Long Covid is especially difficult for the elderly – 09/11/2023 – Balance and Health

Ask Patricia Anderson how she is doing and you probably won’t get a routine answer. “Today I’m working and I’m fine,” she said on a recent Tuesday. “On Saturday and Sunday, I couldn’t get out of bed. Long Covid is a rollercoaster.”

Before the pandemic, Anderson practiced martial arts and lived without a car. Instead, she walked or rode the bus to get around Ann Arbor, Michigan, where she is a medical librarian. Just before contracting Covid-19 in March 2020, she had walked 11,409 steps in one day. Yes, she takes note of your daily steps.

The virus caused extreme chills, shortness of breath, a nervous system disorder, and cognitive decline so severe that Anderson couldn’t read a book for months.

“I was very sick for a long time and never really recovered,” she said. On some days, fatigue prevents her from walking a thousand steps in a day. Attempts at rehabilitation brought him advances, but then strong setbacks.

The dozens of symptoms that are collectively known as long-term Covid, or post-Covid, can bring down anyone who has contracted the disease. But they have an especially strong impact on some older patients, who may be more likely to have certain forms of the disease.

About 11% of American adults developed long-term Covid after a Covid infection, the Centers for Disease Control and Prevention (CDC) reported last month, down from the nearly 19% recorded between June 2022 and June 2023. The figure suggests that some adults are recovering from the syndrome over time.

People over 60 actually have lower rates of long Covid overall than people aged 30 to 59. This could reflect higher rates of vaccination and booster vaccinations among older Americans or their adherence to protective behaviors like mask wearing and avoiding crowds.

“There may also be biological factors that we don’t yet understand,” said Akiko Iwasaki, an immunologist and researcher at the Yale School of Medicine. Knowledge about long Covid has increased, she said, but much remains unknown about the disease.

Patricia Anderson, 66, only recently recovered most of her cognitive and some physical functions; Today she can walk between 3,000 and 4,000 steps a day. But she wears an N95 mask whenever she leaves the house and carries a cane attached to a stool. “That way, if I’m at the supermarket and I get exhausted in the middle of the aisle, I can get some rest.”

And she cares. The library she works for has let her continue to work remotely, but what if it starts requiring her to do face-to-face duties more than one day a week, like now? “I can’t afford to retire,” she said. “It is scary.”

The CDC says long Covid begins when symptoms persist for a month or more after infection. But the World Health Organization defines long-term Covid as “the continuation or development of new symptoms” three months after the additional infection, symptoms lasting at least two months with no other explanation.

The long list of Covid symptoms includes breathing difficulties, cardiovascular and metabolic diseases, kidney disease, gastrointestinal disorders, cognitive loss, fatigue, muscle pain and weakness, and mental health issues.

“There’s virtually no organ system that long-term Covid doesn’t hit,” said Dr. Ziyad Al-Aly, a clinical public health researcher at the Washington University School of Medicine and senior author of a recent study showing that these symptoms can persist for two weeks. years. “It can affect virtually anyone, from children to the elderly.”

While long Covid is more likely to strike people who become seriously ill with Covid and need to be hospitalized—and although long Covid symptoms last longer in these patients—it can also occur after mild infections. It can occur after the first Covid infection, the second or the fourth.

Older people are not more likely to suffer long Covid, but Al-Aly’s research using large databases from the Department of Veterans Affairs shows that older people are at greater risk of experiencing four particular clusters of symptoms:

• Metabolic disorders, including recent diabetes and high cholesterol.
• Cardiovascular problems, including heart disease, heart attacks, and arrhythmias such as atrial fibrillation.
• Gastrointestinal problems such as diarrhea, constipation, pancreatitis and liver disease.
• Strokes, cognitive decline and other neurological symptoms.

Jane Wolgemuth contracted Covid in June 2022, with her husband. “He got over it in two days,” she said. “I spent a week in bed.”

Both felt better after taking the antiviral Paxlovid orally. Months later, however, Wolgemuth, who is 69 and a retired bank clerk living in Monument, Colo., began to notice cognitive problems, especially when she was driving her car.

“I was reacting slowly,” she said. “Brain fog was getting the better of me.”

Elderly people may confuse long Covid with other conditions that are common in old age. “They might think, ‘Maybe I’m just getting older or maybe I need to change the dose of my high blood pressure medication,'” said Monica Verduzco-Gutierrez, director of rehabilitative medicine at the University of Texas Health Science Center at San Antonio. She co-authored guidelines from the American Academy of Medicine and Physical Rehabilitation on the treatment of long Covid.

Long Covid can also exacerbate health problems that many older people already face. “If the person already had a mild cognitive impairment, could that progress to dementia? I’ve seen that happen,” Verduzco-Gutierrez said. A mild heart problem can worsen, reducing an older person’s mobility and increasing their risk of falling.

“The best way to avoid long Covid is to avoid Covid,” said Al-Aly. With infection rates rising again across the country, returning to wearing a mask indoors and eating outdoors in restaurants are behaviors that can help reduce infections.

“Take the booster doses, without a doubt,” he recommended. “Vaccination and boosters do not eliminate the risk of long Covid, but they reduce it” — between 15% and 50%, as studies show.

“If you get infected, get tested to make sure it’s Covid and then call your doctor as soon as possible and see if you’re eligible for Paxlovid,” he said. Antiviral treatment also reduces the risk of long Covid by 20% for people in their 60s and by 34% for those over 70.

In the absence of longitudinal studies, it is currently unclear whether older people take longer to recover from long Covid.

Patients like Patricia Anderson and Jane Wolgemuth have already tried treatments of various types — supplements, electrolytes, compression garments and physical therapy of various types. “But we don’t have a medicine that has been proven to reverse long Covid,” Iwasaki said.

^{Translation by Clara Allain}