For some patients, long after the acute symptoms of a COVID-19 infection fade, lingering symptoms remain and can alter their day-to-day quality of life.

These “post-COVID” symptoms can vary, from fatigue, dyspnea (difficult breathing), chest pain or palpitations to continued loss of smell or taste, body aches, headaches, trouble sleeping or brain fog and difficulty concentrating. Whatever their symptoms, many post-COVID patients experience one similar frustration. It is very hard to find answers and treatment for a condition that is so new and that scientists and health care providers are still learning about.

That is where UAB Medicine primary care physicians can play a role. In November 2020, about eight months after COVID hit the United States, UAB Medicine launched a multidisciplinary Post-COVID Treatment Program to help patients experiencing these lingering symptoms. The program consists of specialists, including neurologists, cardiologists, pulmonologists, psychiatrists and more, and primary care providers such as Sumayah Abed, M.D., assistant professor in the Department of Family and Community Medicine and a clinician at UAB Medicine Hoover Primary & Specialty Care.

In addition to her regular patients, Abed now sees post-COVID patients referred to her for symptoms that persist more than 12 weeks after the initial illness. She walked us through four key points to keep in mind about post-COVID syndrome, which varies but on average affects about 15-30% of COVID patients in some way.

The symptoms can vary widely and might be unexpected.

To be eligible for the post-COVID program, patients must be at least three-four weeks post-COVID infection and experiencing ongoing symptoms. Many patients considered to be experiencing post-COVID syndrome have ongoing symptoms at least 12 weeks out from infection.

Sumayah Abed, M.D.

In her time treating patients with lingering post-COVID symptoms, Abed has seen a wide variety of issues. Some patients experience ongoing problems with “typical” COVID symptoms, such as coughing or shortness of breath. Others experience more neurological problems – headaches, brain fog, trouble concentrating, dizziness, irritability, loss of taste or smell or strange tastes or smells. Still others have cardiac symptoms, such as heart palpitations or chest pain, or problems with excessive sweating, trouble sleeping, or psychological complaints of anxiety, depression and PTSD. Many patients experience multiple symptoms at one time.

Though researchers and providers are still looking into the causes of these symptoms, Abed said they most often occur in patients who were hospitalized during the acute phase of their illness or who had a severe case even without hospitalization. Providers suspect that many of the symptoms could be due to the extreme inflammation that COVID triggers in the body, seemingly system-wide.

“During COVID, most of [a patient’s] inflammatory markers go up,” Abed said. “Chronic inflammation (post-viral) and excessive autoimmune or organ damage due to acute illness could contribute to post-COVID syndrome. These are some of the theories.”

Primary care providers can help diagnose, manage and refer.

For many post-COVID patients, managing all of their symptoms, from pulmonary to neurological, can get tricky. That is where a primary care provider can help. As a family medicine physician, Abed can take a holistic look at the patient’s symptoms and health history, run tests, discuss diet, sleep and exercise habits, provide treatment where possible and refer the patient to other UAB specialists as needed.

“When I am evaluating a patient with post-COVID symptoms, I will take a history of their illness, including the severity of the acute phase, if they were hospitalized and what treatments, such as oxygen or antibodies infusion, were used,” Abed said. “We will talk about how symptoms changed over time, what is mainly bothering them now and do a systemic-based examination.”

The examination might include respiratory tests, oxygen saturation levels, walking tests to check for shortness of breath, EKG or other cardiac testing, and any necessary labwork or imaging, such as chest X-rays or CT scans. There is no definitive test specifically for post-COVID syndrome.

Then, Abed will evaluate the case and use mainly supportive treatment that can include rehabilitation, such as cardio-pulmonary rehabilitation for those with dyspnea (trouble breathing) or chest pain. She discusses a healthy diet, programmed exercise and getting enough sleep. Then she will follow up with the patient to see if the symptoms resolved. For cases that are not improving or worsening, or have abnormal work-ups, she will refer the patient to a cardiologist, neurologist or other specialist, sharing the facts of the case and streamlining and expediting care as much as possible.

Mental health is an urgent issue.

Psychological concerns play a huge role in treating post-COVID patients, according to Abed.

“We have seen a spike in depression, anxiety and PTSD symptoms,” she said. “Not only were these patients infected with COVID, often experiencing severe illness, many of them also had friends and family members who were infected or who died. All of that is connected, emotionally and physically.”

For patients needing mental health treatment, Abed refers them to Kaylee Crockett, Ph.D., assistant professor in the Department of Family and Community Medicine and a clinical health psychologist and clinical scientist or to another mental health provider at UAB Medicine. She can also help patients begin to seek mental health care through their employer or connect them to supportive groups.

“For many patients, it is very important for them to connect with a psychologist and/or psychiatrist,” Abed said.

Post-COVID treatment for children is a growing need.

Looking forward, Abed sees an expanding need for post-COVID programs for children, who were affected by the hyper-contagious omicron variant and who, if they are under the age of five, are not yet eligible for the COVID-19 vaccination.

“Unfortunately, in this latest surge, we saw more cases in children,” Abed said. “I think there is a need for a post-COVID program specifically for them.”

Patients who want to learn more about UAB’s Post-COVID Treatment Program can call 205-975-1881. Both UAB and community physicians can refer patients to the Post-COVID Treatment Program. For more information, visit https://www.uabmedicine.org/covid.