 Joining us for our Your Health segment, Dr. Andrea Levine and assistant professor of medicine at the University of Maryland School of Medicine at a pulmonary and critical care specialist at the University of Maryland Medical Center. Dr, you run a clinic at the medical center for COVID long haulers. How do you define that? How long do somebody's symptoms need to persist before they need to come see you? I think it depends on who you ask that question to. Thank you for having me here tonight. I really appreciate it. So the definition of long haulers is not exactly clear cut. More and more the CDC, the US guidelines are looking to define that as maybe four weeks of symptoms after your initial diagnosis of COVID-19. The European guidelines are a little bit different. They actually define it as having 12 weeks of symptoms after your initial diagnosis with no other explanation for ongoing symptoms. For me, I'm a little bit maybe more liberal in my clinic. So I accept patients who are still suffering with symptoms of COVID-19 after they've gone through their typical two week or so period of acute illness. There's no cutoff for exactly how many weeks they have to be sick before they can come see us in our clinic. When you see folks in that situation, are they exhibiting the same symptoms that we associate with the onset, the active phase of the disease? Yeah, so I would say far and away the most common symptom that people complain of is exercise intolerance. Lots of people are coming to me saying that they were healthy and they were fit before they got sick. They could walk their dog in the park. They could work a long day on their feet. Maybe they worked a 12 hour shift with no complaints. But now they're really struggling to make it through a couple hours of their work day. They're profoundly fatigued. They're napping throughout the day. They're unable to walk their dogs. They're sort of gasping for breath. A lot of exercise intolerance and persistent fatigue is really what I'm seeing most of. I read somewhere that the symptoms for the long haulers can sometimes be nothing like the symptoms that they saw early on. Have you seen that? Yeah, that's right. So some of my patients, their symptoms were the traditional shortness of breath and coughs that brought them into the hospital. Oftentimes, they required admission to the intensive care unit because they were so short of breath and hypoxic. And then their residual symptoms may be more along the lines of fatigue. Or some patients will have persistent loss of smell or loss of taste for even weeks or months after their diagnosis. But that may not have really been part of their presenting symptoms at all. Does it correlate with the severity of the presenting symptoms? Well, I don't know. Do you see anybody who was asymptomatic initially or close to it? It's a really good question. So anecdotally, in my own clinic, I've noticed that there does not appear to be a correlation with patients' initial presenting symptoms, either in terms of the actual nature of the symptoms or the severity of the symptoms. So I have a lot of patients who are critically ill in the intensive care unit, even some of them needing life support, mechanical ventilation, ECMO, as thick as you could possibly be. They'll see me in my clinic and they have experienced a lot of recovery and they've gone back to their lives and they've started to work again. And unfortunately, I have lots of other patients who see me in my clinic who were never sick enough to be admitted to the hospital in the first place, but are persistently disabled and really unable to go back to work. There's a new article that actually came out just in the past couple of days that is looking specifically at what you just asked on whether there's a correlation between the severity of people's initial symptoms and the persistence of their symptoms and the presentation of the long hauler or the long COVID syndrome. And it doesn't look like there's necessarily a correlation, that people who maybe were not quite as sick from the beginning may in fact have very persistent symptoms and people who were very sick in the beginning may not have symptoms that last for a long time. We really can't seem to correlate those two necessarily. Let me remind our viewers if you have a question about COVID-19, you can give us a call. We'll have the number up on the screen. You can also email the question right now to live questions at mpt.org. Doctor, this may be a silly question, but so long after somebody had the acute phase of the disease, would they test positive at this point? That also depends. So the tests are often PCR tests. PCR tests can be very, very sensitive to detecting very low levels of virus. We've seen patients even weeks and months after they had COVID-19 still having positive PCR tests. Some patients are not having positive tests, but are starting to have positive antibody tests, indicating that they had been exposed, had the disease, and now have some immunity to the virus. And so it really is variable. The patients that you saw today, I know it was a busy Monday for you, and I know you can't get into too many specifics, but as a group, how are they doing? I would say all in all, most people are recovering slowly. I think there is quite a bit of frustration in this population of patients because many have been sick for upwards of nine months now. I have a couple of patients who are very, very early diagnosed with COVID-19 in early March, right when COVID was coming to the United States, and they've been battling these symptoms and out of work now for the better part of the year. They're still suffering with symptoms. They don't have a good explanation for why. They don't have a good treatment available to them, but I think there is hope in that a lot of the patients who were very symptomatic and were very acutely ill are starting to make some steps forward. We're seeing patients who are very acutely ill, who are on death stores separately, getting better, getting discharged from the hospital. Some patients are going back to the normal day-to-day life, but it is unfortunately very, very difficult and frustrating for lots of these patients who are just not seeing that forward progress quite yet. This might be a good time to review how we can all stay safe and avoid catching this disease in the first place. We know it is widespread at the moment. The number of patients hospitalized with COVID-19 in Maryland hospitals hit a new record last week, closing in on 2000 hospitalized patients. We've had 6,000 Marylanders die of this. What would you advise the general public before the vaccine is widely available? What should we all be doing? I think my advice is the same as it's been for the past couple of months. You have to wear your mask. You have to wear it all the time when you're out in public. You have to stay away from people, so stay at home to the best of your abilities. Understand that you may have to go to the grocery store to the pharmacy to pick up your medication, but that should really be the extent to which you're going out. When you're going out, please wear a mask. Wash your hands, stay away from people. We still don't have the magic bullet treatment for COVID-19, and we are unable to predict who's going to have acute severe illness and whose illness is going to last for nine, 10 months and even longer than that. I think because we don't know who's going to get sick, we don't know who symptoms are going to persist, the only thing we can do to stay safe for ourselves and for each other is to try to prevent getting the virus. I think the surefire thing to do to prevent it is to wear a mask, stay at home, wash your hands. Email question from a viewer wants to know if COVID long haulers can be affected by their environment. Can the virus maybe linger in the home or workplace resulting in continued symptoms? Could they be reinfecting themselves or maybe some of the contributing factors still be present? Yeah, I don't think that we have evidence to support that. There's been variable data on how long the COVID virus can live on objects, a desk chair, your work desk, your work environment, but I don't think we have evidence to suggest that people are continuing to reinfect themselves by returning to their office, for example, or by having contaminated their home. I think that it's probably related to some marker of your immune system, some ongoing immunity that's causing these persistent symptoms, maybe some neural tropism, the virus itself may impact some nerves or may impact the lungs causing these ongoing symptoms, but I don't think that it's a reinfection process. Let's take a phone call Charlie in Carroll County. Charlie, thanks for the call. Go ahead. Hi, you there? Yes, sir. What's the question? I wanted to know if the people that are in the hospital that are dying are getting the same shot that the president got. Good question. I don't know if you're treating patients who are hospitalized at this point, but it might be a good chance to talk about the therapeutics which have been unfortunately slow to come along. Yes, so I do treat the patients in the hospital as well. I'm actually a critical care doctor, so I do take care of patients that are COVID-19 ICU, and your question is a good one. So are patients getting the same treatment that the president got? And the answer is, no, not all patients. So the president got the Regeneron cocktail. The Regeneron cocktail is being experimentally studied, and it really has been utilized primarily in patients who are not critically ill, who are not requiring hospitalization. There are other therapeutic options for people who are critically ill or patients who require hospitalization, and there are dozens and dozens of ongoing clinical trials really to try to understand and explore what the best treatment options are for these patients. We've had some success in some of the pharmacotherapeutic trials that we've run, which is great, and we've had a lot of failures. And we have many more that are still ongoing that are important to continue to run these clinical trials so we can find as many good therapeutic options for patients as we can. Let's take a call from Montgomery County. This is Betty. Betty, thank you for calling. Go ahead. Yes, I'd like to know whether people with Parkinson's can take the vaccine because I heard that it could be fatal. Thanks for the phone call, doctor. I don't know if that's exactly your area. What can you tell us? Yeah, it is not my area, but it's a great question. So I'm definitely not a virologist, and I think the best answer I have for you is to really discuss with your primary care doctor or an infectious disease doctor, if necessary, to see whether or not Parkinson's disease is a contraindication to getting the vaccine. How hopeful are you about the vaccine? I mean, the people, critical care specialists of all kinds, I mean, you're taking big risks. What happens next and how important is it if we can get frontline workers, whatever level of immunity the vaccine is going to provide? I feel hopeful and I feel optimistic. I feel grateful that I've been given access to getting the vaccine myself. And I think for most of us who've been caring for patients at the frontline for the last year almost at this point, we're all very grateful to have whatever amount of immunity that this vaccine confers. I do think that most of us will say that it doesn't, it's not a cure for COVID-19. It's not a bulletproof shield for COVID-19. I think even when we're vaccinated, at least for a short amount of time, we're going to have to continue to do all the things we already mentioned, wear a mask, wash our hands, stay socially distant. We're going to need the majority of the public to get the vaccine before we can start talking about immunity as a population. And I think until we have more immunity and until we better understand the long-term immunity this virus provides, while it provides some security and lots of hope, it certainly does not mean that we can change the way we're behaving at this point. One big fear was that we were going to have a widespread flu epidemic along with the COVID pandemic. Have you seen any signs of that? I will say I am so grateful that this year we have not seen very much influenza. There are many, many years as a critical care doctor that we've seen horrible influenza outbreaks that have led to many young people, older people as well, but all sorts of people really ending up critically ill on life support on ECMO. Luckily, this has not been such a year. I suspect a lot of it has to do again with people staying inside, people being hypervigilant about hand washing and wearing masks. That too is an effective way to start the spread of influenza. Doctor, it's a great place to leave it, Dr. Andrea Levine of the University of Maryland Medical Center. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.