July 25, 2022 – There is no doubt that chronic COVID is real. Even as doctors and federal agencies struggle to define the syndrome, hospitals and health care systems are opening long-term COVID-specific treatment programs. Today, nearly every state has at least one long-term COVID center — 48 out of 50, according to the patient advocacy group Survivor Corps.
The biggest challenge will be treating the long-term health impacts of COVID-19 from mental illness. After people recover from an acute COVID infection, they still experience a variety of lingering symptoms, including depression, anxiety, brain fog and post-traumatic stress disorder.
Addressing these issues while the U.S. grapples with mental health needs.
A study of COVID patients found that more than a third of them had depression, anxiety, or post-traumatic stress disorder 3 to 6 months after initial infection . Another analysis of 30 previous studies of long-term COVID patients found that about one in eight had major depression — and the risk was similar whether people were hospitalized for COVID-19 or not.
“Any of these symptoms Many may appear for months over the long course of COVID,” said Jordan Anderson, a neuropsychiatrist who sees patients at the Long COVID-19 Program at Oregon Health and Science University in Portland. Psychological symptoms are often made worse by physical setbacks, such as extreme fatigue, and the challenges of working, caring for children and maintaining daily routines, he said.
“The effects are not just severe, but chronic for many,” he said.
Like dozens of hospitals across the country, the Oregon Health and Science Center opened a long-term COVID center because it became clear that more patients needed help with ongoing physical and mental health symptoms. Today, every state except Kansas and South Dakota has at least one long-term COVID center — sometimes called a post-COVID care center or clinic, Survivor Corps said.
Many of the long-term COVID care centers are designed to address physical and mental health symptoms, said Dr. Tracy Vannorsdall, a neuropsychologist in the Johns Hopkins University Post-Acute COVID-19 Team Program. One of Hopkins’ goals, she said, is to identify patients with psychological problems that might otherwise go unnoticed.
John A significant portion of Hopkins’ patients — as high as about 35 percent — reported mental health problems that occurred after they became ill with COVID-19, Van Nosdahl said. The most common mental health issues providers see are depression, anxiety and trauma-related distress, she said.
“Routine assessment is key,” Vannorsdall said. “If patients are not asked about their mental health symptoms, they may not spontaneously report them to their providers for fear of being stigmatized or simply not understanding that there are effective treatments for these problems.”
It’s common to worry that doctors won’t take symptoms seriously, says Heather Murray MD, senior lecturer in psychiatry at the University of Colorado School of Medicine.
“Many patients worry that their doctors, loved ones, and society won’t believe them or minimize their symptoms and distress,” said Siddhartha, who treats patients at the UCHealth Post-COVID Clinic. said.
Diagnostic tests for long-term COVID patients are often inconclusive, which can lead doctors and patients themselves to question whether symptoms are really “physical or psychosomatic,” she said. “It’s important that providers trust their patients and treat their symptoms, even if diagnostic testing doesn’t reveal it.”
Patients who have survived a severe COVID-19 infection often find their way to an academic treatment center. But in milder cases, more and more long-term COVID patients are showing up at these centers. These patients were never hospitalized with COVID-19, but still had persistent symptoms such as fatigue, thinking problems, and mood disturbances.
One of the main challenges is the lack of mental health care providers to meet the surge in demand for care since the start of the pandemic. Globally, anxiety and depression surged by 25% in the first year of the pandemic, according to the World Health Organization.
In the U.S., 40% of adults report feelings of anxiety According to a March 2022 White House statement, one in three high school students feels sad and hopeless.
Despite the surge in demand for care, almost half of Americans live in areas with severe shortages of mental health care providers, according to the Health Resources and Services Administration. As of 2019, the United States was short of about 6,790 mental health providers, the agency said. The shortage has worsened since then; there are now about 7,500 suppliers.
“One of the biggest challenges hospitals and clinics face in treating mental illness during prolonged COVID is limited resources and long wait times for evaluation and treatment,” said neuropsychologist Dr. Nyaz Didehbani. Treating long-term COVID patients in the University of Texas Southwestern Medical Center’s COVID Recovery Program at Dallas, Didehbani said.
These delays can lead to worse results. “Furthermore, patients don’t feel like they’re being heard because many providers are unaware of the impact of mental health and the relationship to physical and cognitive symptoms,” she said.
Even Thida Thant, M.D., assistant professor of psychiatry at the University of Colorado, said that when physicians recognize the pervasive psychological challenges of long-term COVID patients, they still have to think creatively to come up with solutions that meet these Treatments for the unique needs of patients. Doctors treating patients at the UCHealth Post-COVID Clinic.
“There are at least two major factors that complicate psychological issues in long-term COVID treatment: the pandemic is a society that is still going on and still so divided, and we don’t The fact of knowing one of the best ways to treat long-term COVID symptoms,” she said.
Some common treatments for anxiety And depression approaches, like psychotherapy and medication, you can sed for long-term COVID patients with these conditions. But another intervention that can do wonders for many people with mood disorders—exercise—has not always been effective in those who have been chronically infected with the new coronavirus. That’s because many of them struggle with physical challenges, such as chronic fatigue and so-called post-exercise discomfort, or worsen symptoms even after limited physical activity.
“While we generally encourage physical activity in order to keep patients active, maintain their daily routine, and engage in physical activity as part of their mental health treatment, some patients with long-term COVID-19 infections are finding their symptoms It gets worse after increased activity,” Vannorsdall said.
Physicians at many programs across the country agree that it is easier to diagnose and treat mental health problems for patients who can reach long-term COVID care centers. But Anderson, from Oregon Health & Science, said many of the patients most affected by the outbreak — the poor and minorities — are also unlikely to be readily available at hospitals that offer these programs.
“Affluent, predominantly white populations are in these clinics, although we know that non-white populations have disproportionately high rates of virus-related acute infection, hospitalization and mortality,” he said.
Clinics are also concentrated in academic medical centers and urban areas, limiting options for people in rural communities who may have to drive for hours to get care, Anderson said.
We already know that many people live in areas without adequate mental health services,” said John Zulueta, assistant professor of clinical psychiatry at the University of Illinois at Chicago who provides mental health assessments. At UI Health Post-COVID Clinic.
“As more patients develop long-term COVID-related mental health issues, this will put pressure on an already stressed system. More pressure,” he said.