Selected Podcast
Post-Covid-19 Syndrome
Dr Viren Kaul leads a discussion on Post-Covid-19 Syndrome.
Featured Speaker:
Dr. Kaul earned his medical degree at Karnataka Institute of Medical Sciences in his native India. He completed his residency in Internal Medicine at SUNY Upstate Medical University and served as Chief Resident in Internal Medicine at Lahey Hospital and Medical Center in Burlington, MA, outside of Boston. Dr. Kaul then went on to complete a Fellowship and serve as a Chief Fellow in Pulmonary and Critical Care Medicine at the Icahn Mount Sinai School of Medicine, in its Elmhurst Hospital Center, located in Queens.
Dr. Kaul is a member of the American College of Physicians, American College of Chest Physicians and the American Thoracic Society. Additionally, he is widely published, with a particular clinical interest in the applications of technology in medical education and the clinical setting. He is fluent in Hindi and Kashmiri, with a proficiency in Punjabi.
Viren Kaul, MD
Viren Kaul, MD, is board certified in internal medicine and board eligible and fellowship trained in pulmonology and critical care medicine. At Crouse Medical Practice he welcomes new patients having lung conditions including chronic obstructive pulmonary disease (COPD), asthma, bronchitis, emphysema, pneumonia, pulmonary fibrosis and sarcoidosis. He also serves as a member of the Critical Care Medicine team at Crouse Hospital.Dr. Kaul earned his medical degree at Karnataka Institute of Medical Sciences in his native India. He completed his residency in Internal Medicine at SUNY Upstate Medical University and served as Chief Resident in Internal Medicine at Lahey Hospital and Medical Center in Burlington, MA, outside of Boston. Dr. Kaul then went on to complete a Fellowship and serve as a Chief Fellow in Pulmonary and Critical Care Medicine at the Icahn Mount Sinai School of Medicine, in its Elmhurst Hospital Center, located in Queens.
Dr. Kaul is a member of the American College of Physicians, American College of Chest Physicians and the American Thoracic Society. Additionally, he is widely published, with a particular clinical interest in the applications of technology in medical education and the clinical setting. He is fluent in Hindi and Kashmiri, with a proficiency in Punjabi.
Transcription:
Post-Covid-19 Syndrome
Maggie McKay: COVID-19, you can't really go a day without hearing about it for the last couple of years, but what about the aftermath? It's called post-COVID-19 syndrome. And a lot of people are trying to make sense of what it is, how you know if you have it and more. Joining us to answer some of those questions is Dr. Viren Kaul, Division Chief for Pulmonary Medicine and Critical Care Medicine Specialist at Crouse Health.
This is Crouse HealthCast. And today, we're talking about post-COVID-19 syndrome. I'm your host, Maggie McKay. Welcome, Dr. Kaul, and thank you for talking with us today about this relatively new syndrome.
Dr. Viren Kaul: Thank you for having me, Maggie. I am very excited that we're actually talking about this so we can help people understand what post-COVID-19 syndrome is and how we can all deal with it together.
Maggie McKay: I can't wait to hear about this because there are so many conflicting reports about it. So for starters, what is post-COVID-19 syndrome?
Dr. Viren Kaul: So the way the think about post-COVID-19 syndrome or post-acute COVID-19 syndrome, and it's been colloquially called long-haul COVID syndrome, right? It's when symptoms of COVID, they persist past what we are now calling four weeks. And it's a little bit arbitrary, the four-week period, because we are essentially saying that, you know, the virus itself has stopped replicating and now it's the sort of fall out from the initial insult. So it's those persisting symptoms that are going on and on after four weeks.
Maggie McKay: And the symptoms sound like so many things we all experience anyway for other reasons. So can you explain what the symptoms are?
Dr. Viren Kaul: So I just want to highlight that post-COVID-19 syndrome, while it has its own name, it's not the first time we have experienced this. This can happen after any severe infection. It can happen after other severe respiratory infections as well. And post-COVID, what we are seeing is that you can have symptoms across a whole spectrum. So it's not just one or two things.
So just maybe going head to toe, maybe that might be a way to do it, is you can start with symptoms that affect the brain. So you've heard about brain fog. What that means is that you can have difficulty with memory, with cognition. And these can be sometimes not as discreet as you would think, so it can be hard for patients to communicate this with their care team, which is why they can be a little disconcerting. You can get fatigue, body aches, muscle aches, headaches, okay? But then there's the part where it affects the psychiatric part of your symptoms. People can get anxiety, depression, their sleep can be very disturbed and then PTSD, right? And these manifestations actually have been reported in about 40% of people who have survived COVID-19, so it's not a small number, right?
Coming down, is to your lungs. And you can have shortness of breath that lasts long time. You might require oxygen for a long time. Your exercise capacity and ability to, you know, do things that you normally would have done goes down. And again, that's very distressing, right? Because so if I am able to, say, go to my job, and then after unfortunately going through COVID, I'm not able to return to my job, that's huge. And so just because you're not in a hospital, doesn't mean you're not feeling sick.
Similarly, it can affect your heart. There's something called stress myopathy, which is you know, having gone through so much illness, you can have inflammation in the heart tissue. You can get issues with the electricity in the heart, something called arrhythmias. Continuing down, your kidneys can oftentimes take a huge hit and may take a long time to recover. Reduction in kidney function has almost been seen up to six months. It might be even longer as we learn about this. And then it can affect your blood, and we've heard about this clotting from COVID.
And we understand COVID infection, it's a very inflammatory state. So for lack of a better word, your body is angry. It's just angry and very inflamed. And part of that is these clots and these clots can form in legs, in the lungs, people can have strokes. And so those risks can continue after COVID, though they're not as frequent as some of the other symptoms. And then there's some other things like hair loss, so 20% of COVID survivors actually have reported hair loss.
So you put all of this together and it really can impact a number of different systems. So it's not one or two things. So if you're somebody recovering from COVID and you're feeling all of these things, it is important to tell your caregivers all of those things.
Maggie McKay: Right. And so you said about four months, if it's persisting after that, is that how you know you have it? I mean, because, you know, maybe you have one or two of them and you think, "Oh, it wasn't from the COVID," when do you know when to see a doctor about it?
Dr. Viren Kaul: So that's a good question. It's four weeks from your symptom onset where we start saying, "Okay, you have post-COVID, you know, these symptoms that are going on, okay? Now how long they can last? That's a tricky question. Like I said, we've already seen the studies already shown that they last well into two, three, four or six months or even longer.
So when should you talk to your clinician, right? Typically, the sense that is coming out is that, you know, at four to six weeks, once you are sort of getting better, maybe talking to your primary care or depending on your symptoms, talking to somebody at that point is a good idea. And then, if they persist, you know, we might even need to see people regularly, maybe every few months.
Maggie McKay: So, doctor, how is it treated? How is post-COVID-19 syndrome treated?
Dr. Viren Kaul: So this is the part that is very difficult. And the reason I say difficult is because there's so many things that can be involved, so many issues, right? So one specialty is not enough to address this. So I think so if you look at a lot of major centers now and even before COVID, were creating these clinics they called post-ICU clinics and now post-COVID clinics. So facilities that have these post-COVID clinics are trying to get multiple specialists in there to gather so they can see what is affecting you and who can help you. But broadly, depending on the system involved, you would need all those specialists. So you may need a lung and heart the person to help if you have shortness of breath or oxygen requirements and not able to exercise. You may need a blood doctor if there's blood clotting issues involved. Kidney doctors, if it's the kidneys. And the neuropsychiatrist, like I told you the neuropsychiatric symptoms are pretty common, so somebody who can deal with that. And then the primary here is central and essential because they really can help the patient navigate and guide them towards which specialty or which service can be most beneficial to them.
Now, one specialty or service that I really want to give a shout out to is our therapists, our physical therapists, occupational therapists, speech therapists. Lot of recovery from sickness that is severe like this is about reconditioning, is helping people get back into their ability to exercise and, you know, exert and increasing their tolerance and their involvement, really rehabilitation involvement is critical. So our rehab colleagues more than ever are super important in recovery in post-COVID scenarios.
Maggie McKay: So if there isn't one of these clinics near you, you have to go to all those different doctors possibly?
Dr. Viren Kaul: Right. And that's challenging. That's exactly right. So oftentimes let's say you don't have ability for everybody to see you together, becomes even more essential that your primary care and your maybe lung doctor, if that's your main symptoms, helps you coordinate with all of these people. And it can be a lot, right? Because it's not just seeing the person, you have to go there. It's a burden on transportation. It's a financial burden. It's a lot of effort for the patient.
Maggie McKay: Does insurance cover this, the post syndrome?
Dr. Viren Kaul: Yeah. So symptoms after, you know, acute sickness, if they need care, absolutely most insurances should be covering them. Because again, you've seen this, we've seen this with other illnesses too. So they should be covering these. Now, as a specific diagnosis, it is being recognized increasingly, so that is making things very easy. But while we're on that topic, you know, the financial burden after you've been sick with COVID is huge. And I know that's not maybe part of what we were going to talk about today, but I don't think you can separate that from the medicine, right?
So there was a study showing that I believe around a quarter of patients, they declared bankruptcy a month after being admitted for COVID and that's a lot of burden. And how can we expect people to be able to seek care? So clearly, as a healthcare system, as a society, we are learning the big impact of this.
Maggie McKay: I like to go back for a minute about the symptoms. Does it matter which variant you have, whether it's Omicron or Delta or any of them? Is it all pretty much the same symptom-wise?
Dr. Viren Kaul: So it's hard to tell, right? Because we are seeing Omicron come through now, right? And then there was Delta and the original wild type before that. But what is, you know, a little bit clear is that the sicker you are, chances are that your symptoms are going to continue longer and persist longer, right? So if Delta was the variant where people were sicker and more impacted, what I think is going to be shown is that, you know, those people have longer symptoms. We're going to find out the burden of Omicron. So far, its indication is that it's more transmissible, but maybe not as a destructive, but I don't know the answer to that right now. From Delta, we know that this is persisting for a long time.
Maggie McKay: Right. And what do you tell patients who have gotten maybe a little bit casual about their prevention? Because, you know, it's been around now a couple of years and some people who haven't been affected at all think, "Oh, I'm not going to get it if I haven't gotten it by now," what would you say to them?
Dr. Viren Kaul: I think the key here to understand is that at the end of the day, it's not going to impact us as individuals. One person may not get impacted, but the effects of COVID in the population will affect us all whether that means that we have staff shortages, so you don't get care for other diseases, for example, or you get sick when you do and you're not able to go to work, so economic impact, or you have somebody who at your home maybe impacted because they maybe don't have adequate immunity.
So I think thinking about each other as a society, I think leaving the politics aside because everybody's really heated, and I understand that, right? So leaving the politics aside and I think trying to do reasonable things. So I do think that at this point, the data for vaccination is pretty clear in the sense that nothing is perfect, but it is preventative, especially for severe infection, right? We know that. It doesn't mean you're not going to get COVID, but it prevents hospitalizations and that decreases it. And there's a good safety signal. There's not been any significant population-wide horrible impact. So I think understanding that data is clear and, you know, going out and getting vaccinated is key. I think reasonable population health measures are important, right? I don't think shutting businesses down is viable two years into a pandemic, because it's people's livelihoods. At the same time, you know, if you're going to be indoors with a lot of people, it's impossible to know who could have an asymptomatic infection, so doing simple things, wear a mask in that situation.
Maggie McKay: Right.
Dr. Viren Kaul: So I'm a big believer in moderation.
Maggie McKay: Is there anything else you'd like to add that we didn't cover?
Dr. Viren Kaul: I think the key here at this point is, well, to be, you know, kind to each. I can not stress that enough. I think your healthcare workers, your essential workers or people in restaurants or patients, I think everybody is going through a hard time in one way or the other. And we may not understand why the other person's going through a hard time, but I think it's a safe assumption that they are, and just, you know, trying to work with each other and maybe letting cool collaborative heads prevail is I think the way out of this pandemic.
Maggie McKay: Kindness is key always. You're right, Dr. Kaul. Thank you so much for clearing up some of the mystery behind post-COVID-19 syndrome. If you'd like to find out more, Dr. Kaul is welcoming new patients. For an appointment, please call (315) 701-2550 or visit www.crousemed.com. Thank you for tuning into Crouse HealthCast. I'm Maggie McKay. Be well.
Post-Covid-19 Syndrome
Maggie McKay: COVID-19, you can't really go a day without hearing about it for the last couple of years, but what about the aftermath? It's called post-COVID-19 syndrome. And a lot of people are trying to make sense of what it is, how you know if you have it and more. Joining us to answer some of those questions is Dr. Viren Kaul, Division Chief for Pulmonary Medicine and Critical Care Medicine Specialist at Crouse Health.
This is Crouse HealthCast. And today, we're talking about post-COVID-19 syndrome. I'm your host, Maggie McKay. Welcome, Dr. Kaul, and thank you for talking with us today about this relatively new syndrome.
Dr. Viren Kaul: Thank you for having me, Maggie. I am very excited that we're actually talking about this so we can help people understand what post-COVID-19 syndrome is and how we can all deal with it together.
Maggie McKay: I can't wait to hear about this because there are so many conflicting reports about it. So for starters, what is post-COVID-19 syndrome?
Dr. Viren Kaul: So the way the think about post-COVID-19 syndrome or post-acute COVID-19 syndrome, and it's been colloquially called long-haul COVID syndrome, right? It's when symptoms of COVID, they persist past what we are now calling four weeks. And it's a little bit arbitrary, the four-week period, because we are essentially saying that, you know, the virus itself has stopped replicating and now it's the sort of fall out from the initial insult. So it's those persisting symptoms that are going on and on after four weeks.
Maggie McKay: And the symptoms sound like so many things we all experience anyway for other reasons. So can you explain what the symptoms are?
Dr. Viren Kaul: So I just want to highlight that post-COVID-19 syndrome, while it has its own name, it's not the first time we have experienced this. This can happen after any severe infection. It can happen after other severe respiratory infections as well. And post-COVID, what we are seeing is that you can have symptoms across a whole spectrum. So it's not just one or two things.
So just maybe going head to toe, maybe that might be a way to do it, is you can start with symptoms that affect the brain. So you've heard about brain fog. What that means is that you can have difficulty with memory, with cognition. And these can be sometimes not as discreet as you would think, so it can be hard for patients to communicate this with their care team, which is why they can be a little disconcerting. You can get fatigue, body aches, muscle aches, headaches, okay? But then there's the part where it affects the psychiatric part of your symptoms. People can get anxiety, depression, their sleep can be very disturbed and then PTSD, right? And these manifestations actually have been reported in about 40% of people who have survived COVID-19, so it's not a small number, right?
Coming down, is to your lungs. And you can have shortness of breath that lasts long time. You might require oxygen for a long time. Your exercise capacity and ability to, you know, do things that you normally would have done goes down. And again, that's very distressing, right? Because so if I am able to, say, go to my job, and then after unfortunately going through COVID, I'm not able to return to my job, that's huge. And so just because you're not in a hospital, doesn't mean you're not feeling sick.
Similarly, it can affect your heart. There's something called stress myopathy, which is you know, having gone through so much illness, you can have inflammation in the heart tissue. You can get issues with the electricity in the heart, something called arrhythmias. Continuing down, your kidneys can oftentimes take a huge hit and may take a long time to recover. Reduction in kidney function has almost been seen up to six months. It might be even longer as we learn about this. And then it can affect your blood, and we've heard about this clotting from COVID.
And we understand COVID infection, it's a very inflammatory state. So for lack of a better word, your body is angry. It's just angry and very inflamed. And part of that is these clots and these clots can form in legs, in the lungs, people can have strokes. And so those risks can continue after COVID, though they're not as frequent as some of the other symptoms. And then there's some other things like hair loss, so 20% of COVID survivors actually have reported hair loss.
So you put all of this together and it really can impact a number of different systems. So it's not one or two things. So if you're somebody recovering from COVID and you're feeling all of these things, it is important to tell your caregivers all of those things.
Maggie McKay: Right. And so you said about four months, if it's persisting after that, is that how you know you have it? I mean, because, you know, maybe you have one or two of them and you think, "Oh, it wasn't from the COVID," when do you know when to see a doctor about it?
Dr. Viren Kaul: So that's a good question. It's four weeks from your symptom onset where we start saying, "Okay, you have post-COVID, you know, these symptoms that are going on, okay? Now how long they can last? That's a tricky question. Like I said, we've already seen the studies already shown that they last well into two, three, four or six months or even longer.
So when should you talk to your clinician, right? Typically, the sense that is coming out is that, you know, at four to six weeks, once you are sort of getting better, maybe talking to your primary care or depending on your symptoms, talking to somebody at that point is a good idea. And then, if they persist, you know, we might even need to see people regularly, maybe every few months.
Maggie McKay: So, doctor, how is it treated? How is post-COVID-19 syndrome treated?
Dr. Viren Kaul: So this is the part that is very difficult. And the reason I say difficult is because there's so many things that can be involved, so many issues, right? So one specialty is not enough to address this. So I think so if you look at a lot of major centers now and even before COVID, were creating these clinics they called post-ICU clinics and now post-COVID clinics. So facilities that have these post-COVID clinics are trying to get multiple specialists in there to gather so they can see what is affecting you and who can help you. But broadly, depending on the system involved, you would need all those specialists. So you may need a lung and heart the person to help if you have shortness of breath or oxygen requirements and not able to exercise. You may need a blood doctor if there's blood clotting issues involved. Kidney doctors, if it's the kidneys. And the neuropsychiatrist, like I told you the neuropsychiatric symptoms are pretty common, so somebody who can deal with that. And then the primary here is central and essential because they really can help the patient navigate and guide them towards which specialty or which service can be most beneficial to them.
Now, one specialty or service that I really want to give a shout out to is our therapists, our physical therapists, occupational therapists, speech therapists. Lot of recovery from sickness that is severe like this is about reconditioning, is helping people get back into their ability to exercise and, you know, exert and increasing their tolerance and their involvement, really rehabilitation involvement is critical. So our rehab colleagues more than ever are super important in recovery in post-COVID scenarios.
Maggie McKay: So if there isn't one of these clinics near you, you have to go to all those different doctors possibly?
Dr. Viren Kaul: Right. And that's challenging. That's exactly right. So oftentimes let's say you don't have ability for everybody to see you together, becomes even more essential that your primary care and your maybe lung doctor, if that's your main symptoms, helps you coordinate with all of these people. And it can be a lot, right? Because it's not just seeing the person, you have to go there. It's a burden on transportation. It's a financial burden. It's a lot of effort for the patient.
Maggie McKay: Does insurance cover this, the post syndrome?
Dr. Viren Kaul: Yeah. So symptoms after, you know, acute sickness, if they need care, absolutely most insurances should be covering them. Because again, you've seen this, we've seen this with other illnesses too. So they should be covering these. Now, as a specific diagnosis, it is being recognized increasingly, so that is making things very easy. But while we're on that topic, you know, the financial burden after you've been sick with COVID is huge. And I know that's not maybe part of what we were going to talk about today, but I don't think you can separate that from the medicine, right?
So there was a study showing that I believe around a quarter of patients, they declared bankruptcy a month after being admitted for COVID and that's a lot of burden. And how can we expect people to be able to seek care? So clearly, as a healthcare system, as a society, we are learning the big impact of this.
Maggie McKay: I like to go back for a minute about the symptoms. Does it matter which variant you have, whether it's Omicron or Delta or any of them? Is it all pretty much the same symptom-wise?
Dr. Viren Kaul: So it's hard to tell, right? Because we are seeing Omicron come through now, right? And then there was Delta and the original wild type before that. But what is, you know, a little bit clear is that the sicker you are, chances are that your symptoms are going to continue longer and persist longer, right? So if Delta was the variant where people were sicker and more impacted, what I think is going to be shown is that, you know, those people have longer symptoms. We're going to find out the burden of Omicron. So far, its indication is that it's more transmissible, but maybe not as a destructive, but I don't know the answer to that right now. From Delta, we know that this is persisting for a long time.
Maggie McKay: Right. And what do you tell patients who have gotten maybe a little bit casual about their prevention? Because, you know, it's been around now a couple of years and some people who haven't been affected at all think, "Oh, I'm not going to get it if I haven't gotten it by now," what would you say to them?
Dr. Viren Kaul: I think the key here to understand is that at the end of the day, it's not going to impact us as individuals. One person may not get impacted, but the effects of COVID in the population will affect us all whether that means that we have staff shortages, so you don't get care for other diseases, for example, or you get sick when you do and you're not able to go to work, so economic impact, or you have somebody who at your home maybe impacted because they maybe don't have adequate immunity.
So I think thinking about each other as a society, I think leaving the politics aside because everybody's really heated, and I understand that, right? So leaving the politics aside and I think trying to do reasonable things. So I do think that at this point, the data for vaccination is pretty clear in the sense that nothing is perfect, but it is preventative, especially for severe infection, right? We know that. It doesn't mean you're not going to get COVID, but it prevents hospitalizations and that decreases it. And there's a good safety signal. There's not been any significant population-wide horrible impact. So I think understanding that data is clear and, you know, going out and getting vaccinated is key. I think reasonable population health measures are important, right? I don't think shutting businesses down is viable two years into a pandemic, because it's people's livelihoods. At the same time, you know, if you're going to be indoors with a lot of people, it's impossible to know who could have an asymptomatic infection, so doing simple things, wear a mask in that situation.
Maggie McKay: Right.
Dr. Viren Kaul: So I'm a big believer in moderation.
Maggie McKay: Is there anything else you'd like to add that we didn't cover?
Dr. Viren Kaul: I think the key here at this point is, well, to be, you know, kind to each. I can not stress that enough. I think your healthcare workers, your essential workers or people in restaurants or patients, I think everybody is going through a hard time in one way or the other. And we may not understand why the other person's going through a hard time, but I think it's a safe assumption that they are, and just, you know, trying to work with each other and maybe letting cool collaborative heads prevail is I think the way out of this pandemic.
Maggie McKay: Kindness is key always. You're right, Dr. Kaul. Thank you so much for clearing up some of the mystery behind post-COVID-19 syndrome. If you'd like to find out more, Dr. Kaul is welcoming new patients. For an appointment, please call (315) 701-2550 or visit www.crousemed.com. Thank you for tuning into Crouse HealthCast. I'm Maggie McKay. Be well.