Eighteen months after we first became aware of COVID-19, we are in the midst of a new epidemic, “Long COVID,” an array of physical and psychological problems that outlasts the original disease. That is, even though a person now tests negative, they can show symptoms that hang on for weeks or months. As a result, affected individuals can become depressed, anxious and, in some cases, disabled.
Here, Dr. Ahron Friedberg, author of Through a Screen Darkly describes “Long COVID” to Digital Journal and offers ways of most effectively dealing with it.
Dr. Ahron Friedberg: Medical symptoms can include shortness of breath, coughing, chronic pain, loss of smell, fatigue, palpitations, and gastrointestinal distress that last well beyond acute infection.
A clear psychiatric component with difficulties in concentrating/focusing, brain fog, fatigue/tiredness, and trouble sleeping. This may be related to a general inflammatory process in the body that affects brain.
A sub-clinical component that is epidemic, though not directly related to the medical/psychiatric aspect of the disease. It is often referred to as “languishing.”
DJ: What causes Psychiatric & Psychological Long COVID?
Friedberg: Based on meetings with my patients throughout the pandemic, here are a few examples of how Long COVID occurs:
- Like over 30% of MDs, one ER physician is burned out. She can’t focus or concentrate, and is also chronically sleep-deprived and tired. As a result, she is more prone to clinically significant errors, (e.g., she mistakenly sent someone home who had pneumonia).
- A child is very anxious about returning to school. She feels vulnerable because she is still unvaccinated. Masks and distancing make socializing difficult. She fears losing her friends. Her mother wonders if her social skills will diminish over time, leaving her permanently withdrawn.
- Citing the imminent arrival of booster shots, a parent fears that the vaccine is now less effective. She also worries that boosters could produce side-effects. Further, she is afraid to venture out (e.g., public transport, returning to work) because she might infect her family.
- For a paycheck-to-paycheck construction worker, increased stress due to COVID led to more severe back pain. He missed some days of work and is now afraid of returning. He might re-injure himself, and also bring COVID home to his family.
- An elderly, fully vaccinated woman will not accept visits from her family for fear that they could infect her. She is lonely and now isolated, and feels helpless about what to do until boosters arrive in September (at the earliest).
- A middle-aged son lost his mother to COVID, and was unable to see her in the ICU or to travel to her out-of-town funeral. He feels guilty and unable to fully process her loss.
- An Upper East Side woman tries to measure the risk of being around people whom, she suspects, are unvaccinated. She is wary of those that, demographically, tend to be less likely be vaccinated. She has also experienced conflicts in the elevator with unmasked neighbors.
DJ: What can people do about Psychiatric & Psychological Long COVID?
Friedberg: In general, increase your resilience. Do not be afraid to defend yourself. Practice the new etiquette: it is okay to insist on social distancing, and to ask if people in your space if they are vaccinated. To keep up your spirits, connect with others where it is safe; maintain your convictions; get counseling and other forms of help.
You can practice concentration by setting yourself goals – e.g., finish the daily crossword, read ten pages of a novel without getting up, keep a diary. Have goals and remain engaged with interesting projects. Keep lethargy at bay.
It’s okay to tune out the news for a few days. We tend to personalize the whole world’s troubles. But don’t let your own problems fester – even a telemedicine chat with your GP can be comforting. GPs know what’s going on in your community and can provide immediately useful advice.
The bottom line is that solutions are specific to individuals, depending on their experiences and situations.
DJ: What parting advice would you leave for Digital Journal readers?
Friedberg: COVID has already shown that it will have a “long tail” (not unlike PTSD). This includes psychiatric and psychological issues associated with Long Covid. We should therefore identify individual and family problems and help ourselves and one another to do better.
Dr. Ahron Friedberg, M.D. is a Clinical Professor of Psychiatry at Icahn School of Medicine at Mount Sinai. He is a practicing psychiatrist and psychoanalyst in Manhattan.
