gastroenterologist, neurologist, physical therapist, behavioral health therapist, sleep therapist, and speech pathologist. She takes a variety of medications including ramelteon [insomnia] , citalopram [depression], amitriptyline [low dose for gastric sensorimotor dysfunction], aripiprazole [depression/anxiety], and clonazepam [anxiety]. A stomach biopsy revealed inflammation of the stomach lining, however, no ulcerations were found. Uterine inflammation coupled with severe dysmenorrhea resulted in a hysterectomy procedure. To improve her gait and physical state, our subject has gradually increased her activity level to 30 minutes a day on a recumbent stationary bicycle. As a result of the limitations in what she can eat and lack of appetite, the patient had lost 70 pounds since contracting COVID-19. With the guidance from her healthcare team, she gradually increased her daily caloric intake to 1600 calories and has been slowly regaining weight. The neurological issues caused by COVID-19 have affected her gait, speech, and have given her involuntary tics (mostly associated with anxiety). Her balance has become severely compromised by the combination of neurological issues and gait impairments. To assist with ambulation, the subject uses trekking poles.
Uniqueness: Despite COVID being primarily considered a respiratory illness, our subject now faces a plethora of other issues including gastrointestinal tract issues and neurological issues that have lasted over 20 months following her contracting COVID-19. For her entire team of medical specialists, COVID is new, uncharted territory with a unique virus that offers outcomes ranging anywhere from zero symptoms to death. It has been estimated that 27-33% of COVID patients will develop some form of “long-haulers” sequelae. The severity of the initial symptoms are not indicative of the development and/or severity of “long-haulers.” In our subject’s case, her symptoms were severe, but did not require hospitalization or a ventilator. Yet, she still developed significant “long-hauler” symptoms. With her March 2020 contraction of COVID, she was in the first wave of patients. With millions of people contracting COVID since then, this is an ominous foreshadowing as to the potential wave of future ‘long-hauler” cases.
Conclusion: Our subject still suffers from gait, coordination, gastrointestinal tract, and neurological issues. She has made tremendous improvement on her neurological impairments, but still deals with tics and speech problems associated with anxiety. She has had severely decreased cognitive communication, including her attention span, immediate memory, and delayed memory. Overall, she has made considerable progress, but still has a long path of healing and recovery before she will be considered functional for her activities of daily living. She now lives with her parents, since she is presently unable to fully live on her own. Post-COVID “Long-Haulers” syndrome still needs considerable research in order to learn the etiologies and preferred treatments.
Main takeaway: Despite the belief that most COVID patients recover easily in 2 weeks, a significant amount of patients develop long term symptoms, or “Long Haulers COVID”, a condition that is severely under-researched.