{"id":626765,"date":"2024-02-15T09:30:19","date_gmt":"2024-02-15T14:30:19","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=626765"},"modified":"2024-10-25T10:09:12","modified_gmt":"2024-10-25T14:09:12","slug":"counseling-long-covid-patients","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/counseling-long-covid-patients\/","title":{"rendered":"How to counsel your patients with long COVID"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Last May, COVID-19 was deemed <\/span><a href=\"https:\/\/www.who.int\/news\/item\/05-05-2023-statement-on-the-fifteenth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-coronavirus-disease-(covid-19)-pandemic\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">no longer a global health emergency<\/span><\/a><span style=\"font-weight: 400;\"> 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.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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.<\/span><\/p>\n<h2 id=\"long-covid-the-risk-symptoms-and-long-term-effects\"><b>Long COVID: The risk, symptoms, and long-term effects<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Many patients may experience a variety of symptoms post-COVID infection, commonly referred to as long COVID or post-COVID conditions (PCC). <\/span><a href=\"https:\/\/www.thelancet.com\/journals\/eclinm\/article\/PIIS2589-5370(22)00491-6\/fulltext\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Nearly half<\/span><\/a><span style=\"font-weight: 400;\"> of the people who have had COVID-19 are still dealing with health issues four months after they&#8217;ve recovered, and this includes those who didn&#8217;t need to stay in the hospital. The type and severity of symptoms can vary from person to person.&nbsp;<\/span><\/p>\n<h3 id=\"the-symptoms\"><b>The symptoms<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">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:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Neurological symptoms<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Brain fog<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Headache<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Dizziness<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Loss of taste or smell<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Sleep disturbances<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Respiratory symptoms<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Shortness of breath<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Chest pain<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Cough<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Cardiovascular symptoms<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Heart palpitations<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Chest tightness<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gastrointestinal symptoms<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Nausea<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Abdominal pain<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Loss of appetite<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Diarrhea<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Musculoskeletal symptoms<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Joint pain<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Muscle aches<\/span><\/li>\n<\/ul>\n<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Other symptoms<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Intense fatigue<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Fever or chills<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Skin rashes<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Changes in menstrual cycle patterns<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">These aren&rsquo;t all the possible symptoms. <\/span><a href=\"https:\/\/www.thelancet.com\/journals\/eclinm\/article\/PIIS2589-5370(21)00299-6\/fulltext\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Around 200<\/span><\/a><span style=\"font-weight: 400;\"> symptoms have been identified in people with long COVID, according to an online survey from <\/span><i><span style=\"font-weight: 400;\">eClinicalMedicine<\/span><\/i><span style=\"font-weight: 400;\"> in over 3,000 people from 56 countries. Because there&rsquo;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.&nbsp;<\/span><\/p>\n<h3 id=\"the-risk-of-long-covid\"><b>The risk of long COVID<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">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:&nbsp;<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Older age:<\/b><span style=\"font-weight: 400;\"> Older individuals may have a higher risk of experiencing long COVID symptoms.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Underlying medical conditions: <\/b><span style=\"font-weight: 400;\">People with <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC9816074\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">pre-existing health conditions<\/span><\/a><span style=\"font-weight: 400;\">, such as asthma, rheumatoid arthritis, or depression or anxiety, may be more susceptible to long COVID.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Severe initial COVID-19 infection: <\/b><span style=\"font-weight: 400;\">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.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Race and ethnicity: <\/b><span style=\"font-weight: 400;\">Certain <\/span><a href=\"https:\/\/covid19.nih.gov\/news-and-stories\/symptoms-long-covid-differ-people-different-racial-and-ethnic-groups\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">racial and ethnic groups<\/span><\/a><span style=\"font-weight: 400;\"> may be disproportionately affected by long COVID, such as those who are Black or Hispanic.&nbsp;<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Another potential factor that may influence the risk is<\/span><a href=\"https:\/\/aasm.org\/risk-long-covid-people-pre-existing-conditions-higher-among-short-sleepers\/\" target=\"_blank\" rel=\"noopener\"> <span style=\"font-weight: 400;\">sleep duration<\/span><\/a><span style=\"font-weight: 400;\">. 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.&nbsp;<\/span><\/p>\n<h3 id=\"long-term-effects-and-complications\"><b>Long-term effects and complications<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Long COVID can lead to a range of serious health complications that aren&rsquo;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&#8217;s response to the infection can lead to long-term complications, such as:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Pulmonary problems:<\/b><span style=\"font-weight: 400;\"> Persistent lung damage, including scarring and decreased lung function, may lead to long-term breathing difficulties.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Neurological complications:<\/b><span style=\"font-weight: 400;\"> An increased <\/span><a href=\"https:\/\/www.neurology.org\/doi\/10.1212\/WNL.0000000000201595\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">risk of seizures<\/span><\/a><span style=\"font-weight: 400;\"> and the potential for long-term neurological diseases may occur due to brain inflammation.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Renal issues:<\/b><span style=\"font-weight: 400;\"> Kidney damage can develop, which in some cases may require long-term dialysis or increase the risk of chronic kidney disease.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Cardiovascular events: <\/b><span style=\"font-weight: 400;\">Patients with pre-existing heart conditions may be at a <\/span><a href=\"https:\/\/www.nature.com\/articles\/s44161-023-00336-5\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">higher risk of a heart attack or stroke<\/span><\/a><span style=\"font-weight: 400;\"> after having COVID.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Coagulation disorders:<\/b><span style=\"font-weight: 400;\"> An increased risk of blood clots, leading to deep vein thrombosis, pulmonary embolism, or other vascular complications, can arise.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Immune problems:<\/b> <a href=\"https:\/\/singlecare.com\/blog\/autoimmune-disease-management\/\"><span style=\"font-weight: 400;\">Autoimmune conditions<\/span><\/a><span style=\"font-weight: 400;\"> in which the immune system mistakenly attacks healthy cells can develop and lead to a range of autoimmune diseases.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">These complications can be a severe burden on a person&rsquo;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.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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&mdash;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.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The findings of one study showed that for people who weren&#8217;t hospitalized but had COVID-19, most of the <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC10785462\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">ongoing symptoms<\/span><\/a><span style=\"font-weight: 400;\"> 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&#8217;t a significant difference in the long-term symptoms.<\/span><\/p>\n<h2 id=\"counseling-patients-on-post-covid-challenges\"><b>Counseling patients on post-COVID challenges<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A patient-centered approach is key when counseling those with long COVID. As a pharmacist, you can stress the importance of<\/span> <a href=\"https:\/\/jamanetwork.com\/journals\/jama\/fullarticle\/2805540\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">continued monitoring and care<\/span><\/a><span style=\"font-weight: 400;\"> following an infection. Pharmacist strategies for counseling patients with long COVID might include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Being vigilant and discussing potential symptoms of long COVID&nbsp;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Providing guidance on the appropriate use of medications<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Reinforcing the importance of following prescribed treatment regimens<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Recommending lifestyle changes to manage fatigue and other debilitating effects<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Cautioning against unproven treatments that may do more harm than good<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">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 <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37731377\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">effectiveness for treating long COVID symptoms<\/span><\/a><span style=\"font-weight: 400;\">. One study from the <\/span><i><span style=\"font-weight: 400;\">Journal of Medical Virology<\/span><\/i><span style=\"font-weight: 400;\"> found that taking Paxlovid during acute infection was <\/span><a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1002\/jmv.29333\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">not associated<\/span><\/a><span style=\"font-weight: 400;\"> with a reduced risk of developing long COVID symptoms. However, even if patients felt sick again after finishing their Paxlovid treatment, these symptoms didn&rsquo;t make it more likely for them to have long-term issues.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Paxlovid is a CYP3A4 inhibitor that comes with <\/span><a href=\"https:\/\/www.mdpi.com\/2226-4787\/11\/3\/87\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">drug interactions<\/span><\/a><span style=\"font-weight: 400;\">. Therefore, pharmacists may need to monitor for potential adverse reactions, especially in people taking <\/span><a href=\"https:\/\/www.covid19treatmentguidelines.nih.gov\/therapies\/antivirals-including-antibody-products\/ritonavir-boosted-nirmatrelvir--paxlovid-\/paxlovid-drug-drug-interactions\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">common drugs<\/span><\/a><span style=\"font-weight: 400;\">, such as statins, anticonvulsants, and certain heart or blood pressure medications. They may need potential dosage adjustments or alternative therapies in some cases.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Effective communication can be key when counseling patients with long COVID. Pharmacists should:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Listen actively and empathetically to patient concerns<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Offer clear explanations about medications and potential side effects<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Encourage patients to share their health changes over time for better follow-up<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Recommend consulting with healthcare providers before making any treatment decisions<\/span><\/li>\n<\/ul>\n<h2 id=\"potential-long-covid-treatments\"><b>Potential long-COVID treatments<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">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.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For general symptoms like fatigue and loss of appetite, patients could benefit from getting <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/counseling-patients-with-sleep-disorders\/\"><span style=\"font-weight: 400;\">enough sleep<\/span><\/a><span style=\"font-weight: 400;\">, 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.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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.<\/span><\/p>\n<h2 id=\"staying-up-to-date-on-the-latest-findings\"><b>Staying up-to-date on the latest findings<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">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 <\/span><a href=\"https:\/\/www.cidrap.umn.edu\/covid-19\/common-diabetes-drug-shown-prevent-long-covid\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">improve patient outcomes<\/span><\/a><span style=\"font-weight: 400;\"> when administered in the acute phase of the infection.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A new drug known as <\/span><a href=\"https:\/\/www.nature.com\/articles\/s41467-023-39341-4\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">NACE2i<\/span><\/a><span style=\"font-weight: 400;\"> may help manage the persistent inflammation associated with long COVID. The evidence points to NACE2i&#8217;s ability to halt viral replication, shield from re-infection, and repair lung damage caused by long COVID. It&rsquo;s been tested across several independent laboratories and pre-clinical models and may be key for preventing or treating complications of long COVID.&nbsp;<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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.&nbsp;<\/span><\/p>\n<h2 id=\"bottom-line-personalized-care-is-required\"><b>Bottom line: Personalized care is required<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">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.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":135,"featured_media":626640,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[9340],"tags":[14636,743],"coauthors":[8669],"class_list":["post-626765","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-the-checkout","tag-coronavirus","tag-pharmacies","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>How to counsel your patients with long COVID<\/title>\n<meta name=\"description\" content=\"The symptoms and complications of long COVID vary from person to person and often require personalized treatment. 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