PORTSMOUTH — While it’s too early to say for sure, there are several spaces of medical fear doctors are looking at in others who have “recovered” from COVID-19 or who are going to have COVID long-term.
At a recent State of the City event in Rochester, Kristin Laberis, administrative director of cardiology at Portsmouth Regional Hospital and Frisbie Memorial Hospital, spoke about the emerging rate of cardiac events they say are linked to COVID-19 patients.
“COVID is so new that we’re just beginning to feel the long-term impacts,” Laberis said. “We’ve treated acute cases and now we’re in chronic cases, and we’re seeing cardiac impacts. We saw a 63% increase in heart care desires in the year after COVID, even among asymptomatic people.
Laberis said many studies look at post-COVID patients, up to a year after their recovery date. He said they should show a higher incidence of arrhythmias, either ischemic and non-ischemic. They have myocarditis and central failure, he said.
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When asked about COVID-19’s effect on the heart, Dr. Christopher Lawson, a cardiologist at Appledore Medical Group, the answers are not yet known.
“We don’t have a diagnostic test to show the effect of COVID on the heart,” Lawson said. “We know that other people with COVID show fatigue for a long time. Your blood pressure may fluctuate. We don’t have anything to say, “yes, it’s because of COVID. “
Lawson said it’s not certain whether the center’s illnesses manifested as a direct result of contracting the virus or because other people were delayed in caring for the pandemic.
“We know that other people were not looking to remedy the pandemic,” Lawson said. “They fell behind in scheduled care. They didn’t exercise because they were afraid of fainting. No diagnostic tests were done and their lifestyles changed. It shows. I say my patients faint, walk, even 20 to 30 minutes is passod. “
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Dr. Artemio Mendoza, an infectious disease physician, said he doesn’t see COVID patients after they recover, nor those who are considered long-term COVID patients.
“Every once in a while, I get calls from providers with questions, but that’s it,” he said. “Some of the questions are about other people with chest pain or fog after COVID. it’s a clinic specializing in prolonged COVID. “
Mendoza said he wonders if patients with disorders at the center come because they have those comorbidities in addition to having COVID. He said high blood pressure and cardiomyopathy are not unusual in the general public.
“You have to distinguish whether COVID caused the problem, or is it incidental?” he said. “We’re talking about things like COVID-related myocarditis, there are still very few cases shown. “
“It’s frustrating for services because we don’t know the answer yet,” Laberis said. “A Veterans Affairs study investigated 5. 8 million veterans. For every 1,000 veterans, there were 23 more central attacks. “
Vaccination will also be a priority, Lawson said, to help protect the public.
“The concern that vaccines cause myocarditis is not a problem,” he said. “It’s very rare and the rate is lower than the rate for other people with COVID. “
Lawson said doctors are still looking to outline the long-term effects of COVID. He said it may only be years before answers are provided.
The long-term effects of COVID aren’t all physical. Dartmouth Medical Center’s physical care formula is one of the first in the country to open a long COVID (or Post Acute COVID Syndrome) clinic.
Mendoza said the concept of COVID-related depression, which is also on the rise, doesn’t surprise him.
“Depression is a little more subjective,” he said. “There is no objective test, and it’s based on how a user feels. With the pandemic ongoing, other people feel remote and discouraged through the endless outbreaks seen. So I’m not surprised that COVID-related depression is building up. “
Dr. Brian J. Rosen, resident leader in psychiatry at Dartmouth Hitchcock Medical Center in Lebanon, has published the findings of his studies on COVID-related depression. He proposed 3 questions.
1. Who is most likely to suffer from depression after COVID and why?
“It’s not clear why other people suffer from depression after COVID-19 while others don’t,” Rosen said. and the severity of a person’s other long-term COVID symptoms. People with a history of depression, anxiety, and PTSD appear to have an exacerbation of those symptoms after COVID. “
Rosen said many studies implicate the intensity of initial COVID-19 infection, and add the need for hospitalization and ICU admission as predictors of depression.
“Finally, patients who revel in other post-COVID symptoms, such as fatigue, pain or insomnia, are more likely to suffer from depression because those symptoms are themselves independent points that can cause or worsen depression,” he said.
2. What are the most likely physiological and mental mechanisms?
“Some elements of depression in the long COVID are certainly situation-related, namely an adverse mental reaction to adverse life circumstances, in addition to physical symptoms, loss of tasks and stress from the family circle,” Rosen said. “But for many patients, the cause of depression can stem directly from the brain, even in the absence of external stressors or adverse situations. Depression is a well-studied condition that can spread as a result of a wide variety of situations affecting the brain, such as traumatic brain injury, cerebrovascular disease, types of infections, and inflammation in general. “
Rosen said that infection with SARS-CoV-2 (the virus that causes COVID-19), the virus enters the brain, but the resulting changes have not been fully clarified.
“It has been postulated that the virus or remnants of the virus can persist in the brain and cause inflammation, cause adjustments in the brain’s chemical signaling or, in all likelihood, adjust blood flow in small blood vessels, but the mechanism remains under study,” he said. “Until the mechanism can be firmly established, the most productive bureaucracy of the depression remedy in the long COVID will be uncertain. “
3. What are the tactics for treating post-viral depression caused by COVID-19?
“While the underlying mechanism of depression is likely different, at this time we do not have express knowledge of the remedy for patients with post-COVID depression,” Rosen said. “Therefore, depression that is part of prolonged COVID is treated as depression in other contexts: with a variable combination of cognitive behavioral therapy, lifestyle changes, and medication. Many patients with prolonged COVID suffer from insomnia and anxiety. It is very important to treat the concomitant symptoms as part of any successful remedy. Medications can play a vital role in reducing the severity and effect of anxiety and depression, and many patients experience a dramatic reaction to antidepressant medications.
Rosen said medications to treat depression deserve to be considered as a complementary and transient solution, as symptoms of prolonged COVID tend to disappear over time for most patients.