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Dr. Seth Congdon, Co-Director of the COVID-19 Recovery Clinic at Montefiore-Einstein, discusses what is long-haul COVID, symptoms of the disease, available treatment options, the recovery process and what Montefiore-Einstein's CORE Clinic is doing to help.

What is long-haul COVID and how does it impact the body? Dr. Seth Congdon, Co-Director of the COVID-19 Recovery Clinic at Montefiore-Einstein, discusses symptoms of the disease, available treatment options, the recovery process and what Montefiore-Einstein's CORE Clinic is doing to help.

Transcript

STAY STRONG

– Long Haulers and COVID-19

– What is a COVID-19 long hauler?

- A COVID-19 long hauler is someone that had COVID-19 and then either continues to experience symptoms or develops new symptoms that last for four weeks or longer and are not fully explained by some other medical condition.

– Who is vulnerable to becoming a long hauler?

– Anyone who gets COVID-19 is vulnerable to becoming a long hauler. It's been seen in people that were hospitalized and people that were not hospitalized, people who had life-threatening COVID pneumonia, and others who had relatively mild acute cases. It's unclear at this time what the risk factors are for developing long COVID, but based on surveys and other population-based research, roughly 10% of people who get COVID go on to have prolonged symptoms.

– What are long haulers' symptoms?

– There are many possible long hauler symptoms. Some of the most common are fatigue, shortness of breath, decreased exercise tolerance, and trouble with memory or concentration, which is commonly called brain fog. There are people whose sense of smell and taste has never returned to normal or took a long time to return to normal. Long COVID can essentially affect any part of the body. There has been issues with digestion, nausea, stomach pain, chest pain, heart palpitations, headaches, trouble sleeping, muscle and joint pains. The list unfortunately goes on.

– What is the recovery process for long haulers?

– The recovery process for long haulers is also quite variable. Some only take a few weeks or months to recover, while others have been experiencing symptoms for over one year at this point. It's important that people with long haul COVID work with medical providers that are empathetic, that validate long haul COVID is real, that acknowledge we're still learning about it, but pledge to work with you and other medical specialists on your treatment and recovery.

– What is the treatment for long haulers?

– The treatment for long haulers is different depending on what your symptoms are, but in general, it's helpful to track your symptoms with a symptom diary to try and figure out what could be contributing to them, what things seem to make them worse or better. In addition, many people benefit from doing physical therapy, occupational therapy, and cognitive therapy.

– Why is mental health care important for long haulers?

– Mental health care is very important for long haul patients. The mind-body connection is real and the psychological distress of having these prolonged symptoms that are not well understood can be significant. It's important that people understand that depression or anxiety is not the cause of their symptom, the only thing going on, but they can have very real effects on the body and make recovery more difficult. Taking the time to improve your mental health is an important part of recovery. This can mean working with a therapist and/or a psychiatrist, practicing meditation or other mindfulness strategies, and engaging in long haul COVID support groups.

– Can long haulers get the vaccine?

– Long haulers can and should get the vaccine. Vaccination is proven to reduce risk of reinfection and severe disease if you do get reinfected. While there is not clear evidence at this time that vaccination improves long hauler symptoms, there is evidence that people who are vaccinated and then get COVID-19 have a lower risk of becoming a long hauler.

– Is there any way to reduce the chance of getting long COVID?

– The way to reduce the chance of getting long COVID is to prevent getting COVID in the first place. The most important way to do this is to get vaccinated. The vaccines are safe and effective. And there is also evidence now that people that are vaccinated, but unfortunately still get a breakthrough COVID infection, have a lower risk of developing long hauler symptoms.

– How is Montefiore-Einstein's CORE Clinic helping long haulers?

– Montefiore-Einstein's COVID recovery or CORE clinic is helping long haulers by evaluating their symptoms, explaining the current understanding of what could be causing them, referring to medical specialists as appropriate, and making recommendations to the patients and their primary care doctors on the best way to try and diagnose, manage, and treat their symptoms as we all work together towards their recovery.

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Dr. Charles Esenwa,  Montefiore’s Medical Director at the Comprehensive Center for Stroke Care, discussing strokes and COVID-19.

Why are some COVID-19 patients having strokes? Montefiore’s Medical Director at the Comprehensive Center for Stroke Care, Dr. Charles Esenwa, explains why some COVID-19 patients experience strokes, who is most at risk and what causes these COVID-19-associated strokes.

Transcript

- What we've noticed in COVID-19 is that there's about a 1% risk of patients suffering a stroke while they're infected with COVID-19. And before we talk about the specifics, I think it's really important to define what a stroke is. In order to do that, I have a model of a brain here, and as you can see, the model has all of these folds, and each one of these is responsible for doing something. So for example, this part of the brain and this fold specifically here controls movement of one side of the body. This fold, for example, controls speech or language. Now, if a blood vessel that supplies this part of the brain is blocked off, and that part of the brain is not receiving blood, that's exactly what a stroke is, and that is the definition of a stroke. Now, in COVID-19, we've noticed that the patients who we're treating and who are coming in with strokes tend to be younger. And what I mean by that is, the typical age for a stroke is anywhere in the 60s and 70s, but we've encountered a lot of patients who come in in their 40s and more so in their 50s. The other difference is that COVID-associated stroke or patients with COVID-associated stroke are less likely to have what we call traditional risk factors. And what I mean by that are the typical risk factors that we think of, like hypertension or high blood pressure, smoking, diabetes, high cholesterol. Patients with COVID-associated stroke are younger, and they're less likely to have these traditional risk factors. Now, the good news is that, as I said earlier, stroke seems to affect a very, very small percent of people with COVID-19, and that's less than 1%. But we are still working on trying to decipher why it is that COVID affects the younger and also more healthy individuals. What we're starting to come to, however, is that, with COVID-19 infection and with the pneumonia that people suffer, they also have a heightened inflammatory state in their body. And what I mean by inflammatory state is that the body is trying to fight off the virus. And in doing that, all of the chemicals and things in the blood that help in that fight can make people more likely to develop clots. And when people develop clots in their blood, those clots can lodge themselves and block off critical arteries that supply the brain, hence, leading to a stroke. If somebody with COVID-19 starts to experience symptoms of a stroke, the most important thing to do is to call 911 immediately. During the COVID-19 surge, we actually measured how many patients with stroke came to the hospital, and it was about a 50% drop in the number of patients that we were able to treat for their stroke. This is an important thing to talk about, because we don't want people staying at home with stroke symptoms. And if they were to come to the hospital, we could potentially treat them and limit any long-term disability that they would otherwise have from their stroke. Now, here at the Montefiore Comprehensive Center for Stroke Care, the first comprehensive stroke center from Northern Manhattan to Albany, and one of only 200 such centers nationwide, we treat mild strokes, all the way out to the most severe strokes, but we only have about 4 1/2 hours to do that. And we know that the quicker people come to the hospital, the less likely they will have long-term disability from stroke. And that's true, no matter if they have COVID-19 or not. The quicker we can treat, the better people will do in the long run. Early on, ahead of the COVID-19 surge, we implemented measures to prevent COVID-19 infection in people coming into the hospital for emergencies, like stroke. Those measures have remained in place today, including COVID-free zones for treatment.

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COVID-19 Symptoms

People with COVID-19 have had a wide range of symptoms reported, from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. Individuals experiencing these symptoms or combination of symptoms may have COVID-19:

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Cover Coughs

Cough

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Shortness of Breath

Shortness of breath or difficulty breathing


Or at least two of the symptoms below:

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Fever

Fever

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Chills

Chills

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Repeated shaking with chills

Repeated shaking with chills

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Muscle Pain

Muscle pain

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Headache

Headache

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Sore Throat

Sore throat

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New loss of taste or smell

New loss of taste or smell

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Diarrhea

Diarrhea


This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning to you.

Care doesn’t stop

To ensure the safety of all our patients, we’ve implemented rigorous COVID-SAFE Care protocols, tailored to each setting.

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Covid-safe Care

Your Gratitude Keeps Us Going

The current outpouring of appreciation for New York's healthcare workers has been truly humbling. Our community's grace and optimism in the face of hardship inspires us every day. To all those who have cheered and honored our heroes, and to the many who are giving to support our COVID-19 efforts, Montefiore-Einstein would like to thank you. To those who would like to show their support, here's how.

How does COVID-19 spread?

The virus is thought to spread by people in close contact (approximately within 6 feet) through respiratory droplets when an infected person coughs or sneezes. It is also possible to contract the virus by touching an infected surface or item and then touching the nose, eyes or mouth. The virus may be able to live on a surface for a prolonged period of time.

Protect Yourself
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Wash Hands
Wash hands frequently with soap
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Avoid Touching eyes and mouth
Avoid touching eyes, nose, mouth
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Seek Care
Seek care if you develop a fever, cough or shortness of breath
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Avoid Close Contact
Avoid close contact with people who are sick
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Distance
Maintain social distance of at least 6 feet
Protect Others
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Stay Home
Stay home if you’re unwell
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Cover coughs and sneezes
Cover coughs and sneezes
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Clean and disinfect surfaces
Clean and disinfect surfaces
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Mask
Use a face covering when leaving the home for essentials
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Distance
Maintain social distance of at least 6 feet

Trusted Information Resources

Centers for Disease Control and Prevention

The leading national public health institute of the United States
 

NY.gov

For the latest COVID-19 guidelines and information from New York State 

World Health Organization

UN agency responsible for international public health