Will COVID-19 long-haul push the ambulatory medical system to breaking point?

Carolina Nieto of Escondido and Julio Lara of Valley Center became the newest patients in Sharp HealthCare’s COVID-19 recovery program on Friday, meeting with rehabilitation specialists about the persistent symptoms they have suffered since 2021.

Nieto, 63, arrived still pulling an oxygen cylinder more than a year after the virus hospitalized her for 15 days. She continues to struggle with multiple symptoms of COVID-19, including short-term memory and exhaustion when trying to walk more than a few steps at a time.

Lara, 42, said he was unable to return to his active life. His scarred lungs, he said, suspended activities from surfing to snowboarding, with intense fatigue making simple tasks like bringing trash to the sidewalk elapse even months after he fell ill. in September.

With symptoms persisting for more than three months after infection, the two are experiencing what the world has dubbed the long COVID, a state of continuous illness that may not resolve for months or even years. Only showing up this week, neither are victims of the recent wave of Omicron, with Nieto’s infection occurring in January 2021 when the original strains of the virus were still causing the pandemic. . Lara’s disease began in September, when the Delta variant was still dominant.

Their visit to the San Diego Recovery Clinic last week illustrates an important point: Previous waves of illness continue to generate significant demand for healthcare services, even as Omicron’s latest surge subsides.

Julio Lara walks with respiratory care practitioner Kathleen Kennedy as they visit the COVID-19 Recovery Clinic at the Sharp Allison deRose Rehabilitation Center on Friday. Lara is suffering from persistent symptoms of COVID-19, including fatigue and body aches, months after her hospitalization in September 2021.

(Nelvin C. Cepeda/The San Diego Union-Tribune)

It’s a disheartening trend given that local records show more than 300,000 San Diego County residents have either started showing symptoms or tested positive since Christmas Day. The question quickly becomes: if new, protracted COVID cases are still surfacing from exposures that occurred a year ago, will Omicron’s lingering symptoms push the ambulatory medical system beyond breaking point?

After all, previous long COVID estimates indicate that between 10-30% of all infections will have multiple symptoms that will persist months after the original infection resolves. So those 300,000 holiday infections might be expected to generate between 30,000 and 90,000 additional long-lasting COVID cases.

But local experts say they think previous long COVID prevalence estimates, made when other virus variants were dominant, are likely too high for Omicron’s push.

While the post-COVID holiday hangover is already being felt in medical practices across the region and nation in the form of increased demand for appointments, there is optimism that demand will not become as fierce as it could have been with any of the previous variants.

The nature of Omicron itself and the fact that a large part of the population was vaccinated in the last surge are the two key factors that give experts hope.

There is a growing consensus in the medical literature that the lower overall disease severity caused by Omicron will likely result in fewer lengthy COVID diagnoses. The hope is that less severe disease will correlate with less severe persistent symptoms.

And research increasingly shows that those who are partially or fully vaccinated before being infected have fewer long-lasting symptoms of COVID-19 than those who have never been vaccinated.

A study of 1.2 million UK residents published last month in The Lancet, a respected British medical journal, found that the chances of having symptoms 28 days after infection were “about halved by having two doses of vaccine”.

Carolina Nieto, 63, works on exercise equipment under the supervision of respiratory therapist Suzanne Pruitt.

On Friday, Carolina Nieto trains at the Sharp Allison deRose Rehab Center.

(Nelvin C. Cepeda/The San Diego Union-Tribune)

Another research report from a Massachusetts expert panel shows clear gains even for those who were unvaccinated at the time of infection, noted Dr. William Tseng, an internal medicine specialist and deputy medical director of Kaiser Permanente San Diego. After reviewing the medical records of more than 240,000 people who tested positive, researchers found that those who received at least one dose before infection were seven to ten times less likely to report two persistent COVID-19 symptoms or more, compared to unvaccinated patients.

And those better odds also seem to extend to those who get vaccinated even after beginning their recovery.

“You’re about four to six times less likely to have long COVID if you vaccinate within four weeks, and even if you do it four to eight weeks, you’re three times less likely,” Tseng said.

There is also growing evidence that for some people with severe disease, the vaccine can serve as something of an immunological reset button. This was certainly the case for Nieto.

While vaccines weren’t widely available when she fell ill in January 2021, she began her shooting streak in April that year when she was still feeling miserable.

“The first vaccine made me feel so much better,” she said. “I used to shake a lot, and it went away like the day after my first dose.

“My shortness of breath was really bad, I couldn’t be without oxygen for even a second. It’s not perfect yet, I still need oxygen when I walk, but it’s been so much better since I have the vaccine.

Lara said he and his family were unvaccinated when they went to a concert in Las Vegas, returning home feeling unwell in mid-September. A 10-day hospital stay on high-dose oxygen followed, and he later learned that his lungs had pulmonary fibrosis, a condition caused by scarred lung tissue. Today, he says, his doctors say he has permanently lost about 30% of his total lung capacity.

Now dedicated to preserving what’s left, the father, husband and business owner said he has yet to decide whether to get vaccinated. He will focus for now, he said, on rehabilitation, particularly breathing exercises which he hopes will allow him to regain his ability to exercise at a pace close to this he was able to do before he got sick. The patchy test results – there were four negatives before he tested positive – and the swirling political maelstrom surrounding the vaccine, he added, left him skeptical of the vaccination.

Julio Lara, 42, checks in with respiratory care practitioner Kathleen Kennedy to check his vital signs.

On Friday, Julio Lara spoke with respiratory practitioner Kathleen Kennedy at Sharp Memorial Hospital’s Sharp Allison deRose Rehabilitation Center.

(Nelvin C. Cepeda/The San Diego Union-Tribune)

“At this point, the damage is already done,” he said. “The vaccine is not going to help me get my lungs back to where they were.”

Experts would likely counter that the natural immunity gained from winning a fight against the coronavirus is diminishing over time and there is growing evidence of reinfection with the coronavirus, especially in places where Omicron has caused an increase in case.

While vaccination seems capable of reducing the long burden of COVID linked to Omicron, local doctors said this week that they believe the large number of cases that have arisen in such a short time are still capable of straining a system. health already overwhelmed.

Dr. Lucy Horton, a UC San Diego infectious disease specialist who runs the university’s long-running COVID-19 clinic, said the infection is especially difficult for people with chronic illnesses and conditions. For example, it is often more difficult for people with diabetes to control their blood sugar. Migraines may occur more often. Previously mild asthma may intensify.

These factors are likely to make Omicron’s presence felt despite the advantage of a vaccinated population when it arrives.

“I’m somewhat optimistic that the numbers will be a bit lower because of this,” Horton said. “However, just because of the number of cases that have occurred recently, even five percent would be significant.”

Dr. Abisola Olulade, a family physician working in Sharp’s COVID recovery program, agreed.

“Anecdotally, in my practice, I’m seeing more people with long-term symptoms, I’ve certainly seen in the last, I’d say, four to eight weeks since starting Omicron,” Olulade said.

These symptoms, along with brain fog, added Dr. Bradley Patay, medical director of the COVID Recovery Program at the Scripps Clinic in Torrey Pines, are the most common of the long-lasting symptoms. Brain fog, often described as an inability to focus or concentrate and a tendency to forgetfulness, has so far been the most difficult to overcome with therapy.

Some, he said, find it difficult to retain, manipulate and act on ideas, a condition particularly distressing for the large number of local residents engaged in scientific careers.

Techniques like writing down ideas can help dispel the fog, but progress is slow. Part of the problem is the overwhelming amount of anxiety that comes with being sucked into a mental fog that prevents a person from returning to their previous levels of productivity.

“The brain takes longer to heal,” he said. “It’s almost one of the last things I see getting better in patients.”

Although the vaccination helped clear things up, Nieto said she continued to feel a little foggy.

“When I speak, I forget words, whether in English or Spanish,” she said. “I want to say something, and I don’t get the words I wanted to say. It’s like having an incomplete conversation.

Shutting off the oxygen and further eliminating the mental effects of COVID, she said, are her main hopes for therapy.

But she and Lara said they also want broader recognition of the long COVID-19 in the community and the broader healthcare system.

After spending time in hospital, the two said they were sent home and struggled to get follow-up appointments with specialists. Referrals to rehabilitation programs took a long time. In the community, few seem to talk about symptoms that last forever.

“They just don’t talk much about long-haul anymore,” Nieto said. “One way or another, we are forgotten.”

“You know, there are so many other people going through this, but you feel kind of alone,” Lara added. “You’re kind of on your own trying to figure out what you need to do next to get better.”

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