University of Virginia researchers are working to better understand and treat the persistent symptoms of long COVID affecting millions of Americans.
UVA Health recently joined two national clinical trials that are part of the National Institutes of Health’s Researching COVID to Enhance Recovery Initiative, which seeks to understand and prevent long COVID.
“It’s estimated that between 5% and 30% of people who had COVID-19 may experience symptoms of long COVID,” said Dr. Alexandra Kadl, director of UVA Health’s post-COVID clinic, which opened in July 2020.“Given that pretty much all Americans have had at least one episode of COVID, the estimates right now are that maybe 50 million Americans could be affected by it in different severities.”
Dr. Alexandra Kadl has worked with patients with COVID-19 since the start of the outbreak. (Photo by Harry Moxley)
Kadl said the definition of long COVID has changed over time. The most widely accepted definition now is that it “is a chronic disease that persists at least three months after your COVID infection. It can have about 200 different symptoms that are severe enough to alter your lifestyle and ability to work,” she said.
The most common symptoms she sees are respiratory complaints like chronic cough and shortness of breath, sleep issues, gastrointestinal trouble and neurological symptoms
One of the trials, RECOVER-SLEEP, is enrolling two patient populations with different sleep issues after having COVID-19. The trial is enrolling adults with hypersomnia, meaning they sleep a lot more than before they had COVID-19, to the point where it interferes with their daily activities; and those with complex sleep disturbances, who have poor sleep quality or problems falling asleep.
Participants with hypersomnia will receive either a placebo or one of two medications, Solriamfetol and Modafinil. Those with complex sleep disturbances will be randomized to receive either low-intensity light or high-intensity light in addition to either placebo or Melatonin.
The second trial is called RECOVER-AUTONOMIC and is enrolling adults who developed symptoms of postural orthostatic tachycardia syndrome, or POTS, after having COVID-19. Symptoms include dizziness, fatigue and fast heart rate, especially when lying down or standing up from a seated position.
Kadl explains long COVID is now widely defined as a chronic illness lasting at least three months after infection, with symptoms that can significantly impact daily life and work. (Photo by Harry Moxley)
People who may qualify are “anybody who starts to feel lightheaded, dizzy when they walk or exercise, even when the exercise is minimal,” Kadl said.
The study has two study groups. One group will receive intravenous immunoglobulins (IVIG), which contains antibodies to help the body fight infection, or a placebo, and the other ivabradine, an oral medication that reduces heart rate, or a placebo.
All participants will recieve non-drug care or coordinated non-drug care that includes weekly phone calls from study coordinators, compression belts and high-salt diets, recommended for those with POTS.
To determine eligibility, the team runs a series of tests on potential participants, including a tilt table test, where a patient lays flat on a table and is gradually tilted upwards while their blood pressure and heart rate are monitored. If their blood pressure or heart rate changes, that may be a good indicator they qualify.
“This is a group of people who have a normal heart and lungs, but somehow, they don’t work together,” Kadl said. “Blood pools in your legs and is not able to move up to your heart and areas that need it because the regulation of the heart is disturbed.”
Managing long COVID is especially challenging because many of the patients’ symptoms are dismissed as personal weaknesses and not serious, Kadl said, though they are very real.
