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Covid Long Haul – Overview

April 29, 2021
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COVID long haul are symptoms that persist long after someone's recovered from COVID-19. Beginning in May, June, and July of 2020, we began to see patients come in with complaints of severe shortness of breath with normal long imaging, meaning they had either chest x-rays or CAT scans of the chest to try and figure out why they were persistently short of breath, and the lung doctors involved and the primary care doctors involved with tell these patients, "look, your lungs are clear, your CAT scan is clear. You should just go on with your life." But these people felt very, very impaired, so we started to see them. What we noticed was that their vocal folds were closing instead of opening during quiet breathing. How does that work? Normally, you're looking at me, I'm looking at you - our vocal chords (represented by my hands) are wide open. When you talk, the vocal cords close, they vibrate. When you breathe, they open. And during quiet breathing, as you can imagine, your vocal chords should be open. In these patients, the vocal chords shut. And if over a 20 or 30 second period and your vocal chords are shut 70 to 80%, of the time you can cough, or you're going to feel a little shortness of breath. Now, there are some very key characteristics of the shortness of breath and this group of patients. Before I tell you exactly what these characteristics are, what are the numbers? They estimate that at least as of right now, approximately a hundred million Americans have had COVID-19 and about half of them have persistent symptoms - about 50 million people. Of that group, about half of that (25 million) have no organ damage on imaging studies, or on blood testing. This is the group of long haulers that we're seeing - no organ damage, but persistent symptoms. In this case, persistent cough and/or shortness of breath. It's shortness of breath, with or without cough, and normal lung imaging. There are some key clinical characteristics. One, the shortness of breath or the cough does not wake patients up in the middle of the night. I'm not talking about, "do you have the symptoms at night?" Does it wake you up in the middle of the night? If it wakes you up in the middle of the night, that's not vocal cord dysfunction. That's not a vagal nerve injury. That is something going on with the heart or lungs, and you have to see your heart or lung doctor. Very often these patients come to me after seeing their lung doctor, after seeing their cardiologist, and everything is okay, and they're told, "listen, there's nothing we can do." What I'm asking people to do is when you have these persistent symptoms, the shortness of breath and your lung exam is normal and your heart exam is normal, see your ear, nose, and throat doctor. Getting back to the clinical characteristics: number one, the shortness of breath will not wake you up in the middle of the night. Number two, you will be able to exercise. After exercise - once you've completed your exercise - you may then feel the symptom of shortness breath. Finally, very acidic foods such as wine, such as vinegar, such as sodas - may trigger this shortness of breath. Again, talking, shouting, yelling, screaming, singing karaoke, voice use may trigger the shortness of breath. Changes in temperature, odor, smells may trigger this short breath.

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