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DHMC Works To Set Up Post COVID-19 Syndrome Clinic As 'Long Hauler' Questions Remain

Vaccination site in Concord, N.H.
Christina Phillips / NHPR
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The vaccination site at the former Sears at Steeplegate Mall in Concord.

More than a year into the coronavirus pandemic, doctors and researchers are still trying to learn more about patients who have become known as "long haulers" for continuing to experience health effects long after first showing symptoms.

All Things Considered host Peter Biello spoke with Dr. Jeffrey Parsonnet, an infectious disease physician at Dartmouth-Hitchcock Medical Center in Lebanon, about what the medical community knows about long-term impacts of COVID-19. Parsonnet is also Associate Professor of Medicine at the Geisel School of Medicine.

(Below is a computer-generated transcript of the interview.)

PETER BIELLO: So, Doctor Parsonnet, what do we know so far about the different ways people experience long term COVID infection?

DR. JEFFREY PARSONNET: Unfortunately, we really don't have a very good understanding of what we would say that pathophysiology of this is. We know that people who get COVID can be sick for a week or two, but many people, maybe up to 30 percent of people will have long term symptoms, which we sort of define as symptoms going on beyond eight to 12 weeks after their acute illness. And curiously, many of these people, maybe most of these people, didn't have very severe illness during the acute covid stage. Some people with so-called long covid symptoms really had minor illness or asymptomatic. So the the way in which it comes about remains to be seen. Most people feel that it doesn't have to do with the virus still being present in your body, but more of an immune reaction of some kind to having had the virus and the most common long term symptoms related to the respiratory tract, cough and shortness of breath and people who fatigue unbelievably easily with minimal exercise, brain, so-called brain fog and difficulty just carrying on any kind of activity without being exhausted. And the reason for this that these things occur is still under investigation. 

BIELLO: So what does that investigation look like? Are you collecting data or do you know if other other researchers are collecting data on how long this lasts and the range of symptoms?

DR. PARSONNET: There are many studies going on around the country, principally by centers where the disease hit hardest, which would be large urban centers. So there are big post covid syndrome clinics in New York, Boston and elsewhere in the country. We have had far fewer cases here and we've gotten started on this later. So we haven't yet started collecting data, but we are starting up a post-covid Syndrome clinic care pathway and we will be collecting data. And of course, we have unique challenges here in investigating this and studying this and caring for patients because of the rural nature of our institution.

BIELLO: What do we know about the vaccine's efficacy when it comes to relieving some of the long covid symptoms?

DR. PARSONNET: You're asking a question that really just came up in the news just a few days ago with what we would call anecdotal reports of people with long covid symptoms who seem to get strikingly better after they got the vaccine. And that raised the possibility in some people's minds that the virus is still around and that by giving by inducing antibody with a vaccine, that you would kind of clean up the extra virus. But I don't think that's the that's the way it would really work. I think it probably has more to do with an immunological mechanism. And frankly, those kinds of reports really have to be confirmed in a in a controlled way. You know, there are people who maybe these are people who might have gotten better anyway and there's a placebo effect possibility. So we really can't say with any confidence that getting the vaccine will be helpful and relieving long term symptoms

BIELLO: For those who are dealing with long-term covid symptoms, what support is there for them? You mentioned the clinic at Dartmouth-Hitchcock, what's available at Dartmouth-Hitchcock and what might be available elsewhere?

DR. PARSONNET: Well, first of all, it's not quite available yet. We haven't started up our clinic, although we have people in all of our departments who are participating in setting this up and who have a special interest and are working on developing programs. I'm not aware of other programs in New Hampshire for this. And I think some people are traveling great distances to Boston and New York, for example, for subspecialty clinics. I have to emphasize that there are no specific therapies for this. There's no none of the monoclonal antibodies are effective for this. There are no there are no specific therapies for any manifestation of long term covid. So research is intense and these centers are all doing research on patients. And we will probably be collecting a database of patients and hoping to enroll them in studies as they come along at the moment. Well, we're close, I think, to being able to to have a clinical care pathway set up here at Dartmouth-Hitchcock and maybe will involve the southern region as well.

BIELLO:  Well, Dr. Parsonnet, thank you very much for speaking with me.

DR. PARSONNET: Thank you. We look forward to being able to help out our patients.

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