Long Covid is not a little weak on the chest and lying in bed. Long Covid can change lives, destroy livelihoods, families and hopes.
Nobody knows this better than Jördis Frommhold. The internist and pulmonologist is an expert in Long Covid diseases. In autumn 2022 she founded the first institute for Long-Covid in Rostock in Germany. Last year alone, she dealt with 1,200 patients who were struggling with the long-term effects of one or more corona infections. Who can’t go for a walk for more than ten minutes because of their exhaustion, can’t look after their children, can’t make a living.
FOCUS online asked Frommhold on the phone about Long Covid. And she didn’t respond in a typical Mecklenburg-tranquil manner*, but rather transferred the speed of her thoughts to the speed of her speech.
Does the risk of Long Covid increase with every corona infection?
People become infected with Corona particularly often in the cold season and traditionally after the Christmas holidays and the New Year. For many it is now the second or even third infection. But does the frequency of corona diseases actually have an impact on the development of Long Covid?
“You can’t really say that the risk increases the more often you have an infection,” says Frommhold. “But what is striking is that those affected have the feeling that they cannot get rid of the infection.”
This is because the so-called convalescence times, in which health is gradually restored, are lengthening. The cause: Many people would no longer recover sufficiently and would go to work while still infected. “This increases the risk of Long Covid. “You become more careless with an acute infection, you run the risk of suffering long-term consequences,” says Frommhold.
People with severe corona courses do not have the highest risk of long-term effects
In the process, the expert also dispels a common misconception: it is not necessarily patients with severe corona infections or previous illnesses who are particularly susceptible to Long Covid – but rather those with mild cases.
“They are young and middle-aged, between 20 and late 50, and have not taken enough time off,” said the expert. Patients who are very agile and ambitious and who are, so to speak, among the service providers are particularly affected. Meanwhile, women (66 percent) have twice the risk of developing Long Covid as men (33 percent). Frommhold explains this with their “multidisciplinary” responsibility. “They work, take care of their family and the household. It’s difficult for them to say that they need recovery time now,” says the doctor. In addition, women in this age range are predestined for autoimmune diseases.
Long Covid luminary Frommhold: If you don’t cure Corona, the virus can stay in the body
If you start again too quickly after – or even with – a corona infection and do not recover completely, this can also lead to virus persistence. The virus remains in the body and survives in a kind of retreat area. In certain situations, the residual virus can be reactivated and trigger another illness.
So how long should patients rest? “If I have symptoms such as coughing, feeling weak, a slightly elevated temperature and have a positive corona test in my hands – then I don’t belong at work. As long as I have symptoms, I’m not healthy,” says the pulmonologist. In a performance-oriented society, it is considered good manners to still go to work or at least do something in the home office. But Frommhold strongly advises against it: “That’s not possible. You have to realize that it’s work too.”
Vaccinated people can also get Long Covid
This puts an enormous strain on the body – regardless of how fit and immunized a person is. Even those who have been vaccinated are not immune to Long Covid. “There are patients who have almost all been vaccinated, some four times, and have caught Corona and developed Long Covid after or between vaccinations,” reports the expert from the practice. “It’s not true that you don’t get long Covid if you’re vaccinated. The solidarity doesn’t work.”
Long Covid expert: Some doctors make incorrect “diagnosis of despair”
It is sometimes a long ordeal before Long Covid is actually diagnosed. It can happen that the treating doctors do not recognize the long-term effects of corona and, in the course of a “despair diagnosis”, certify a psychological illness, says Frommhold.
“It is noticeable that Long Covid patients are relegated to the psychosomatic track. “Long Covid patients receive the false diagnosis that they do not have Long Covid, but rather a psychosomatic illness such as depression,” says the expert. Sometimes the diagnosis would be made despite patients’ objections that they do not suffer from the disease.
“Symptoms of Long Covid are all diffuse? That’s not true”
Diagnosing Long Covid is not rocket science. “There are people who say that there are 200 different symptoms for Long Covid and they are all diffuse. “That’s not true,” says Frommhold. “When you look at the patients, you realize that the most common symptoms are fatigue and exercise intolerance.”
Other complaints for which there is often no other explanation include:
Dizziness Joint pain Tinnitus Concentration problems Respiratory mechanical problems Cognitive limitations Inflammation of the heart muscle
“What’s interesting is that some patients Histamine intolerances “develop,” adds the Long Covid expert. In addition, new autoimmune diseases could also occur after a corona illness – regardless of whether those affected have Long Covid or fatigue or not.
Malfunction of mitochondria in muscle cells – an explanation for Long Covid?
Where this exhaustion comes from in Long Covid patients has not yet been conclusively clarified. A study by the Free University of Amsterdam provided a possible explanation: Fatigue could be due to a malfunction in the muscle cells of the mitochondria, which are components of the cell and provide energy for its operation.
Frommhold believes this approach is plausible. With Long Covid, the mitochondria do not work properly, the muscles are exhausted, and movement is often accompanied by a leaden feeling. “Although there are already preparations that are intended to restore the function of the mitochondria, Frommhold has to dampen the euphoria: “There is no sensible therapy yet. You can’t get to the mitochondria yet.”
Long Covid sufferers with fatigue: “You are no longer able to participate in life”
The exhaustion that some Long Covid patients suffer from is sometimes an exhausting up and down. There are phases in which those affected feel better again and are euphoric about doing things. However, the symptoms would then worsen again.
“The more the course fluctuates, the more the symptoms worsen. The patients are then bedridden and no longer able to participate in life,” says the institute director. “They are in need of care, for example they can no longer look after their own children. “It’s a total social collapse, and it’s also accompanied by existential hardship,” says Frommhold. The institute would look after entire families in which a relative is ill with Long Covid and who feel left alone with the situation.
Corona infection can worsen Long Covid symptoms
Another corona infection could also set back those affected by Long Covid. “It does happen that patients who we were able to stabilize suffer a setback. Symptoms may worsen and may even lead to bed rest. “That shouldn’t be ignored,” says the pulmonologist. “Corona infections can intensify Long Covid.”
In order to minimize the viral load and avoid increasing Long Covid symptoms, the antiviral Paxlovid, among other things, is recommended.
“Pacing” is of great importance when treating long Covid
When treating patients with fatigue, “pacing” – i.e. “adjusting” – is particularly important. In this process, those affected learn to adapt to the level of activity that their body can handle. This includes recognizing your own limits and developing strategies to deal with fatigue.
As a result, those affected practice managing their energy in such a way that the symptoms are reduced. The expert says that activating methods, such as those used in the treatment of depression, only worsen the exhaustion.
The key points: This is what lies behind “Pacing”
“Pacing” also plays a crucial role in the prevention of Long Covid and fatigue. “This makes it easy to minimize the risk,” says Frommhold.
Since “God knows not everyone knows what this is all about,” the institute director summarizes the key points of pacing again:
Take symptoms seriously, don’t overestimate yourself and don’t go to work to cure yourself
In addition, the head of the institute recommends the following preventive measures:
Reduce fever Relieve pain with saline inhalation Do breathing exercises during the infection – for example breathing into your stomach – so that you don’t get used to shallow breathing
If the symptoms worsen four to six weeks after corona infection, you should see a doctor
If you notice that your symptoms are getting worse four to six weeks after a corona infection, the expert recommends that you first contact your family doctor or a special center for an exclusion diagnosis. The Institute for Long-Covid offers a video consultation. In addition, after medical advice, off-label medications can also help. In this case, medications are used outside the intended area of application for which they are approved.
“The important thing is: the sooner I notice that Long Covid symptoms are developing, the sooner I should get support so that it doesn’t become chronic,” says Frommhold.
*Note: The author herself comes from Mecklenburg-Western Pomerania, so she can say that.