Millions of people across the United States have contracted and overcome a COVID-19 diagnosis. However, for some, the road to recovery has been difficult. Known as ‘long COVID,’ some patients continue to experience symptoms of COVID-19 weeks to months after their initial diagnosis.
While experts are unsure of its prevalence, the number of people with long COVID is significant and has prompted the creation of programs like the Mount Sinai Center for Post-COVID Care where patients are treated and researchers investigate the condition. Joseph Herrera, DO, Chair of Rehabilitation and Human Performance for the Mount Sinai Health System, and cardiology fellow Saman Setareh-Shenas, MD, explain what it means to be a COVID-19 long hauler and how the Mount Sinai Health System is working to get these patients back to physical activity.
What is long COVID patient?
Saman Setareh-Shenas, MD: This is a patient with Post-COVID Syndrome, which is a series of symptoms ranging from shortness of breath, chest pain, heart palpitations, heart racing, the inability to return to pre-COVID level of physical activity, and brain fog. These symptoms are present for weeks after their initial COVID-19 symptoms have resolved. We have seen patients experiencing these symptoms for six months, or even longer.
Joseph Herrera, DO: We are seeing some patients that have not even been hospitalized with COVID-19 who are having difficulty progressing their activity to pre-COVID-19 infection levels. They will have good days and bad days, and will try to push themselves physically. But, instead of taking two steps forward, they take 10 steps back. That is a common theme with our long haulers.
How do you guide a patient back to physical activity?
Dr. Herrera: Important for a patient’s physical and cognitive activity is understanding their submaximal exercise limits. This is a measure of a patient’s aerobic fitness and maximum oxygen uptake while doing rigorous—but not overly strenuous—activity like jogging on a treadmill or using an exercise bike. Some patients who have difficulty with physical exertion may also benefit from a formal breath work program that helps patients understand breathing techniques. At Mount Sinai, we progress patients using the rule of tens. This means that every 10 days we increase the intensity duration of the exercise by 10 percent. So, it does take some time to get ‘back to normal.’ But we advise our patients that their body needs that time to heal and rest. The symptoms resolve, but it does take a prolonged period for those symptoms to get better.
What advice do you have for long haulers who are trying to get back into exercise?
Dr. Herrera: If you have long COVID, you have to respect the symptoms you are experiencing and understand that your body is in the process of healing. I advise patients to create a diary of what they are experiencing and work with a physical therapist to address their concerns. Slowly working toward a gradual return to activity is the goal. You can’t rush this. Anytime our patients try to rush the process, they end up taking 10 steps back instead of three steps forward.
Dr. Setareh-Shenas: COVID-19 comes with a lot of inflammation and the body needs time to heal. Give yourself that time; go slowly, and gradually you can get back to your baseline. Normal household stuff is important, like walking and grocery shopping. Then, once you are comfortable, move on to exercising and boosting your exercise capacity.
Dr. Herrera: I think the most important message is, if you’re experiencing any symptoms of long COVID, don’t push yourself too hard but do see a specialist. Get evaluated to see if you qualify for any of the programs that we offer at Mount Sinai.