Nursing News October 20, 2021

By Debra Wood, RN, contributor

What We Know About COVID's Long-term Effects

More than half of patients diagnosed with a SARS-CoV-2 infection experience COVID's long-term effects, and the volume of post-COVID conditions will likely strain the health system, according to a new Penn State study.

“These findings confirm what many health care workers and COVID-19 survivors have been claiming, namely, that adverse health effects from COVID-19 can linger,” said colead investigator Vernon Chinchilli, PhD, chair of the Department of Public Health Sciences at Penn State College of Medicine in Hershey, Pennsylvania, in a statement.

Nurses and nurse practitioners are among the health care workers who must be prepared to recognize COVID long haulers and understand treatment is available. The long-haul program at Providence St Jude Medical Center in Fullerton, California, has successfully treated people with the condition, said Valerie Warren, PT, at Providence St Jude.

“Nurses need to be cognizant of all of these symptoms that are occurring in patients, and practitioners, in general, need to rule out COVID long haul,” said Mary Ellen Roberts, DNP, RN, APNC, FNAP, FAANP, FAAN, associate professor and director of the Doctor of Nursing Practice and Acute Care Nurse Practitioner Programs at Seton Hall University/College of Nursing in Nutley, New Jersey.

Recognizing COVID's long-term effects

The World Health Organization (WHO) recently released a clinical case definition of post-COVID conditions, with 12 domains. The condition occurs in people with a history of COVID-19, with symptoms, new or persisting from the acute infection with SARSCoV-2, lasting for at least two months and cannot be explained by another diagnosis. Symptoms may occur and relapse. COVID long haulers experience fatigue, shortness of breath, cognitive dysfunction and symptoms that affect daily functioning.

The U.S. Centers for Disease Control and Prevention (CDC) also includes in its description of post-COVID conditions: multi-organ effects or autoimmune conditions, post-exertional malaise, cough, chest or stomach pain, headache, palpitations, joint or muscle pain, diarrhea, sleep difficulties, fever, lightheadedness, rash, and changes in mood, smell, taste or menstrual cycles.

he Penn State researchers also included a decrease in mobility, chest pain, hair loss, and a lack of appetite and nausea.

“The burden of poor health in COVID-19 survivors is overwhelming,” said Penn State co-lead investigator Paddy Ssentongo, MD, PhD, in a statement.

Long COVID also affects patients’ family members and colleagues, Roberts said.

As a member of a multidisciplinary team at a New Jersey post-COVID recovery clinic, Moira Kendra, DNP, MA, RN, ACNP-BC, a clinical assistant professor at Seton Hall College of Nursing, sees many long-hauler patients with brain fog, neurological complications, fatigue, weight loss, and respiratory and cardiac complaints.

“Nobody really knows why that is happening,” said Roberts, adding that the symptoms may depend on what happened to the person during the acute COVID illness, such as being sedated, intubated and placed in a prone position. Research is ongoing.

It could be due, at least in part, to a post-viral syndrome, Kendra added.

Many patients with long COVID have not had underlying conditions, such as
hypertension or chronic obstructive pulmonary disease, Kendra said. Most are middle aged. Many must take a leave of absence from their work.

Nurses in a variety of settings should ask patients about their symptoms and if they have recovered from an acute COVID infection.

“Nurses need to know when taking an intake history on patients to ask if the person has ever had COVID-19,” Roberts said.

Caring for COVID long haulers

Research is taking place to learn more about the causes and potential treatments for COVID’s long-term effects. The National Institutes of Health has awarded nearly $470 million to support research to investigate why some people experience prolonged symptoms or develop new or returning symptoms after the acute phase of infection from SARS-CoV-2. The research aims to learn more about treatment and prevention of long COVID.

The American Academy of Physical Medicine & Rehabilitation recently released treatment guidelines for post-COVID fatigue, which includes starting a return-to-activity program, teaching energy conservation, healthy eating and hydration, and treating any underlying health issues that could contribute to fatigue, such as pain and mood issues.

Currently, there are no approved long-COVID treatments. Some medical centers have created long-haul programs, including Providence St Jude. That health system’s program includes physical therapy to work on strengthening and endurance, occupational therapy to help with pacing strategies and cognitive impairments, and speech therapy for patients with significant cognitive impairment. The center also includes a virtual breathing program.

“We have had great outcomes,” Warren said. “Folks are getting better and getting off oxygen and able to go back to work.”

Kendra also reported patients returning to prior employment, but it often takes months. With the chronic nature of post-acute COVID, a multidisciplinary approach leads to better outcomes.

“We are helping people get back to where they were and resuming their previous lives,” Warren said.

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