Ask Patricia Anderson how she’s doing, and you probably won’t get a regular answer. “Now, I’m working and I’m fine,” he said last Tuesday. “Saturday and Sunday, I lay in bed. Long Covid is a roller coaster.”
Before the pandemic, Ms. Anderson practiced martial arts and did not own a car, instead walking and taking buses around Ann Arbor, Mich., where he was a medical librarian. Before falling ill with Covid-19 in March 2020, he had taken — oh, he was tracking — 11,409 steps a day.
The virus caused severe tremors, shortness of breath, a nervous system disorder and such cognitive decline that, for months, Ms. Anderson has not read the book.
“I was sick for a long time, and I never really got better,” he said. In a few days, exhaustion reduced his step count to three digits. Attempts at rehabilitation brought progress, then crashed.
The dozens of symptoms collectively known as long Covid, or post-Covid, can sideline anyone infected. But they cause particular harm to some elderly patients, who may be more susceptible to certain types of disease.
About 11 percent of American adults have developed prolonged Covid after infection, the Centers for Disease Control and Prevention reported last month, down from the nearly 19 percent recorded from June 2022 to June 2023. The figure suggests some adults are shedding the syndrome over time.
People over the age of 60 actually have lower rates of prolonged Covid overall than those aged 30 to 59. That could reflect higher vaccination and booster rates among older Americans, or more protective behavior such as masking and avoiding audiences.
“There may also be biologic factors that we don’t understand yet,” said Akiko Iwasaki, an immunologist and researcher at the Yale School of Medicine. Although knowledge of lingering Covid has increased, he added, much remains unknown about the disease.
Recently, Ms. Anderson, 66, the most cognitive and some physical function; he can manage 3,000 to 4,000 daily steps now. But she wears an N95 mask every time she goes out and grabs a sitting cane so “if I’m shopping and I run out of steam in the middle of the aisle, I can rest.”
And he was worried. Her employer allowed her to continue working remotely, but what if the library started requiring more than her current one day a week on site? “I can’t afford to retire,” he said. “It’s so scary.”
The CDC says the long Covid will begin when symptoms persist a month or more after infection. But the World Health Organization refers to the long Covid as “the persistence or development of new symptoms” three months after the initial infection, lasting at least two months without any other explanation.
The extensive list of long Covid symptoms includes difficulty breathing, cardiovascular and metabolic disease, kidney disease, gastrointestinal disorders, loss of consciousness, fatigue, muscle pain and weakness and mental health problems.
“There is hardly any organ system that remains untouched by Covid,” said Dr. Ziyad Al-Aly, a clinical epidemiologist at the Washington University School of Medicine and senior author of a recent study showing that these symptoms can last for two years.
“It can affect almost everyone from children to adults, throughout life,” he said.
Although prolonged Covid is more likely to afflict people who become seriously ill with Covid and require hospitalization – and Covid symptoms last longer in those patients – it can also follow mild infections. It can appear after the first bout of Covid, or the second or fourth.
While older people are not more susceptible to prolonged Covid in general, the research of Dr. Al-Aly using the large database of Veterans Affairs shows that they are more at risk for four specific clusters of symptoms:
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Metabolic disorders, including new-onset diabetes and high cholesterol.
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Cardiovascular problemsincluding heart disease, heart attack and arrhythmias such as atrial fibrillation.
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Gastrointestinal problems such as diarrhea and constipation, pancreatitis and liver disease.
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Strokes, cognitive decline and other neurological symptoms.
Jane Wolgemuth caught Covid in June 2022, along with her husband. “He thought about it for two days,” he recalled. “I was laid up for a week.”
They both improved after taking the oral antiviral Paxlovid. But after a few months, Ms. Wolgemuth, 69, a retired bank employee in Monument, Colo., began noticing mental problems, especially when driving.
“I don’t respond quickly,” he said. “Brain fog really takes over.”
After an MRI and other tests came back normal, Ms. Wolgemuth was diagnosed with long Covid. He’s taking supplements and trying light therapy, and he’s stretched his walking distance to four miles most days.
He’s feeling better about himself, he says, but “it’s remarkable how destructive Covid is.”
Seniors may mistake prolonged Covid for other conditions common in older ages. “They may think, ‘Maybe I’m just getting older or I need to adjust my blood pressure medication,'” says Dr. Monica Verduzco-Gutierrez, the chair of rehabilitation medicine at the University of Texas Health Science Center in San Antonio. He co-authored the American Academy of Physical Medicine and Rehabilitation guideline statements for treating chronic Covid.
Prolonged Covid can also exacerbate health problems that many seniors already face. “If they have a mild cognitive impairment, do they move into dementia? I’ve seen that happen,” said Dr. Verduzco-Gutierrez. A mild heart condition can become more serious, reducing mobility. act like an older person and increase the risks of falling.
“The best way in the world to avoid long Covid is to avoid Covid,” said Dr. Al-Aly. As infection rates rise across the country, masking again in close quarters and eating out at restaurants can help reduce infection.
“Definitely boosted,” he said. “Vaccination and strengthening reduce but do not eliminate the risk of long Covid” — by 15 percent to 50 percent, studies have found.
“If you’re infected, get tested to make sure it’s Covid, then call a provider as soon as possible and see if you’re eligible for Paxlovid,” he said. Antiviral treatment also reduces risk of long Covid by about 20 percent for those over 60, and about 34 percent for those over 70.
In the absence of longitudinal studies, it is unclear whether older people recover more slowly from prolonged Covid. Patients like Ms. Anderson and Ms. Wolgemuth recommends a range of treatments – supplements, electrolytes, compression garments, various physical therapy regimens. “But we don’t have a drug that’s been shown to reverse it,” said Dr. Iwasaki
certainly rehabilitation techniques already proven effective, pointed out Dr. Verduzco-Gutierrez, but there are not enough programs or clinics that have experienced prolonged Covid. Some doctors dismiss long-term Covid symptoms, patients report.
That leaves them looking for solutions on their own.
“They rose together to promote research and find treatments,” said Dr. Iwasaki, who compared long-term Covid patients to AIDS activists in the 1980s. He is in charge of Yale LISTEN studythat works with chronic Covid patients to better understand their conditions.
The Biden administration recently announced a new one federal office to lead long-term research into Covid, and more clinical trials are starting. However, for now, many patients rely on groups like this Long Covid Support and the Covid-19 Longhauler Advocacy Projectand participate in Patient-Led Research Collaborative.
Sheila McGrath, 71, who lives in Herndon, Va., recovered from her first Covid infection in February 2020, but has suffered since her second bout five months later. Although her health has improved, “I’ve never been back to my old self,” she said.
Now she and Ms. Anderson hosts an online chat for Long Covid Support. “Usually a person breaks down in tears,” said Ms. McGrath. “They are very frustrated at not being listened to, not being validated, being told it’s psychosomatic, being denied treatment. None of us want to be sick.”