Although we continue to hear a chorus of cautions from the wise folks in the public health community, most of us and our political leaders have allowed the SARS-CoV-2 pandemic to slip quietly into the dark recesses of our been-there-done-that pile. Obviously, this failure to continue learning from our mistakes is an oversight for which we will pay dearly the next time a public health crisis requiring a coordinated effort on a national and international scale raises its ugly head.
However, there is a significant portion of the population for whom the pandemic is fresh in their minds because they are experiencing the symptoms of what they have been told is long COVID. In January 2023 the Kaiser Family Foundation reported that 15% of the U.S. population feels that at some point they have experienced the symptoms of long COVID. And 6% report that they believe they currently have long COVID.
William G. Wilkoff, MD
As long ago as February of 2021, Congress gave the National Institutes of Health $1.5 billion to fund a 4-year study of the prolonged health consequence of SARS-CoV-2. Sadly, 2 years into the study we aren’t too much further along in our search for answers. The Post Acute Sequelae of SARS-CoV-2 has earned an acronym, PASC, but it continues to be little more than a laundry list of vague symptoms including shortness of breath, fatigue, fever, headaches, “brain fog,” and a variety of other neurologic problems. We seem to have slipped into the same trap we find ourselves in with conditions such as chronic Lyme disease and chronic fatigue syndrome that lack workable diagnostic criteria.
However, I have just stumbled across a study in the JAMA Network Open that hints at a partial answer. Using data collected from a prospective study of nurses, investigators based at the T.H. Chan School of Public Health at Harvard found that adherence to healthy sleep prior to infection with COVID was inversely related to PCC, or Post COVID Condition, their chosen acronym for long COVID.
After taking into account a long list of covariants, the investigators found that women with consistently healthy sleep before and after their infection had the lowest risk of PCC when compared with women with consistently unhealthy sleep.
This finding seems to be telling us is that we shouldn’t be surprised to learn that folks who were relatively less healthy prior to contracting COVID are more likely to report feeling unhealthy after the acute phase of the illness has passed. It is unclear whether this observation is because their suboptimal health prior to the infection made them more vulnerable to its aftereffects or whether this is a return to their baseline for which we have labeled long COVID.
The results of this study are particularly important because it highlights our continued failure to acknowledge the critical role of sleep in the entire wellness picture. The broader message is of equal importance and that is when we are trying to discover what is making our patients sick, we must adhere to our traditional practice of taking a good and thorough history. When a patient asks the surgeon whether he will be able to play the violin after surgery, the prudent physician will always ask whether the patient has ever played the instrument.
As with any good study, it leaves more questions than it answers. While this study addresses the vague and neurologically based symptoms of long COVID, many of which are known symptoms associated with sleep deprivation, it doesn’t address the patients with more organically based symptoms such as those who have pulmonary or renal damage acquired during the acute phase of the illness. Many of these unfortunate individuals may have entered the pandemic with already damaged or vulnerable organ systems.
Finally, it leaves a very interesting question unanswered: Can we help the long COVID patients suffering with primarily neurologic symptoms by aggressively managing their preexisting unhealthy sleep habits? Or, has the damage already been done? I suspect and certainly hope it is the former.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at pdnews@mdedge.com.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
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COMMENTARY
A Glimmer of an Answer to Long COVID
William G. Wilkoff, MD
DisclosuresJune 30, 2023
Although we continue to hear a chorus of cautions from the wise folks in the public health community, most of us and our political leaders have allowed the SARS-CoV-2 pandemic to slip quietly into the dark recesses of our been-there-done-that pile. Obviously, this failure to continue learning from our mistakes is an oversight for which we will pay dearly the next time a public health crisis requiring a coordinated effort on a national and international scale raises its ugly head.
However, there is a significant portion of the population for whom the pandemic is fresh in their minds because they are experiencing the symptoms of what they have been told is long COVID. In January 2023 the Kaiser Family Foundation reported that 15% of the U.S. population feels that at some point they have experienced the symptoms of long COVID. And 6% report that they believe they currently have long COVID.
William G. Wilkoff, MD
As long ago as February of 2021, Congress gave the National Institutes of Health $1.5 billion to fund a 4-year study of the prolonged health consequence of SARS-CoV-2. Sadly, 2 years into the study we aren’t too much further along in our search for answers. The Post Acute Sequelae of SARS-CoV-2 has earned an acronym, PASC, but it continues to be little more than a laundry list of vague symptoms including shortness of breath, fatigue, fever, headaches, “brain fog,” and a variety of other neurologic problems. We seem to have slipped into the same trap we find ourselves in with conditions such as chronic Lyme disease and chronic fatigue syndrome that lack workable diagnostic criteria.
However, I have just stumbled across a study in the JAMA Network Open that hints at a partial answer. Using data collected from a prospective study of nurses, investigators based at the T.H. Chan School of Public Health at Harvard found that adherence to healthy sleep prior to infection with COVID was inversely related to PCC, or Post COVID Condition, their chosen acronym for long COVID.
After taking into account a long list of covariants, the investigators found that women with consistently healthy sleep before and after their infection had the lowest risk of PCC when compared with women with consistently unhealthy sleep.
This finding seems to be telling us is that we shouldn’t be surprised to learn that folks who were relatively less healthy prior to contracting COVID are more likely to report feeling unhealthy after the acute phase of the illness has passed. It is unclear whether this observation is because their suboptimal health prior to the infection made them more vulnerable to its aftereffects or whether this is a return to their baseline for which we have labeled long COVID.
The results of this study are particularly important because it highlights our continued failure to acknowledge the critical role of sleep in the entire wellness picture. The broader message is of equal importance and that is when we are trying to discover what is making our patients sick, we must adhere to our traditional practice of taking a good and thorough history. When a patient asks the surgeon whether he will be able to play the violin after surgery, the prudent physician will always ask whether the patient has ever played the instrument.
As with any good study, it leaves more questions than it answers. While this study addresses the vague and neurologically based symptoms of long COVID, many of which are known symptoms associated with sleep deprivation, it doesn’t address the patients with more organically based symptoms such as those who have pulmonary or renal damage acquired during the acute phase of the illness. Many of these unfortunate individuals may have entered the pandemic with already damaged or vulnerable organ systems.
Finally, it leaves a very interesting question unanswered: Can we help the long COVID patients suffering with primarily neurologic symptoms by aggressively managing their preexisting unhealthy sleep habits? Or, has the damage already been done? I suspect and certainly hope it is the former.
Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine, for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Other than a Littman stethoscope he accepted as a first-year medical student in 1966, Dr. Wilkoff reports having nothing to disclose. Email him at pdnews@mdedge.com.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
Follow Medscape on Facebook, Twitter, Instagram, and YouTube
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Image 1: William G. Wilkoff, MD
Cite this: A Glimmer of an Answer to Long COVID - Medscape - Jun 30, 2023.
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Authors and Disclosures
Authors and Disclosures
Author
William G. Wilkoff, MD
Practicing clinician in primary care pediatrics, New Brunswick, Maine
Disclosure: William G. Wilkoff, MD, has not disclosed any relevant financial relationships.