The paper said that while numerous cases SARS-CoV-2 RT-PCR and antigen testing are not 100% sensitive. Before ordering laboratory testing for post-COVID conditions, the goals of testing should be clear to the healthcare professional and to the patient. The National Institutes of Health (NIH) is conducting a research project, called the RECOVER Initiative, to understand how people recover from a COVID-19 infection and why some people do not fully recover and develop long COVID or post-COVID conditions. Dr. Arbaje mentioned that the study uses claims data, something the authors point out as well. 6-month neurological and psychiatric outcomes in 236379 survivors of COVID-19: a retrospective cohort study using electronic health records. People with pre-existing substance use disorder may be at risk for relapse. 2021 May 10. doi:10.1016/S1473-3099(21)00211-5, Carf A, Bernabei R, Landi F, et al. For instance, how safely can we start rehabilitation interventions? 2021 Mar 31. doi:10.1016/j.chest.2021.03.044, OBrien H, Tracey MJ, Ottewill C, et al. An error has occurred and we have not been able to send your data, please try again later. At the same time, people in these groups might have less access to the primary healthcare and treatment options that are needed by people suffering from post-COVID conditions. So we were learning that COVID-19 can lead to problems with coagulation, and it may be that it creates a new, thickened blood that can then lead to cardiovascular disease or other things., So I think it could be one of two things or maybe both: accelerating what was already coming, because the immune system is no longer able to tend to those [issues], because its so focused on dealing with COVID-19, or it may create new injuries that then need to be dealt with again, by an immune system that may already be overburdened. Dr. Alicia Arbaje. What is the latest research on the form of cancer Jimmy Carter has? The World Health Organization renamed the virus COVID-19 for coronavirus disease 2019. However, the study was carried out on a small group of patients, with all the limitations this involves. You may also breathe faster. MMWR Morb Mortal Wkly Rep 2020;69:887-892. actively investigate the full spectrum of COVID-19 illness, Services and Supports for Longer-Term Impacts of COVID-19, Multidisciplinary Quality Improvement Initiative, 2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play, Post-COVID-19 Conditions in Children and Adolescents, Long COVID: A Primer for Family Physicians, European Respiratory Society Statement on Long COVID-19 Follow-Up, COVID-19 rapid guideline: managing the long-term effects of COVID-19, Guidance on Long COVID as a Disability Under the ADA, Section, COVID-19 and the Americans with Disabilities Act, Supporting Employers with Long COVID: A Guide for Employers, What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Providing Medical Evidence for Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), PolicyNet/Instructions Updates/EM-21032 REV : Evaluating Cases with Coronavirus Disease 2019 (COVID-19), ECHO Program on Long COVID Treatments and Fatiguing Illness Recovery, Webinar Thursday, May 5, 2022 Evaluating and Supporting Patients Presenting with Cognitive Symptoms Following COVID, Webinar September 30, 2021 Evaluating and Supporting Patients Presenting With Fatigue Following COVID-19, Webinar June 17, 2021 Evaluating and Caring for Patients with Post-COVID Conditions, Find COVID-19 guidance for your community, The Accountable Health Communities Health-Related Social Needs Screening Tool, AAFP Social Determinants of Health resources, Nalbandian A, Sehgal K, Gupta A, Madhavan MV, et al. Though medical systems have come very far, unequal care-giving remains an issue. Nature. Sensitivity to and awareness of stigma, completing a full clinical evaluation, and maintaining an attitude of empathy and understanding can help address these concerns. The FDA has approvedthe antiviral remdesivir(Veklury) for the treatment of patients hospitalized with COVID. What does COVID-19 recovery actually look like? the increased risk for incidental findings. After over 100 days with these devices, both patients developed tricuspid valve vegetations. 2021 Apr 26. doi:10.1101/2021.04.26.21256110. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. A wide variety of health effects can persist after the acute COVID-19 illness has resolved (e.g., pulmonary fibrosis, myocarditis). 2021 Apr;27(4):626-631. doi:10.1038/s41591-021-01292-y, Lund LC, Hallas J, Nielsen H, et al. Severe illness due to the wild-type SARS-CoV-2 and the previous variants often involves the infection and inflammation of the lungs. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Healthcare providers should encourage patients to report any new or changing symptoms and to discuss any changes in activities or routines. Int J Clin Pract. An improvement might be to ask patients about their symptoms rather than basing the study on billing and administrative data. SARS-CoV-2, the virus that causes COVID-19, is part of the coronavirus family. COVID-19 pneumonia spreads like multiple wildfires, leaving destroyed lung tissue in its wake, January 11, 2021 Stals, M.V. J Gen Intern Med. I think this work is significant. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction. 2019 Jun;15(2):98-101. doi:10.1183/20734735.0013-2019, Lavery AM, Preston LE, Ko JY, et al. It is observed that 40% display changes to respiratory function a month after discharge, although the large majority of patients can carry out their day-to-day activities with no restrictions. Are vaccines safe in patients with Long COVID? Methods Seventy-two patients Get the latest news delivered to your inbox. COVID-19 was only identified in 2019 and scientists are learning more every day about what it can do to your lungs. At the end of each branch are tiny air sacs called alveoli. Int J Clin Pract. The study also revealed why the mortality among patients on a ventilator for COVID-19 was lower than patients on a ventilator due to regular pneumonia, the study reports. In addition, there is a growing recognition of long COVID among researchers and clinicians. Further caution may be exercised in ordering imaging in children without a high index of suspicion of pathology. Others had scarring in their lungs. Causes behind painful breathing, fluid buildup. This is the first study in which scientists analyzed immune cells from the lungs of COVID-19 pneumonia patients in a systematic manner and compared them to cells from patients with pneumonia from other viruses or bacteria. Within three to six months, you may feel a bit tired and eventually symptom-free. doi:10.1136/bmj.m3026, COVID-19 Rapid Guideline: Managing the Long-Term Effects of COVID-19. Authors: Jacobo Sellars, director of the Interstitial Lung Disease Working Group, and Oriol Sibila, Head of Department at the Hospital Respiratory Care. The study suggests macrophages cells typically charged with protecting the lung can be infected by SARS-CoV-2 and can contribute to spreading the infection through the lung. Effects of COVID-19 illness or hospitalization can include tracheal stenosis from prolonged intubation, severe weakness, and muscle atrophy. Breathe (Sheff). Older adults and people who have other health conditions like heart disease, cancer, and diabetes may have more serious symptoms. I see patients who still have sequela past 120 days, who want to know if their symptoms can still improve. Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition A cohort study. Lee SH, Shin HS, Park HY, et al. Our lower respiratory infection group included exacerbations of chronic obstructive pulmonary disease and likely included some undiagnosed bacterial pneumonias, and therefore, many of these patients were likely quite ill, said Dr. Cohen. Methods persistent symptoms and conditions that begin at the time of acute COVID-19 illness, new-onset signs, symptoms, or conditions following asymptomatic disease or a period of acute symptom relief or remission, an evolution of symptoms and conditions that include some persistent symptoms (e.g., shortness of breath) with the addition of new symptoms or conditions over time (e.g., cognitive difficulties), worsening of pre-existing symptoms or conditions, physical deconditioningat baseline or after a prolonged acute disease course that can be nonspecific to COVID-19, physical and mental health consequences of illness with a long or complicated disease course, including depression and anxiety, social, environmental, and economic stressors caused by the COVID-19 pandemic, Post-exertional malaise* and/or poor endurance, differing symptoms or conditions investigated, the temporal criteria used (three weeks up to many months following SARS-CoV-2 infection), the study settings included (outpatient vs. inpatient), how symptoms and conditions are assessed (e.g., self-report vs. electronic health record database), organ damage resulting from acute phase infection, complications from a dysregulated inflammatory state, ongoing viral activity associated with an intra-host viral reservoir. A person may be experiencing diabetes and hypertension and stroke and COVID-19 not just COVID-19 alone. 2020 Oct;7(10):ofaa420. Saving Lives, Protecting People, Given new evidence on the B.1.617.2 (Delta) variant, CDC has updated the, The White House announced that vaccines will be required for international travelers coming into the United States, with an effective date of November 8, 2021. About 14% of COVID-19 cases are severe, with an infection that affects both lungs. She also said that future research could look at any possible effect the COVID-19 vaccines have on a persons likelihood of developing sequelae: I think that the vaccines are another potential confounder or effect modifier [] Because I think and this is not a political statement, it is just an observational statement that just as COVID-19 is a stressor, the vaccines, because they are so effective at generating an immune response, are also stressors., On some level, said Dr. Arbaje, they may act as COVID-19 not in causing illness per se but in being a stressor. Dr. Irene M. Estores, director of the Integrative Medicine Program at the University of Florida Health, said the findings confirm previous work in this area. Most people who develop COVID-19 fully recover, but current evidence suggests approximately 10%-20% of people experience a variety of mid- and long-term effects after they recover from their initial illness. If your doctor takes a CT scan of your chest, the opaque spots in your lungs look like they start to connect to each other. Dr. Estores said the findings may be due to the limited knowledge doctors currently have of how to care for patients following the acute phase of COVID-19. These mid- and long-term effects are collectively known as post COVID-19 condition or long COVID. Current U.S. government Long COVID research and plans for accelerating research and innovation in Long COVID are summarized in the National Research Action Plan on Long COVID. You might also have more serious pneumonia. Are There Treatments for COVID-19 Pneumonia? The researchers note similar findings for the 2019 comparison group. The Johns Hopkins Post-Acute COVID-19 Team (PACT): A Multidisciplinary, Collaborative, Ambulatory Framework Supporting COVID-19 Survivors. Mental morbidities and chronic fatigue in severe acute respiratory syndrome survivors: long-term follow-up. 2020 Sep 7:e13700. This is not to say that people shouldnt get vaccinated I just think that were still early in this process and that its important to look at the long-term effects of anything that were doing in medicine, said Dr. Arbaje. Milbank Q. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. As a result of the detailed analysis, researchers identified critical targets to. Post-COVID recovery Find out about possible causes of post-COVID-19 conditions and ways to manage symptoms. myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), U.S. Census Bureaus Household Pulse Survey, help assess for current or previous infection, myalgic encephalomyelitis/chronic fatigue syndrome, disparities in social determinants of health, Tools for cross-cultural communication and language access. Eur J Phys Rehabil Med. doi:10.1016/j.amjmed.2020.12.009, Santhosh L, Block B, Kim SY, Raju S, Shah RJ, Thakur N, Brigham EP, Parker AM. But in other areas, such as sleep and mood alterations, cognitive difficulties, and ongoing fatigue and myalgias, to date, we dont have the answers.. WebMD does not provide medical advice, diagnosis or treatment. Some of these effects are similar to those from hospitalization for other respiratory infections or other conditions. Such diaries and calendars can provide greater insight into patients symptoms and lived experience for healthcare providers. Management of post-acute covid-19 in primary care. Long-term effects of About 80% of people who have COVID-19 get mild to moderate symptoms. Avoid anyone whos sick. Huisman, H. Endeman: Incidence of thrombotic complications in critically ill ICU patients with COVID-19, 04.13.2020. The drug to be tested quiets the inflammatory response of these immune cells, thus enabling initiation of the repair process in the injured lung. Dr. Estores said extending the studys observation time could also be a way to develop the research. Now he's died of Covid pneumonia. A comprehensive management plan focusing on improving physical, mental, and social well-being may be helpful for some patients. 2021 Apr 28. doi: 10.1093/cid/ciab338, Hernandez-Romieu AC, Leung S, Mbanya A, et al. The omicron subvariant of COVID-19, BA.5, became one of the dominant strains of the virus in the fall of 2022 in the U.S. At that time, it was the most easily spread strain to date and is able to evade immunity from COVID infection and vaccination. The World Health Organization (WHO) provided an ICD-10 code for post-COVID condition that was incorporated into the International Classification of Diseases, Tenth Edition Clinical Modification (ICD-10-CM) as of October 1, 2021: The code should be used for patients with a history of probable or confirmed SARS CoV-2 infection who are identified with a post-COVID condition. doi:10.1111/ijcp.14357, Rando HM, Bennett TD, Byrd JB, et al. The NHS has warned that the lung condition can lead to symptoms such as a phlegm-producing cough. Evidence indicates that holistic support for the patient throughout their illness course can be beneficial. Continuity of care is important in the management of post-COVID conditions. Regularly clean and disinfect surfaces in your home that you touch often, such as countertops and keyboards. Int J Environ Res Public Health. News release, University of Florida Health. At this time, no laboratory test can definitively distinguish post-COVID conditions from other conditions with different etiologies, in part due to the heterogeneity of post-COVID conditions. People who live in nursing homes or who have other health problems like these also have higher chances of more severe illness with COVID-19: Someone who has a weakened immune system may be more likely to get severe COVID-19 illness, too. Coronaviruses cause respiratory illnesses, so the lungs are usually affected first. Shortness of breath (dyspnea) or trouble breathing. How much or how little should be done? asked Dr. Estores. Clin Infect Dis. An integrated multidisciplinary model of COVID-19 recovery care. This is what the research says. However, researchers have shown that the disease can affect multiple organs in a persons body. 2019 Jan;16(1):59-64. doi:10.30773/pi.2018.10.22.3. Post-acute COVID-19 outcomes in children with mild and asymptomatic disease. Kaptein, J. van Paassen, M.A.M. It can be difficult to distinguish symptoms caused by post-COVID conditions from symptoms that occur for other reasons. Commonly reported symptoms include: * Post-exertional malaise (PEM)is the worsening of symptoms following even minor physical or mental exertion, with symptoms typically worsening 12 to 48 hours after activity and lasting for days or even weeks. We aimed to investigate the clinical effects of intravenous glucocorticoid (GC) therapy for severe COVID-19 pneumonia. 2020;370:m3026. In the present study, the researchers wanted to better understand the likelihood of older adults developing health conditions following a SARS-CoV-2 infection, which experts generally refer to as sequelae. 2021 Mar 5. doi: 10.1101/2021.03.03.21252086, Havervall S, Rosell A, Phillipson M, Mangsbo SM, Nilsson P, Hober S, Thlin C. Symptoms and Functional Impairment Assessed 8 Months After Mild COVID-19 Among Health Care Workers. When the authors compared the COVID-19 group with the lower respiratory tract infection group, risk increases only occurred for respiratory failure, dementia, and post-viral fatigue. These include low lymphocytes and elevated C-reactive protein (CRP). Some treatments have been offered that lack evidence of efficacy or effectiveness and could be harmful to patients. People who belong to racial and ethnic minority populations have experienced a higher burden of COVID-19in part because of structural racism and longstanding disparities in social determinants of healthwhich has led to a higher incidence of post-COVID conditions in some of these same populations. This can start in one part of your lung and spread. First authors are Rogan Grant, Luisa Morales-Nebreda and, Northwestern recognized for internationalization amid high demand for global education, Hes helping young musicians bridge the gap between art and business, Why we should anthropomorphize COVID-19 and the flu, A majority of Americans have not received the latest COVID booster, study finds, Two Northwestern faculty-led teams celebrate 2022 Chicago Innovation Awards. Am J Med. You may also have: If your COVID-19 infection starts to cause pneumonia, you may notice things like: About 15% of COVID-19 cases are severe. COVID-19 is a respiratory disease, one that especially reaches into your respiratory tract, which includes your lungs. Accessed at: https://www.medrxiv.org/content/10.1101/2021.03.11.21253225v2. WebEffects of Early Physical Therapy and Follow-Up in Acute Severe Coronavirus Disease 2019 Pneumonia: A Retrospective Observational Study: Author: Bordas Martnez, Jaume Luzardo Gonzlez, Ana COVID-19 Pneumnia COVID-19 Pneumonia: Issue Date: 11-Apr-2022: Publisher: Frontiers Media: You will be subject to the destination website's privacy policy when you follow the link. Dr. Arbaje was also not involved in the study. Sequelae in Adults at 6 Months After COVID-19 Infection. Again, this is a theory because if we think about what protects us from heart attacks, strokes, and cancer and other things, its our immune system. Objective laboratory or imaging findings should not be used as the only measure or assessment of a patients well-being; normal laboratory or imaging findings do not invalidate the existence, severity, or importance of a patients post-COVID symptoms or conditions. Accessed at: https://www.nice.org.uk/guidance/NG188, Sis-Almirall A, Brito-Zern P, Conangla Ferrn L, et al. Gommers, K.M. Additional diagnostic testing should be guided by findings from the patient history and physical examination and results of previous diagnostic testing, and may include a chest x-ray, pulmonary function tests, electrocardiogram, or echocardiogram for persistent or new respiratory or cardiac concerns, although additional studies and more clinical evidence is needed to support the utility of specific imaging tests for evaluation of post-COVID conditions. Various investigations in this field, which are still being carried out, will determine the real impact of the after-effects of this disease, especially those that persist in the mid- and long-term, in other words, 6 and 12 months after the serious illness caused by COVID. This study showed that many of the sequelae were respiratory complications, but there were cardiovascular, hypercoagulable, clotting disorders, and fatigue as well. The most severely affected patients are older men, individuals of black and Asian minority ethnicity and those with comorbidities. In the most critical cases, your lungs need help from a machine called a ventilator to do their job. If you've been exposed to someone with the virus or have COVID-19 Adults 1 Month After Reported SARS-CoV-2 Infection, November 1, 2021. In its acute phase, COVID-19 mainly involves the respiratory tract. In fact, three months after leaving the hospital about 70 percent of those in the study continued to have abnormal lung scans, an indication that the lungs are still damaged and trying to heal. 2021 Jan-Dec;18:14799731211015691. doi:10.1177%2F14799731211015691, Berger Z, Altiery DE Jesus V, Assoumou SA, et al. Orthostatic vital signsshould be evaluated for individuals reporting postural symptoms, dizziness, fatigue, cognitive impairment, or malaise. Readmission and Death After Initial Hospital Discharge Among Patients With COVID-19 in a Large Multihospital System. The other broad category is those with milder infection not requiring hospitalization, and here, we have fewer answers. Instead of rapidly infecting large regions of the lung, the virus causing COVID-19 sets up shop in multiple small areas of the lung. Slowly work back To do this, Dr. Cohen and his colleagues looked at the health insurance records of 133,366 older adults in the United States. When COVID pneumonia develops, it causes additional symptoms, such as: Shortness of breath Increased heart rate Low blood pressure What's more is that COVID Acta Paediatr. The damage causes tissue to break off and clog your lungs. We have already published a similar analysis in a cohort of 1864-year-olds, and we are completing work on a pediatric population. Klok, M.J.H.A. Lam MH, Wing YK, Yu MW, et al. Survivor support groups are connecting people, providing support, and sharing resources with survivors and others affected by COVID-19. The targets are the immune cells: macrophages and T cells. Pulmonology Department at Hospital Clnic de Barcelona. The bottom line that we can take from this work is that COVID-19 is leading to new [diseases] or is accelerating other illnesses, which means that we need to be ready as a healthcare system. Although the full impact of the lesions is currently unknown, various centres are monitoring these patients to be able to detect the potential development of pulmonary fibrosis early, including post-COVID consultation at Hospital Clnic. Nat Med. It multiplies, and the new viruses infect nearby cells. Our first patient was decannulated from ECMO and discharged, but re Healthcare providers and patients are encouraged to set achievable goals through shared decision-making, and to approach treatment by focusing on specific symptoms (e.g., headache) or conditions (e.g., dysautonomia). Heres what the new coronavirus does to your lungs. Signs of this potentially fatal complication. Healthcare professionals and patients should continue to discuss progress and challenges and reassess goals as needed. They are unable to get enough oxygen to the bloodstream, reducing the body's ability to take on oxygen and remove carbon dioxide what in most cases causes death. Ideally, healthcare professionals, in consultation with the relevant specialists, should develop a comprehensive management plan based on their patients presenting symptoms, underlying medical and psychiatric conditions, personal and social situations, and their treatment goals. The approach to caring for patients with post-COVID conditions will likely change over time as evidence accumulates. This is not a simple pneumonia or an illness that comes and goes. Recognizing and validating the impact of illness on quality of life should be part of the ongoing healthcare professional and patient interaction. The researchers believe this altered immune response explains why COVID-19 pneumonia takes longer to develop and extends hospital stays. The study authors found that 32% of the participants who had a SARS-CoV-2 infection in 2020 sought medical attention for a new or persistent condition. Broadly, I think about post-acute sequelae of COVID-19 as two syndromes, although there is overlap, he explained. CDC uses the 4-week timeframe in describing post-COVID conditions to emphasize the importance of initial clinical evaluation and supportive care during the initial 4 to 12 weeks after acute COVID-19. Eat a well-balanced diet. Accessed at: https://www.cdc.gov/mmwr/volumes/69/wr/mm6927e2.htm, DT Arnold, A Milne, E Samms, et al. You may have trouble breathing or feel short of breath. During the initial years of the COVID-19 pandemic, the incidence of invasive pneumococcal disease (IPD) due to Streptococcus pneumoniae declined substantially in multiple countries. Dr. Arbaje said that there are many ways that the healthcare system and broader social and political changes could support people in a post-acute phase of COVID-19. Check with your local health department about testing availability. Accessed at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/962830/s1079-ons-update-on-long-covid-prevalence-estimate.pdf, Buonsenso D, Munblit D, De Rose C, et al. anxiety about abnormal results that do not have clinical significance, A basic panel of laboratory tests might be considered for patients with ongoing symptoms (including testing for non-COVID-19-related conditions that may be contributing to illness) to assess for conditions that may respond to treatment (, More specialized testing may not be needed in patients who are being initially evaluated for post-COVID conditions; however, expanded testing should be considered if symptoms persist for 12 weeks or longer (, Patient-Reported Outcomes Measurement Information System (PROMIS) (e.g., Cognitive Function 4a), Post-Covid-19 Functional Status Scale (PCFS), Modified Medical Research Council (mMRC) Dyspnea Scale, Screen for Posttraumatic Stress Symptoms (SPTSS), Hospital Anxiety and Depression Scale (HADS), Connective Tissue Disease Screening Questionnaire. Post-COVID Conditions: Information for Healthcare Providers, How to Get Involved in Long COVID Research, Centers for Disease Control and Prevention. Rehabilitation needs of the first cohort of post-acute COVID-19 patients in Hubei, China. But in a study published in Nature on January 11, investigators at Northwestern Medicine show COVID-19 pneumonia is different. Because of the safety concerns, only a handful of groups around the world performed analysis of the immune response in the lungs of patients with COVID-19. When the virus gets in your body, it comes into contact with the mucous membranes that line your nose, mouth, and eyes. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. Attributes and predictors of long COVID. Understanding of post-COVID conditions remains incomplete. As a result, important information about what was killing patients with severe COVID-19 was missing. Can diet help improve depression symptoms? Based on current information, many post-COVID conditions can be managed by primary care providers, using patient-centered approaches to optimize the quality of life and function of affected patients. CDC uses the term post-COVID conditions(PCC) as an umbrella term for the wide range of health consequences that can be presentfour or more weeksafter infection with SARS-CoV-2, the virus that causes COVID-19. Alternative reasons for health problems need to be considered, such as other diagnoses, unmasking of pre-existing health conditions, or even SARS-CoV-2 reinfection. For patients who may require imaging based on clinical findings, symptom management and a rehabilitation plan can often be initiated simultaneously with the imaging workup. The study suggests macrophages cells typically charged with protecting the lung can be infected by SARS-CoV-2 and can contribute to spreading the infection through the lung. Three months after discharge from the hospital, all of the patients were able to return to work. New research finds that the antibodies that the body produces in response to COVID-19 vaccines reduce in number by 57% after 6 months. doi:10.1136/bmj.n693, Atalla E, Kalligeros M, Giampaolo G, et al. Most patients appear to recover from acute COVID-19 illness within four weeks. With over 400 million cases of COVID-19 worldwide, even a modest risk of long-term sequelae will have a major impact on patients and our healthcare systems. FDA-approved or over-the-counter medications, as well as vitamin or electrolyte supplements, may be helpful for indicated illnesses (e.g., headache, anxiety) or documented deficiencies (e.g., vitamin deficiency) after carefully weighing the benefits and risks of pharmaceutical interventions. In terms of causation, or at least speculating around what might account for it, I think and again, this is speculation that there may be two things to keep in mind.