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COVID-19 Long Haulers: Long Term Effects of COVID-19
The reasons why some people recover quickly from COVID while others are still mirroring symptoms are still unclear. Dr. John Arthur talks about what it really means to have long haul COVID and what some of those persistent symptoms are.
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Learn more about John Arthur, MD, PhD
John Arthur, MD, PhD
I am the chief of the nephrology division and I have a number of other roles at the University including associate director of the translational research institute and director of a junior faculty mentored research program, called the KL2 program. I earned my M.D. and Ph.D. from the University of Iowa, did my medicine residency and nephrology fellowship at Duke and was on the faculty at the University of Louisville and the Medical University of South Carolina before coming to Arkansas in 2015. I am excited about the present and the future at UAMS and proud to lead such an awesome division.Learn more about John Arthur, MD, PhD
Transcription:
COVID-19 Long Haulers: Long Term Effects of COVID-19
Prakash Chandran: This UAMS Health Talk COVID-19 podcast was recorded on December 8th, 2021.
The reasons why some people recover quickly from COVID, but others have lingering symptoms are still unclear. But today, we'll learn what it really means to have long-haul COVID. And what some of those persistent symptoms are.
Joining us here to discuss is Dr. John Arthur, Chief of the Nephrology Division at University of Arkansas for Medical Science. This is UAMS Health Talk, the podcast from the University of Arkansas for Medical Sciences. My name is Prakash Chandran. So Dr. Arthur, thank you so much for being here today. I wanted to just start by asking what exactly is a COVID long-hauler?
John Arthur, MD, PhD: That is someone who has had COVID. You see, you have to have COVID to have it. And then they have persistent symptoms, usually lasting for at least three months after the recovery from COVID.
Prakash Chandran: Okay, that makes sense. And what percentage of people does this affect?
John Arthur, MD, PhD: There's been a really wide variety of what's been in the literature about what percent, everywhere from 10% of 70%. But I think most people have settled on somewhere on 20% is probably a good estimate of how many people get it.
Prakash Chandran: Okay. And then what are some of the symptoms that people with long-haul COVID actually experience?
John Arthur, MD, PhD: So that's another one where there's a lot of variability and over 200 symptoms have been described as possible long haul symptoms. But some of the most common ones are neurocognitive effects, difficulty coming up with words, fatigue. Cough is a big one. Loss of taste or smell is another one that a lot of people have, sometimes abdominal symptoms. There's really a big spectrum of what people have.
Prakash Chandran: Okay. And I think people have a good sense of this, but what is the danger of long-haul COVID as opposed to COVID with a quicker recovery time?
John Arthur, MD, PhD: So the acute symptoms of COVID obviously can be really severe, people end up in the intensive care unit on ventilators or even die from it. The symptoms of long-haul COVID are typically not as acutely severe, but the persistence of them can drive people crazy. The fatigue, the difficulty getting out of bed, the depression that goes along with it, a lot of them can be really life-changing and there's a spectrum of severity. Some people have really pretty mild symptoms and some people have severe symptoms.
Prakash Chandran: And I know that this might be a hard question to answer given the fact that we're still in this pandemic, but for the people that do have a long-haul COVID, how long can symptoms last? Like, what is the longest that you've seen?
John Arthur, MD, PhD: Yeah, we still don't know that. But there are people that had COVID fairly early in the pandemic and are still having symptoms now. And we're coming up on two years, a year and a half, so at least that and maybe longer.
Prakash Chandran: And what is the profile of someone that has long-haul COVID? Like, were there other comorbidities or factors that put them more at risk or is it completely random?
John Arthur, MD, PhD: It really does seem to be random. So we think that people that have had more severe disease are more likely to get these long symptoms, but you don't have to have severe disease. In fact, even people who've had asymptomatic disease now have symptoms that we think may be long haul. So in terms of the severity of the disease, it's really kind of all over the place.
People with long-term comorbidities or other diseases are also more likely to get these long symptoms, but that's also not a across the board. You know, young, healthy people can get it as well. So there's really, again, a lot of variability.
Prakash Chandran: And do long-haul cases only affect people that are getting COVID that are unvaccinated? Does it also affect vaccinated people as well with breakthrough cases?
John Arthur, MD, PhD: It can. So there's some evidence that vaccination, even after a COVID infection may actually decrease the symptoms, but yes, people who've been vaccinated also can still get long COVID. Obviously, if you don't get COVID and you're less likely to get COVID if you've been vaccinated, you're not going to get long COVID.
Prakash Chandran: Okay, understood. So we talked about some of these, you know, sustained or persistent symptoms kind of driving people crazy, which I completely understand. What are their treatment options? Are there ways to, for example, bring back the taste or reduce the fatigue? Can you talk a little bit about that?
John Arthur, MD, PhD: Unfortunately, there's really not anything right now. And this is sort of what our research has focused on. We have identified an antibody against a protein called ACE2, which is present in people that have had an infection with the coronavirus and not present in people that haven't had an infection. And we think that may be responsible through one of two mechanisms probably, either by activating the immune system because of the way that antibody can alter the immune system or by actually directly binding into tissues that the antibody could directly go into tissues and activate the immune system that way.
So one way or another, we think it's the immune system that's involved, but unfortunately there is no treatments yet.
Prakash Chandran: Yeah, that's unfortunate. And that kind of dovetails into my next question. You know, you mentioned the mental health effects of having long-haul COVID. Is that something that you can speak about?
John Arthur, MD, PhD: Yeah, so that seems to be one of the most disturbing aspects of long COVID symptoms. Since we published this finding about this antibody, I've gotten a lot of letters and emails from people, some of them really heartbreaking. People that have had to drop out of medical school because they're no longer able to concentrate, people whose marriages have dissolved because of the symptoms of depression. Lots of depression is a major manifestation of long COVID. So it's really heartbreaking, the stories that we've heard from a lot of people.
Prakash Chandran: Yeah, I can only imagine. And that's why I think it's so important for the community of friends and family to really be there for people that might be experiencing the long-haul COVID symptoms, just so they know that you're around, right? It's the physical symptoms, but it's also the mental health symptoms. So just kind of being present in someone's life, just so they know that you're there for them is critically important, wouldn't you say, Dr. Arthur?
John Arthur, MD, PhD: I definitely agree with that. And for people that are struggling with this and have been for a while, a couple other words of potential encouragement. So if this is the mechanism, this antibody, what we know about this type of antibodies is that they do tend to decline over time. So with time, if this is the mechanism, it should get better. And secondly, that we're actually working on designing some trials that hopefully we'll be able to treat people by removing this antibody out of their system.
Prakash Chandran: Yeah, that's definitely good. And I think it might be reassuring for the audience to know that there is just so much science and research going into the treatment and a cure for some of these long-haul symptoms that people are experiencing. So, thanks to people like you and others that are proactively working on this, we should have a solution soon. Isn't that the case that there's just a lot being done right now by way of science and research?
John Arthur, MD, PhD: There is. There's a big emphasis from the NIH, the National Institutes of Health, on long COVID symptoms right now. And there's a lot of funding going into looking into the mechanisms and hopefully treatments. And there's definitely a lot of interest in this. There's a lot of scientists working on this for sure.
Prakash Chandran: So if someone is listening to this and they might be experiencing some of the symptoms of long-haul COVID, is there a way that they can get involved or help or potentially even take part in this study?
John Arthur, MD, PhD: So we have a registry of people who are interested in research. The website is arresearch.org, AR as in Arkansas research.org. And there is checkbox on there that people can check to participate in long COVID research. I'm working on a study right now where we're going to send out a survey to actually everybody in the UAMS system who's been tested for COVID and also everyone who's registered in this research registry and the survey will have questions about the symptoms that they have. And from that, we're actually going to ask some of those people, if they're willing to donate blood that we'd be able to look at and see if this antibody is present. And if there is a correlation between the amount of the antibody that's present and the symptoms, that'll show us that we're on the right track in terms of hopefully tracking down the mechanism and understanding the mechanism is the first step to getting to a cure.
Prakash Chandran: Yeah, absolutely. So just before we close here, Dr. Arthur, is there anything else that you'd like to share with our audience today?
John Arthur, MD, PhD: I know that a lot of people are suffering from this and keep plugging along and it's going get better. This is something that should get better naturally, and hopefully we'll have treatments coming down the pipeline in not too long.
Prakash Chandran: Yeah, it's just so assuring to know that people like you are actively working on it. So thank you so much for everything you're doing.
John Arthur, MD, PhD: No, it's my pleasure. Thank you.
Prakash Chandran: That was Dr. John Arthur, Chief of the Nephrology Division at University of Arkansas for Medical Sciences. Thanks for checking out this episode of UAMS Health Talk. For more information on this topic and to access the resources mentioned, you can visit uams.edu
If you have long-haul COVID symptoms and you are interested in the research that Dr. Arthur was talking about, you can go to arresearch.org and check that box just to let them know that you're interested. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.
Thanks again for listening. My name is Prakash Chandran, and we'll talk next time.
COVID-19 Long Haulers: Long Term Effects of COVID-19
Prakash Chandran: This UAMS Health Talk COVID-19 podcast was recorded on December 8th, 2021.
The reasons why some people recover quickly from COVID, but others have lingering symptoms are still unclear. But today, we'll learn what it really means to have long-haul COVID. And what some of those persistent symptoms are.
Joining us here to discuss is Dr. John Arthur, Chief of the Nephrology Division at University of Arkansas for Medical Science. This is UAMS Health Talk, the podcast from the University of Arkansas for Medical Sciences. My name is Prakash Chandran. So Dr. Arthur, thank you so much for being here today. I wanted to just start by asking what exactly is a COVID long-hauler?
John Arthur, MD, PhD: That is someone who has had COVID. You see, you have to have COVID to have it. And then they have persistent symptoms, usually lasting for at least three months after the recovery from COVID.
Prakash Chandran: Okay, that makes sense. And what percentage of people does this affect?
John Arthur, MD, PhD: There's been a really wide variety of what's been in the literature about what percent, everywhere from 10% of 70%. But I think most people have settled on somewhere on 20% is probably a good estimate of how many people get it.
Prakash Chandran: Okay. And then what are some of the symptoms that people with long-haul COVID actually experience?
John Arthur, MD, PhD: So that's another one where there's a lot of variability and over 200 symptoms have been described as possible long haul symptoms. But some of the most common ones are neurocognitive effects, difficulty coming up with words, fatigue. Cough is a big one. Loss of taste or smell is another one that a lot of people have, sometimes abdominal symptoms. There's really a big spectrum of what people have.
Prakash Chandran: Okay. And I think people have a good sense of this, but what is the danger of long-haul COVID as opposed to COVID with a quicker recovery time?
John Arthur, MD, PhD: So the acute symptoms of COVID obviously can be really severe, people end up in the intensive care unit on ventilators or even die from it. The symptoms of long-haul COVID are typically not as acutely severe, but the persistence of them can drive people crazy. The fatigue, the difficulty getting out of bed, the depression that goes along with it, a lot of them can be really life-changing and there's a spectrum of severity. Some people have really pretty mild symptoms and some people have severe symptoms.
Prakash Chandran: And I know that this might be a hard question to answer given the fact that we're still in this pandemic, but for the people that do have a long-haul COVID, how long can symptoms last? Like, what is the longest that you've seen?
John Arthur, MD, PhD: Yeah, we still don't know that. But there are people that had COVID fairly early in the pandemic and are still having symptoms now. And we're coming up on two years, a year and a half, so at least that and maybe longer.
Prakash Chandran: And what is the profile of someone that has long-haul COVID? Like, were there other comorbidities or factors that put them more at risk or is it completely random?
John Arthur, MD, PhD: It really does seem to be random. So we think that people that have had more severe disease are more likely to get these long symptoms, but you don't have to have severe disease. In fact, even people who've had asymptomatic disease now have symptoms that we think may be long haul. So in terms of the severity of the disease, it's really kind of all over the place.
People with long-term comorbidities or other diseases are also more likely to get these long symptoms, but that's also not a across the board. You know, young, healthy people can get it as well. So there's really, again, a lot of variability.
Prakash Chandran: And do long-haul cases only affect people that are getting COVID that are unvaccinated? Does it also affect vaccinated people as well with breakthrough cases?
John Arthur, MD, PhD: It can. So there's some evidence that vaccination, even after a COVID infection may actually decrease the symptoms, but yes, people who've been vaccinated also can still get long COVID. Obviously, if you don't get COVID and you're less likely to get COVID if you've been vaccinated, you're not going to get long COVID.
Prakash Chandran: Okay, understood. So we talked about some of these, you know, sustained or persistent symptoms kind of driving people crazy, which I completely understand. What are their treatment options? Are there ways to, for example, bring back the taste or reduce the fatigue? Can you talk a little bit about that?
John Arthur, MD, PhD: Unfortunately, there's really not anything right now. And this is sort of what our research has focused on. We have identified an antibody against a protein called ACE2, which is present in people that have had an infection with the coronavirus and not present in people that haven't had an infection. And we think that may be responsible through one of two mechanisms probably, either by activating the immune system because of the way that antibody can alter the immune system or by actually directly binding into tissues that the antibody could directly go into tissues and activate the immune system that way.
So one way or another, we think it's the immune system that's involved, but unfortunately there is no treatments yet.
Prakash Chandran: Yeah, that's unfortunate. And that kind of dovetails into my next question. You know, you mentioned the mental health effects of having long-haul COVID. Is that something that you can speak about?
John Arthur, MD, PhD: Yeah, so that seems to be one of the most disturbing aspects of long COVID symptoms. Since we published this finding about this antibody, I've gotten a lot of letters and emails from people, some of them really heartbreaking. People that have had to drop out of medical school because they're no longer able to concentrate, people whose marriages have dissolved because of the symptoms of depression. Lots of depression is a major manifestation of long COVID. So it's really heartbreaking, the stories that we've heard from a lot of people.
Prakash Chandran: Yeah, I can only imagine. And that's why I think it's so important for the community of friends and family to really be there for people that might be experiencing the long-haul COVID symptoms, just so they know that you're around, right? It's the physical symptoms, but it's also the mental health symptoms. So just kind of being present in someone's life, just so they know that you're there for them is critically important, wouldn't you say, Dr. Arthur?
John Arthur, MD, PhD: I definitely agree with that. And for people that are struggling with this and have been for a while, a couple other words of potential encouragement. So if this is the mechanism, this antibody, what we know about this type of antibodies is that they do tend to decline over time. So with time, if this is the mechanism, it should get better. And secondly, that we're actually working on designing some trials that hopefully we'll be able to treat people by removing this antibody out of their system.
Prakash Chandran: Yeah, that's definitely good. And I think it might be reassuring for the audience to know that there is just so much science and research going into the treatment and a cure for some of these long-haul symptoms that people are experiencing. So, thanks to people like you and others that are proactively working on this, we should have a solution soon. Isn't that the case that there's just a lot being done right now by way of science and research?
John Arthur, MD, PhD: There is. There's a big emphasis from the NIH, the National Institutes of Health, on long COVID symptoms right now. And there's a lot of funding going into looking into the mechanisms and hopefully treatments. And there's definitely a lot of interest in this. There's a lot of scientists working on this for sure.
Prakash Chandran: So if someone is listening to this and they might be experiencing some of the symptoms of long-haul COVID, is there a way that they can get involved or help or potentially even take part in this study?
John Arthur, MD, PhD: So we have a registry of people who are interested in research. The website is arresearch.org, AR as in Arkansas research.org. And there is checkbox on there that people can check to participate in long COVID research. I'm working on a study right now where we're going to send out a survey to actually everybody in the UAMS system who's been tested for COVID and also everyone who's registered in this research registry and the survey will have questions about the symptoms that they have. And from that, we're actually going to ask some of those people, if they're willing to donate blood that we'd be able to look at and see if this antibody is present. And if there is a correlation between the amount of the antibody that's present and the symptoms, that'll show us that we're on the right track in terms of hopefully tracking down the mechanism and understanding the mechanism is the first step to getting to a cure.
Prakash Chandran: Yeah, absolutely. So just before we close here, Dr. Arthur, is there anything else that you'd like to share with our audience today?
John Arthur, MD, PhD: I know that a lot of people are suffering from this and keep plugging along and it's going get better. This is something that should get better naturally, and hopefully we'll have treatments coming down the pipeline in not too long.
Prakash Chandran: Yeah, it's just so assuring to know that people like you are actively working on it. So thank you so much for everything you're doing.
John Arthur, MD, PhD: No, it's my pleasure. Thank you.
Prakash Chandran: That was Dr. John Arthur, Chief of the Nephrology Division at University of Arkansas for Medical Sciences. Thanks for checking out this episode of UAMS Health Talk. For more information on this topic and to access the resources mentioned, you can visit uams.edu
If you have long-haul COVID symptoms and you are interested in the research that Dr. Arthur was talking about, you can go to arresearch.org and check that box just to let them know that you're interested. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.
Thanks again for listening. My name is Prakash Chandran, and we'll talk next time.