How to counsel your patients with long COVID

Last May, COVID-19 was deemed no longer a global health emergency by the World Health Organization (WHO). Instead, the infection has turned into a persistent reality, with many of the recovered facing lingering symptoms known as long COVID. Although still not fully understood, the long-term effects of COVID-19 include a range of symptoms, from fatigue to cognitive issues, that continue to affect a large percentage of the population.

As everyday life resumes and public health restrictions are lifted, pharmacists may come across a new wave of healthcare concerns. Your role goes beyond just dispensing medications to counseling, assisting with symptom management, and educating other health professionals about potential treatments. Continue reading to learn more about long COVID and what you, as a pharmacist, can do to help counsel patients in need.

Long COVID: The risk, symptoms, and long-term effects

Many patients may experience a variety of symptoms post-COVID infection, commonly referred to as long COVID or post-COVID conditions (PCC). Nearly half of the people who have had COVID-19 are still dealing with health issues four months after they’ve recovered, and this includes those who didn’t need to stay in the hospital. The type and severity of symptoms can vary from person to person. 

The symptoms

Many of these symptoms affect different parts of the body, including the nervous, respiratory, and cardiovascular systems. Patients with long COVID might have symptoms that persist for weeks to months after the initial infection has resolved and may include:

• Neurological symptoms
  • Brain fog
  • Headache
  • Dizziness
  • Loss of taste or smell
  • Sleep disturbances
• Respiratory symptoms
  • Shortness of breath
  • Chest pain
  • Cough
• Cardiovascular symptoms
  • Heart palpitations
  • Chest tightness
• Gastrointestinal symptoms
  • Nausea
  • Abdominal pain
  • Loss of appetite
  • Diarrhea
• Musculoskeletal symptoms
  • Joint pain
  • Muscle aches
• Other symptoms
  • Intense fatigue
  • Fever or chills
  • Skin rashes
  • Changes in menstrual cycle patterns

These aren’t all the possible symptoms. Around 200 symptoms have been identified in people with long COVID, according to an online survey from eClinicalMedicine in over 3,000 people from 56 countries. Because there’s such a wide range of possible symptoms, it may be difficult to diagnose and treat long COVID. If symptoms from an acute infection last longer than four weeks, healthcare providers may recommend diagnostic tests to rule out other conditions. 

The risk of long COVID

Long COVID can occur in any individuals who have had COVID-19, with the risk being higher in certain groups. The risk factors may include: 

• Older age: Older individuals may have a higher risk of experiencing long COVID symptoms.
• Underlying medical conditions: People with pre-existing health conditions, such as asthma, rheumatoid arthritis, or depression or anxiety, may be more susceptible to long COVID.
• Severe initial COVID-19 infection: Those who had severe symptoms or were hospitalized may have a higher chance of developing long COVID. However, even mild cases of COVID-19 have been linked to unresolved symptoms.
• Race and ethnicity: Certain racial and ethnic groups may be disproportionately affected by long COVID, such as those who are Black or Hispanic. 

Another potential factor that may influence the risk is sleep duration. Among 2,508 people who had COVID-19 in one study, those who usually slept for six to nine hours a night and had existing health issues, such as lung disease, heart disease, and diabetes, were 84% more likely to experience long COVID than those without such conditions. 

Long-term effects and complications

Long COVID can lead to a range of serious health complications that aren’t just prolonged acute symptoms but can develop as persistent health problems that turn into chronic conditions. The initial damage caused by the virus and the body’s response to the infection can lead to long-term complications, such as:

• Pulmonary problems: Persistent lung damage, including scarring and decreased lung function, may lead to long-term breathing difficulties.
• Neurological complications: An increased risk of seizures and the potential for long-term neurological diseases may occur due to brain inflammation.
• Renal issues: Kidney damage can develop, which in some cases may require long-term dialysis or increase the risk of chronic kidney disease.
• Cardiovascular events: Patients with pre-existing heart conditions may be at a higher risk of a heart attack or stroke after having COVID.
• Coagulation disorders: An increased risk of blood clots, leading to deep vein thrombosis, pulmonary embolism, or other vascular complications, can arise.
• Immune problems: Autoimmune conditions in which the immune system mistakenly attacks healthy cells can develop and lead to a range of autoimmune diseases.

These complications can be a severe burden on a person’s life, including their mental and physical quality of life. In many cases, people with these complications may require ongoing medical visits, which may affect the healthcare system as a whole. 

While persistent symptoms may be the result of COVID-19, some studies suggest that the long-term symptoms some people have after COVID-19 might not be unique to the virus—they could be part of a normal range of symptoms that a lot of people have, or they could be related to being in the hospital for any reason. 

The findings of one study showed that for people who weren’t hospitalized but had COVID-19, most of the ongoing symptoms were found just as often in people who never had COVID-19. However, there were a few exceptions, such as loss of smell and taste, tiredness, shortness of breath, and brain fog, which were more common in the COVID-19 group. On the other hand, when they looked at people who were hospitalized with COVID-19 and compared them to those hospitalized for other reasons, there wasn’t a significant difference in the long-term symptoms.

Counseling patients on post-COVID challenges

With no specific drug confirmed or approved for long COVID, the condition can be even more stressful. Some patients may seek guidance at the pharmacy for ongoing symptoms. With the right awareness and knowledge, you can help guide patients on how to manage their symptoms, watch for potential drug interactions, and direct them to a healthcare provider as needed.

A patient-centered approach is key when counseling those with long COVID. As a pharmacist, you can stress the importance of continued monitoring and care following an infection. Pharmacist strategies for counseling patients with long COVID might include:

• Being vigilant and discussing potential symptoms of long COVID 
• Providing guidance on the appropriate use of medications
• Reinforcing the importance of following prescribed treatment regimens
• Recommending lifestyle changes to manage fatigue and other debilitating effects
• Cautioning against unproven treatments that may do more harm than good

Although Paxlovid has been shown to be effective for treating an acute COVID infection and possibly preventing long COVID, studies are being conducted on its effectiveness for treating long COVID symptoms. One study from the Journal of Medical Virology found that taking Paxlovid during acute infection was not associated with a reduced risk of developing long COVID symptoms. However, even if patients felt sick again after finishing their Paxlovid treatment, these symptoms didn’t make it more likely for them to have long-term issues.

Paxlovid is a CYP3A4 inhibitor that comes with drug interactions. Therefore, pharmacists may need to monitor for potential adverse reactions, especially in people taking common drugs, such as statins, anticonvulsants, and certain heart or blood pressure medications. They may need potential dosage adjustments or alternative therapies in some cases.

Effective communication can be key when counseling patients with long COVID. Pharmacists should:

• Listen actively and empathetically to patient concerns
• Offer clear explanations about medications and potential side effects
• Encourage patients to share their health changes over time for better follow-up
• Recommend consulting with healthcare providers before making any treatment decisions

Potential long-COVID treatments

There are no approved medications and limited evidence for specific treatments for long COVID as a condition. However, some treatments may help manage specific symptoms. The appropriate treatment for long COVID will depend on the symptoms that a patient is experiencing. 

For general symptoms like fatigue and loss of appetite, patients could benefit from getting enough sleep, limiting physical activity, and eating a healthy diet rich in lean proteins, fruits, and vegetables. Respiratory symptoms such as cough and breathlessness can be managed with breathing and stretching exercises, while cardiac symptoms may require avoiding intense exercise and following treatment guidelines for specific conditions. 

For those with neurological problems, symptoms may improve over time, but severe cases may need targeted therapies like speech therapy. Psychological support is also important, including having a social support network and using mental health services for anxiety and depression.

Staying up-to-date on the latest findings

Researchers are actively exploring several medications for their potential to treat long COVID symptoms. For example, metformin, a common antidiabetic medication, has shown promise in preventing long-term complications post-COVID-19. Studies indicate it may improve patient outcomes when administered in the acute phase of the infection. 

A new drug known as NACE2i may help manage the persistent inflammation associated with long COVID. The evidence points to NACE2i’s ability to halt viral replication, shield from re-infection, and repair lung damage caused by long COVID. It’s been tested across several independent laboratories and pre-clinical models and may be key for preventing or treating complications of long COVID. 

These are just a couple of the potential treatment options for long COVID. You may want to stay informed about the latest long COVID findings, so you can offer accurate advice and support for ongoing symptoms. 

Bottom line: Personalized care is required

Patients may experience a wide range of symptoms from long COVID, so personalized care plans are often required. While there are no specific pharmacotherapies available, pharmacists can guide patients on potential lifestyle changes and self-care strategies to help treat symptoms. As new findings on long COVID effects and treatments come out, pharmacists can stay up-to-date and collaborate with other healthcare professionals to support those with long COVID.