This webinar was recorded on December 1, 2022

It’s important to know the difference between being sick with Long COVID and other chronic or contagious conditions.  Listen in to learn the latest information on coping with being sick this winter.


  • Dr. Purvi Parikh
  • Sally Schoessler


Transcript: This transcript is automatically generated. While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.

Speaker 2    00:05

COVID-19 continues to impact our daily lives. And this week, Doctor Anthony Fauci, our leading national infectious disease expert, said that COVID-19 is not over yet. This is Sally Schoessler, director of education for Allergy & Asthma Network, and we’re excited to present our forty first webinar in our covid COVID-19 just our COVID webinars have had over 78,000 thousand views as we work to bring you the latest. Evidence based information on COVID-19 today we’re looking at new studies related to COVID-19 in both adults and in children. Allergy & Asthma Networkworks every day to live out our mission that is and that is to end the needless death and suffering due to asthma, allergies and related conditions through outreach, education, advocacy and research. Today, we welcome our COVID-19 medical expert doctor Purvi Parikh to our webinar. Doctor Parikh is an adult and pediatric allergist and immunologist at allergy and asthma Associates of Murray Hill. She is currently on faculty as a clinical assistant professor in both departments of medicine and Pediatrics at New York University School of Medicine. She’s been passionate about health policy and is on the board of directors of the Advocacy Council of the American College of Allergy, Asthma and Immunology. She is a spokesperson for the Allergy & Asthma Network. She frequently makes appearances as a medical contributor on our behalf to NBC, Fox, CNN, Wall Street Journal and CBS. We’re so lucky to have Doctor Parikh as a part of our webinars and we thank you for being with us today, Doctor Parikh, and we look forward to hearing from you in just a few minutes. So today’s program is going to be in three sections. First, we’re going to start, as we always do with the current state of COVID-19 Then we’re going to look at long COVID-19 with some new studies and we will have a patient case study involved in that as well. And then we’re going to finish up by talking about long COVID-19 in children. This is not something that’s been talked about a lot, but there are some new studies out and it’s very interesting. So we’re going to start today with a poll question. We want to know who it’s with us today and what we’d like to have you do is pick out what category describes you best. Now we realize that these categories don’t address every issue of what somebody would identify themselves as, but we have only this many choices. So if you could please choose either pharmacist and physician, a physician assistant, nurse practitioner, nurse, school nurse. That’s right. Therapist, asthma educator, health educator or patient. So just take a look and see which one might describe you best. Everybody’s getting their votes in and I appreciate that. So just another minute or two and we’ll have the majority of everybody having let us know who’s here. Ok. So here we go. So we’ve got 2% physicians or pharmacists, 4% physician assistant/nurse practitioners and as always, nurses and school nurses make up the bulk of our audience at 78%. We have 13 % respiratory therapists, asthma educators and health educators and 3% patients. So thank you so much for letting us know who’s with us today. So we are going to start with the current state of COVID-19 We always start by looking at the John Hopkins global map. This data is fresh from today at 11:21 AM and always keep in mind when we talk about this chart that the numbers will never go down because it’s accumulative. Look at the issue of COVID-19 across the world. So when we’re looking at the total cases, we’re looking at sixty six hundred and forty three billion cases and total deaths. Over 6 million. So that is just a staggering number but the best part is the last number in green where we look at total vaccine doses administered and that’s over 13 trillion. So this has just been such a public health issue and really it’s there’s really been a mobilization to get vaccines to people to address this. When we look at where the current cases of COVID-19 are in the US, this map changes all the time depending on where they are. The darker, the blue, that’s where the most cases are. So we’re really looking down in the Southwest and we’re seeing most of our cases there except for Ohio somehow is sticking out more towards the East. But if as you look you know when you get towards the Greens or the really light greens that’s where the least number of cases are. So that’s just, I always find it interesting how the map changes and alters. And so when we’ve also ever since the beginning of the pandemic, we’ve tracked the weekly trends in covid cases and this is CDC data and as it starts in January of 2020 and goes through the end of november that takes a little bit of time for them to get the numbers up on this chart but Idownloaded this chart today as well from CDC and as you can see you know we’ve had some big peaks of Covid especially at this time last year that’s when we saw those huge numbers of it. But you know, we’re still just, you know, kind of going up and down a little bit and so it’s still is something we should be looking at on a daily basis so in the news we always like to check the news and see what’s what they’re talking about so when we they they’re talking about two new sub variants of Omicron and then just another one this week so the original omicron is BA point five now we’re seeing them talk about B Q one point one and B Q point one and these two together make up about forty four percent of new COVID infections and BA five is making up just 30% so these two new sub variants really are gaining traction but the preliminary data suggests that they’re better at evading immunity from COVID vaccines including those new bivalent boosters or a previous COVID infection than past variants of Omicron so that might give these of variance a higher transmissible transmissibility but it could fuel a real rise in cases for the winter but then i said just this week another new sub variant was identified and they’re tracking a new one and this one is known as X BB and it’s a combination of the two earlier omicron some variants so this last one now represents it’s still only three point one percent of new covid cases throughout the US and five percent of the cases in the northeast but based on the preliminary estimates from the CDC the cases of X B may be doubling every twelve days so we are going to see a movement here i think and the variant shouldn’t pose the same threat as the emergence of omicron posed a year ago because this is a less severe form of the disease so in also in the news the monoclonal antibodies are not really effective with the new variants so that’s something to consider i would always still recommend everybody talks to their private provider to see what is the right course of action for them but like i said the current systems the current defenses aren’t there really with the monoclonal antibodies related to these new variants and another thing we’re seeing is masks are once again being recommended in los angeles county this isn’t a mandate but public health is strongly recommending wearing a mask in indoor public places and that’s in a relation to a jump in newly reported cases so we’re seeing some movement there so our next poll question today is going to be do you know someone who has or has had long covid so please go ahead and put in your answers it’s just going to be interesting to see with our audience how many people really do like actually know somebody that’s had long covid we hear a lot about it and it’s just it’s going to be interesting to see so if you could please put your answers in go ahead and click on the right circle yes no or i’m not sure so just another minute here or two for to let you get to answering and here we go we’ll look at our results so sixty three percent of you know someone who has long COVID  that’s pretty striking twenty percent of you don’t know someone and seventeen percent of you aren’t really sure but I think that’s pretty striking that sixty three percent of people know somebody with long COVID-19 so at this time i’m going to turn things over to Dr. Parikh to talk about new studies related to long COVID.

Speaker 1    09:29

Ok. Thank you very much. And I was smiling at the poll because technically 100 % of us are patients, right at the end of the day. But yeah, it’s always interesting to know who is in attendance. So long COVID is actually a very important and, you know, pertinent thing as we’re seeing an increase in cases and as I’ve always said, I think it’s going to be a bigger public health emergency than even acute COVID itself. Sorry.

Speaker 1    10:13

Ok, So what is long COVID? So basically the definition of it is people you know who’ve been infected with COVID-19 and are experiencing long term effects from it known as post COVID conditions and usually the cutoff or criteria for it is for at least a month afterwards. However many of these individuals as we know can experience it for months and even years afterwards as we’re. Sadly saying so. There’s many names for it. Long COVID some people call it. The official name is post acute sequelae of COVID-19 or PSC, but either way it’s all the same or chronic COVID. So what do you need to know? So post COVID conditions can include a wide range of ongoing health problems. These conditions can last weeks, months, or longer. Post COVID conditions are found more often in people who had severe COVID-19 illness. But anyone who has been infected with the virus that causes COVID-19 can experience post COVID conditions, even people who had mild illness. Or no symptoms from COVID-19 so and then people were not vaccinated against COVID-19 and become infected are also at a higher risk of developing post COVID conditions as well compared to those who were vaccinated and are having breakthrough infections. And while most people with post-COVID conditions have evidence of infection or COVID-19 illness, in some cases, a person with a post COVID condition may not have even tested positive for the virus or know they were infected. It’s not super common, but I am seeing some asymptomatic cases or mild cases. Cdc and the partners are working to understand more. About who experiences these conditions and why, you know certain groups are disproportionately impacted or at higher risk.

Speaker 2    12:30

So when first?

Speaker 1    12:31

Infected fever, chills, severe cough, tight chest. You know these are all common things, extreme fatigue and they can affect every organ system from head to toe. And many times, you know, some people like, you know, when we let’s start with the first case series, I’m sorry, one second, my screen is having some issues. One second.

Speaker 2    13:12

So while Dr Parikh fixes her screen. What we’re looking at right now is a case study and it and obviously we don’t name the people we do a case study with. But AJ is a 55 year old woman with a history of food allergies, environmental allergies and difficult to control severe asthma she contracted. COVID-19 in May of 2022 and I and Doctor Parikh will when she. comes back. Thank you. I don’t know, I just produced the case study for you, Doctor Parikh.

Speaker 1    13:43

Yeah, it kind of froze, but yes, you know, Sally was saying, you know, this is a true case, 55 year old woman, she’s history of food allergies, environmental allergies and difficult to control, asthma, severe asthma and she contracted COVID-19 in May of 2022 so fairly recently and when first infected had fevers, chills, body aches, severe cough. Tight chest, shallow breathing, congestion, extreme fatigue, headache, sore throat, had to sleep with her head, elevated cough was very bad, unable to eat or drink and actually this scenario is very common. You know many people equate this to like the other coronaviruses which are the common cold or they say oh, it’s similar to the flu. But I just want to reiterate it’s not fun to be infected with COVID-19 whether you are or aren’t vaccinated, even the quote unquote milder cases can feel awful. So you know just to put that out there as well, and people should still try to prevent it. So she went to see her primary care provider. She did a virtual visit and her pulse ox level was greater than 90. She was prescribed Paxlovid, did oral corticosteroids, given nebulizer treatments around the clock, and she was changed from her Dulera to Trelegy. And again, this is very common. I give very similar treatments with my patients as well because they have a similar profile to Andrea and the acute phase lasted about a month with the respiratory symptoms continuing even beyond that. So keep that in your mind and then we’ll go on to say, So what do we know so far about long COVID? So they’re between 7 and 23 million Americans that are suffering from it. The numbers are expected to rise as COVID becomes endemic. And remember, we’re just starting to see these cases, you know, because the actual virus itself has only been around for less than three years, right? So the actual numbers are likely much more. The long COVID symptoms vary from person to person, and the severity varies as well. And symptoms are worse among people who are sick enough to be hospitalized. And the risk of long COVID is greatest in women, older people, and those who live in disadvantaged communities. So again, that disproportionate impact that we see with health equities, unfortunately, is translating into yet another chronic illness. So there have been a few studies and there was a Scottish study that recently came out in October of 2022 that looked at nearly 100,000 participants, which you know, shows that many people do not fully recover even months after being infected with the coronavirus. And what they found was between 6 and 18 months after infection, one in 20 people had not recovered and 42 % reported partial recovery. Now that’s small numbers, right? If you do the math, that’s quite a few people that means that long COVID, unfortunately, is fairly common. There were some reassuring aspects of the study and, you know, people with asymptomatic infections were unlikely to suffer long term effects and vaccination appears to offer some protection from long COVID. And so there are some groups such as Yale, that are now studying the vaccine in the treatment of long COVID. And just anecdotally, I can report that I’ve had cases of patients that have improved their symptoms after the vaccine. And even one that, you know, didn’t improve after the first two shots. But then the booster, the new bivalent booster was what did it and helped all of a sudden clear some of her symptoms. So it’s very interesting. And then as we learn more, we’ll understand the science behind it because it doesn’t work for everyone. I’ve seen some people get worse, unfortunately, after the vaccine too. So these symptoms include breathlessness, palpitations, chest pain, brain fog. It’s very common. Recent studies also show that vaccination reduces the chance of developing lung COVID, but not as much as we previously thought umm. And then some persistent symptoms include previous symptomatic infections. Previous symptomatic COVID infections reported certain persistence of symptoms such as breathlessness, palpitations, confusion and difficulty concentrating at a rate roughly three times as high as uninfected people. Those patients also experience elevated risks of more than 20 or more symptoms relating to, you know, respiratory. Health, muscle aches, mental health and sensory system. The study did not identify greater risks of long term problems in people with asymptomatic coronavirus infection. So again it kind of just breaks down nicely what the study went through. And Sally, do you mind just reading the slide for one moment and sorry, there’s a I think an emergency in my office somebody they keep calling me, just give me one moment.

Speaker 2    19:08

No problem. We will go, we’ll keep going on. So when we look at long COVID-19 people that have those real severe initial cases of COVID were at higher risk for the long term problems, the study found. And that really tracks with that broader idea that COVID is truly a multisystem disorder. You know, I personally know people that have developed heart conditions following the vaccine or COVID itself and people that are really struggling. Especially with that brain fog that’s been just a huge issue for people after having COVID. So you know this is this is with you know the problem is it’s not just the brain, it’s not just the heart, it’s all of the above. So people with long COVID tend to be really affected within multiple body systems and this does reinforce the importance of long COVID patients being really being offered support that extends beyond the healthcare system and really addresses. Needs related to their jobs, education, poverty and disability. It again you know this has really affected people being able to work or being able to go to school and this is just something that we’re going to really have to work through in months and years to come. But the study told us that COVID can appear differently in different individuals and it can have more than one impact on your life. And again it’s you know we say this about asthma. If you’ve seen one case of asthma, you’ve only seen. One case of asthma. It’s not universal, and it’s the same issue with COVID. If you’ve seen one case of COVID, you’ve seen one case of COVID, because what you experienced might be completely different from what I experienced. And as we consider with our, continue with our case study and we’re right back with A J who’s the 55 year old woman with the history of food allergies and difficult to control asthma. She did have long COVID symptoms. She really struggled with fatigue, a tight chest, coughing up phlegm and her PO2 level continues to be below 90 and that’s fairly significant. So the nebulizer, she’s doing that only as needed now using an inhaler as needed but up until October. Used her inhaler twice a day. Accommodations that she’s needed. She’s been using inspiratory spirometry requiring daily naps through October. That was five months of being so fatigued that she needed to have a nap every day. And she’s been using over the counter medications followed up with her pulmonologist and frequent follow-ups with her primary care provider. And recently she’s been also suggested to have supplemental oxygen at night to try to ease the issues she had and get that PO2 level up. So I think I hear Doctor Parikh.

Speaker 1    22:02

Is best right back? I’m sorry. Yes, thank you so again you know thank you Sally for continuing on with the case. So this is a very common presentation. Again the fatigue is probably the most common symptom that I hear from my patients. And now you know unfortunately I’ve become very experienced in treating with COVID, I would say even hundreds of patients to date. It’s becoming very common but you know it affects every organ system. So the brain fog, the chest tightness, heart racing are very common and sometimes. Did you see this where the oxygen level does drop and then we’ll rule out you know other causes to make sure there’s not another reason for the low oxygen like let’s say a blood clot or what have you. And then but many times we find no reason and that’s a common theme too with long COVID that a lot of the testing comes up empty handed all the cardiac work up, pulmonary workup neurological. And so you know, we we’re still trying to understand really what’s. What’s going on and what’s causing this? So the oxygen level continues to be below 90, you know, and she’s using the nebulizer and again as mentioned, you know she’s meeting the inspiratory spirometer requiring daily naps. This is also very common over the counter medicines. And then the anticipated course is you know of course you still have to continue to treat all the other chronic illnesses as well. So long COVID and children. This is something that luckily is not extremely common, but we are starting to see cases. I’ve definitely seen a handful of cases and this is important because you know, often the people who are the naysayers of vaccinating children say, you know, it’s mild in kids, there’s no long term effects, but we can’t really say that, right? We, in something that’s less than three years old, we have no way of knowing what the long term effects are in children or adults to be honest. So, Umm, you know, we need to be aware that this can happen in children, you know, and we don’t know what the impact is for the rest of their lives, you know. So the first large study was in Denmark and basically it was in 2021 And then these are children who have not yet been vaccinated because the vaccine was not available. So with COVID-19 infection, preschool children in the, you know, COVID-19 group experienced more fatigue, loss of smell and taste, and muscle weakness. School age children also had the same loss of smell and taste, but fatigue, respiratory problems, dizziness, muscle weakness, chest pain, again very similar to the adult cohort, and the children in the control group were found to experience significantly more. Concentration difficulties, headache, muscle and joint pain, cough, nausea, diarrhea and fever. And the investigators postulate that concentration difficulties like headache, muscle, joint pain and nausea in the control group may reflect the negative social consequences of the pandemic on the children. So we keep forgetting that this pandemic has had a very large impact on the mental health of everybody, but especially our children, and long COVID symptoms. Dissolved in one to five months to 54 to 75 % of children. So that’s also very reassuring. You know that even though these kids develop symptoms that it is resolved. So how common is it in kids? And it is really hard to tell again because there was a lag, remember in cases in children, period, right. We first saw all the acute cases in adults and we were like, oh, this is interesting, the children are being spared, but then we did start to see cases in kids. So I think the similar lag we’re seeing with long COVID, so different studies. Have shown different results depending what part of the country or world you’re looking at. And there’s a lack of a clear definition. So it’s called several things. So what symptoms are being used to define long COVID, right? So only a small number of these children seek healthcare for COVID. And small children can’t always communicate their symptoms, you know, the way adults can. So sometimes fatigue can manifest itself ironically as hyperactivity, right? So again, it’s really hard to pinpoint this in the patients that I’ve seen. Mostly have been in the teenage age group and they do behave very similarly to adults and many of them it’s been devastating. But luckily they have gotten better and some of them, you know, varsity athletes who are now having trouble walking and having extreme fatigue. You know, other kids who can’t even concentrate in class on some, which has been a bit disturbing, have been having new onset of mental illness like theatric illness, that in a child that never had these issues before. Never had issues with school before. They’ve been falling behind in classes, so it is alarming when you do see it, and luckily it’s not frequent. The AP reports that children and adolescents have experienced chest pain, cough, exercise induced dyspnea, or labored breathing, as well as changes to smell or taste. Affected children and teens have reported fatigue, brain fog, anxiety, joint pain, headache, sore throat, among other symptoms, and some children even experience subtle symptoms when diagnostic testing. It’s done. No abnormalities are found. Some report joint and bone pain and a very small percentage of children tend to develop serious outcomes too. So, and if that’s organ issues, it’s with the brain, heart, kidneys, liver and these organs can be damaged if the child doesn’t receive proper care. So the treatment of long COVID in children is that typically after full evaluation patients are referred to one or more specialists with expertise in a particular area. So long COVID can affect different organs and parts of the body. So in addition to the infectious disease doctors, we also,you know, frequently engage our pediatric cardiologists, neurologists, pulmonologists, rheumatologists, psychologists and others. You know it’s like a full hands on deck approach. For both kids and adults, the treatment tends to be most effective when it addresses each symptom individually. A child with chest pain and decreasing physical conditioning will be referred for a cardiac evaluation. For instance, a child with cognitive challenges will be seen by a neurologist with behavioral health needs. Psychotherapy and medications may be needed. Sometimes the expectation from a parent is that their pediatrician will know everything about this. But again, this is a new disease and doctors are still learning. So, and I can echo that, you know, often I’ve seen people get frustrated with guidelines changing from March of 2020 to March  of 21 to 22 But you know, that’s understandable, right? This is something brand new that everybody’s dealing with even the most experienced medical professionals. COVID  prevention still works, so please keep doing them. Hand washing, masking, distancing vaccines. Don’t forget to practice what works. Be sure to vaccines are up to date 2 weeks before family gatherings and this is an important point. You can’t get your vaccines, COVID flu, any of them, the day before you’re traveling or meeting with large groups of people. This needs to be done at least two weeks in advance for that immunity to have built up by then. And a few notes on COVID. We do have treatments, but some of them unfortunately are not working as well due to the newer variants. So we have monoclonal, the monoclonal antibodies as well as the antiviral pills. So again just to review, the antibody treatment uses the COVID-19 antibodies and other antibodies to help lower that viral load and neutralize infection. It can be given as an ID or an injection as a single dose and the antivirals. The same thing in the sense that they reduce the load by limiting the ability of the virus to replicate. This can be taken at home, which is very nice. It’s easy. I can, you know, call it into any pharmacy and then the patient can have it in their hands in a few hours. It reduces the risk of hospitalizations and deaths, which is also huge. So again, the timing is everything for both of these and they should be taken within the first five days. The bad news is that. Some of the monoclonal antibodies now are not being used as much because they’ve been found to not be as efficacious with some of the newest variants. Paxlovid still appears to be working quite well with the newer variants. But you know all of this could change and This is why it’s still important even though everyone is exhausted, to try to limit the spread because as we limit the spread we can also limit the variance and conserve these medicines that are actually working for us. So asthma care at school post COVID-19 outbreaks. So a student presents at the health office with report of respiratory symptoms. Could it be viral? So how do we tell, you know, I know it’s very confusing for everybody, but especially when dealing with an asthmatic or an allergy sufferer, be right, because the symptoms are very similar. So if you’re sure that it’s not, let’s say that you have access to testing or there’s no fever. There’s no cough, you know, or productive cough. There’s less congestion or tightness, less of that muscle fatigue or sometimes GI symptoms would be more associated, is more associated with the virus than with like run of the mill allergies and asthma. Then, you know, you could fairly be certain you know, but sometimes you can’t tell and you’re in that maybe category. So then you need to assess for additional viral symptoms. So is there a fever, and what we call fever is 100.4 or higher. Is there a cough? It can be with or without wheeze. Nasal congestion, nausea, vomiting, diarrhea, headache, fatigue, myalgia, poor appetite, swelling on hands or feet. And if these symptoms are there then you should be worried that there is something viral. So this child should be isolated, sent home. Parents need to be called and we need to figure out what it is. So the good news is now testing is readily available. You know, hopefully the schools have either rapid tests or PCR’s on hand. So we should be using these tools to find out is it COVID? Is it flu or is it something else? And so that way we can assess the risk to everybody else and consult local health officials, consider, you know, notifying close contacts and what have you. So if we go back to the no category and you feel fairly certain there’s not a virus at play and then, you know, it’s business as usual, you know, follow the asthma action plan. For green, yellow, red, call parent if needed. You know, call 9-1-1 if needed. You know if it still doesn’t appear that there’s a flare up then of course you know return to class as appropriate. But just be aware of these warning signs and kind of going, just reiterating on that other slide about family gatherings and travel because the rapid tests are so available. I highly recommend if you’re meeting with vulnerable family members to test on the day everybody’s meeting and everyone should continue to test 48 to 72 hours afterwards even if they remain symptom free. Because, as we know, this thing can pop up after the fact, especially in asymptomatic individuals.

Speaker 2    34:16

Ok. We have one last poll question. We asked if you knew someone with long COVID, but what we’re really interested in looking at right now is do you know what child who may have long COVID? Because again this is something we haven’t talked about that much. We have. You know, there’s been so much discussion about adults with long COVID-19 but we really haven’t been listening or hearing too much about children with long COVID. So I’m just curious if you know a child who may have long COVID-19 So we’re just going to take another couple of minutes for people to log in their answer of yes or no or I’m not sure. So if you can get your answer in, we will go ahead and launch the results here. Ok. So only 23 % here said yes and no is 60. So this is pretty much flip-flopped from the last time that we asked the question about knowing anyone with long COVID and we still have 16 % of people who just really aren’t quite sure and that’s very understandable. And in this day and age, so, but that’s just so interesting. Ok, well we’re going to look at your questions now. We’re going to look to see what people are asking and Doctor Parikh will stay on the line to answer your questions. So.  And she and the first question is just curious if other clinicians have been experienced an increase in pediatric EKG changes, irregular rhythms or SVT etcetera in those patients who have tested positive for COVID in the past. So Dr Parikh, could you speak to that?

Speaker 1    35:53

That’s actually a great question. I don’t know about Pediatrics, but I can ask my pediatric cardiology colleagues and maybe we can send a follow up to some of these questions, but I have, I do know. In the adult cohort because I see many more of those and disclosure I am married to a cardiologist it is the case in an adult patient. So we are seeing luckily most of them are benign. We haven’t seen any new onset of any life threatening arrhythmias. But for example i just saw patients last couple weeks had some PVC’s on their EKG and there have been a few you know that have may have increased like tachycardia and other rhythms. But the pediatric questions are very interesting. I would have to ask my colleagues, but I can get back to you on that. Wonderful.  The next question is how are the new Omicron variants impacting people who already have long COVID?

Speaker 1    36:48

Yeah, that’s a great question. So it’s kind of a mixed bag. So in the people who already have long COVID, unfortunately I’ve seen cases where it has made their long COVID works if they get reinfected, you know. So that’s why we’re still urging people to avoid infection even if they’ve had it because we are seeing a lot of reinfections and we’re also still encouraging. Excuse me? Vaccinations When it’s, you know, when you’re able to do so. Because for this very reason, that if you’re getting it multiple times, it can exacerbate it and make it worse. I don’t know of any studies that have been done on the newer variants, specifically in long COVID, but so I’m just speaking from my own personal experience. But we are still seeing long COVID with the new variants. But for sure, even people who are just getting COVID for many people are getting COVID for the first time now with the newer variants, and they’re unfortunately developing long COVID still.

Speaker 2    37:42

Ok. And this is a kind of almost a follow up question. Does the current recommended bivalent vaccine cover circulating strains of COVID?

Speaker 1    37:51

Yeah so that’s, that’s a great question. So the current vaccine does, and so that’s why it’s very important to get the updated booster again. I know by the time that booster came out, many people had even told me that they’re like, oh, I’m over vaccines. I can’t get any more shots, which is unfortunate because this one is probably one of the most important boosters to get because it has been updated to the newer Omicron variant.

Speaker 2    38:18

Ok, thanks. The next question, is there a simple way to determine whether someone experiencing COVID like symptoms are truly due to COVID or just a common cold? If home tests are negative, what should people be thinking?

Speaker 1    38:34

Yeah, I mean it’s a bit difficult but I usually tell people to retest it within 48 hours because we see it time and time again that it’s negative, you know day one or day zero whatever you want to call it. And then two days later it’s very clearly positive even in those at whole at home rapid tests. So again just you know assume if you’re not feeling well and symptomatic just either way no matter what the virus is it’s essentially the same you have to isolate yourself till your. Fever and symptoms go away at least for five days, and you know if you’re prone to some high risk condition that you still should contact your doctor even with the negative test because they may still want to start the antivirals empirically depending on your personal situation.

Speaker 2    39:21

Thank you. I’ll take the next one. It’s just this person made a comment that schools need to be thinking of individualized healthcare plans and section five oh four plans for students and staff with long COVID. And I think that is absolutely important, especially since we have so many school nurses listening in. I really do think especially a Section five oh four plan if a student were to need more time for testing with long COVID, I’m thinking about these adolescents who are taking starting to take their SAT’s And if they’ve had long COVID and they’re experiencing that brain fog and that difficulty concentrating, having extra time on the test might be incredibly appropriate. But yes, I do think that schools really should think about IEPs and 504s for students with long COVID. Do you have anything you want to add to that, Doctor Parikh?

Speaker 1    40:10

Oh, no, absolutely. I mean, I think this is here to stay. We’re going to be seeing many cases. So, you know, schools, workplaces, everybody has to accommodate for this because it’s no walk in the park. You know, people are really struggling and suffering.

Speaker 2    40:27

So, we have another question and this one is very pointed and very appropriate. Do you have any suggestions for school nurses to convince school administrators that students do have long COVID and may need accommodations for a long time?

Speaker 1    40:45

That’s a great question. And convincing administrators of things is like the bane of my existence because, you know, physicians have to face it as well, you know, with their hospital systems. It’s not easy. But what I would recommend is, you know, frame it from the point of view that if they don’t take this seriously, it will be more days missed from school for those children, and then those kids will fall behind and it will reflect poorly on the school itself. So even if they don’t take look at it from an altruistic frame of view. And maybe if you can frame it in the sense that it will make them look bad, you know, and poor leadership. I’ve noticed that it tends to work a little bit better. Obviously make the public health case first and foremost, but I know administrators can be difficult to convince in any setting.

Speaker 2    41:33

School administrators in their defense are so geared towards school performance, but state aid is given based on the number of children in the seat each day. And if we talk about making those accommodations for long COVID that will make sure the children can be in school really could go a long way. But I think too, you know, just, you know, educating your administrator in a very collaborative way can go a long way as well and to discuss. You know how we can help these students and think of it in terms of being a really student centered conversation, I think that goes a long way. Ok. Next question, I heard that if Pax Lovid has a bad taste and if the patient discontinues therapy early, their infection can relapse and they might go back into isolation. Is this true?

Speaker 1    42:28

Oh, yeah, absolutely. I mean, it’s the same thing with antibiotics why? We always encourage you to finish the course, right? Even if you’re able to, right. Even if you feel better or whatever, you don’t like the taste because you’re only partially treating the infection, right. So there. Can be relapsed that you’re not really addressing the full viral load. So all for all medications, they should all be taken as directed, you know, unless your physician tells you otherwise.

Speaker 2    42:58

Ok, this one is kind of fascinating for long COVID, our present practitioners just managing the various symptoms or are there treatments that are available to treat long COVID to reverse it?

Speaker 1    43:10

Oh, that’s yeah no, it’s both actually. So we’re looking not only at the symptoms and kind of the, what we call the Natural History of it like learning how this disease plays out, but also we’re treating it. So my the group I’m working with, we’ve actually been treating long COVID patients now for almost two years using medications that already exist for you know, other uses where we’re using them off label. Basically our understanding is that this is a disease of inflammation. And maybe anti inflammatories can help or maybe antivirals can help. So there’s a lot of physicians actually treating it with already existing medications and for some patients certain medicines work amazingly. You know some people are really turned around but unfortunately they don’t work for everyone. So we still need I’ll have a lot to learn and understand, like who is the right person to use which anti-inflammatory on. But yeah absolutely we are looking at treatments and using them.

Speaker 2    44:11

Ok. Our next question is how soon after COVID-19 infection should you get the booster?

Speaker 1    44:17

That’s a great question, too. So the CDC recommends, you know, two to three months. Technically, you can do it at any time. Like let’s say you’re feeling better and you feel even back to your normal self even a month later. You can go ahead and get it. You know that the only real caveat to that is if you receive the monoclonal antibody treatment, then you should wait 90 days so that it doesn’t interfere with the vaccine itself. But other than that, either, once you feel well. Or a good rule of thumb is like two months to three months, you know, so a lot of people like that I know are doing it kind of at the 90 day mark, you know, but yeah, if you feel well, you know go ahead and get it because I’ve been seeing reinfections even within that 90 day period, you know where they get better and then people fall sick again.

Speaker 2    45:10

Thank you. This next one is more of a comment. The individual says I’m concerned some of the learning issues we’re seeing with children are related to children who had COVID or were exposed and perhaps had an asymptomatic infection. We’re expecting children to return to baseline and if they are not, we’re pushing them more to catch up. Perhaps we should go slow and allow the children a chance to improve. We’re giving adults the opportunity to recover, but not the children.

Speaker 1    45:38

Yeah, that’s, yeah, that’s a very important comment. You know, we have to understand, you know, the situation that people are in, right. And it’s not helpful to push something on someone who’s still recovering from a chronic illness. So absolutely.

Speaker 2    45:54

What do you recommend to help long COVID patients to build up their immunity systems? Like the other question, my 20 year old son has been suffering for 15 months with multiple symptoms and has been catching lots of viral infections since.

Speaker 1    46:08

I mean it it’s hard to know without having the full background on your son but I if he is frequently getting ill you may want to take him to an immunologist and just make sure at least at baseline is immune system is functioning the way it should be and there’s not some other easily correctable reason and so I would start there. Outside of that you know the best immunity boosters are things as simple as you know, adequate sleep, good nutrition basically. You know taking very good care of yourself but I understand the frustration if he’s going through you know illness after illness. Another important thing is usually most supplements are not helpful but vitamin D, has been linked to immune health especially in patients who also may have allergies and asthma. So I would recommend you know when you do go for that work up either with the immunologist or your or pediatrician that you know vitamin D level is checked and just basic blood work that we would check in a routine physical. Just to make sure everything is as optimized as it can be.

Speaker 2    47:14

Ok, someone’s asking if we can share the slide with the asthma care at school post COVID. That’s actually a nice free download on our website and we’ll put the link to that in our follow up email so that you’ll be able to go directly to it and download it and use that as you wish. We developed that in the early days of COVID and it certainly has been a help to a lot of people and i would love to have you have that so.

Speaker 1    47:44

Next, I agree. Great slide.

Speaker 2    47:49

Oh, and then somebody saying children with allergies have some of the same symptoms hate to send them home for allergies when it could be COVID. So are you seeing a lot of students, a lot of children, Doctor Berry where they’re at, their symptoms look like allergies or COVID.

Speaker 1    48:07

Oh, yeah, absolutely. And especially, you know, we just came out of ragweed season, you know, so it’s very confusing. But what I would recommend, I don’t know, Sally, maybe you can answer this. Do they have rapid tests readily available at schools. I mean, they should, because that is a great tool.

Speaker 2    48:27

Yeah, and they might be, but in fact if you want to pop a comment into the question box of if you have the test at your school that would be helpful, but i’m not aware that they have them.

Speaker 1    48:40

Yeah, because it is tricky, I agree. Like if there is no fever, right, or other fatigue or stomach issues or something glaringly obvious that it’s a virus or infection. I agree. So it’s impossible to tell and even I’ve been fooled especially during allergy season where people came with what seemed run of the mill allergies. And then I get a call 2 days later like oh, I tested positive, you know. So that’s why I really like the fact that we have this testing on hand because it is helpful when the person is symptomatic. It may not be as helpful when they’re asymptomatic, but if they’re coughing, sneezing, having those allergy type symptoms, it still can pick up a positive.

Speaker 2    49:20

So I’m seeing some comments that are saying that we do have rapid tests and some are saying we do not. So it’s obviously either a state by state or a district by district thing. And so that’s yeah I’m seeing yes we have tests no we do not and we have all Wisconsin schools have access to free test kits and then somebody then test home to parents upon request that’s so you know. As with so much in school health, it’s all different. And that’s why sometimes it’s so hard to support each other because everybody is experiencing something fairly different.

Speaker 1    50:02

Yeah, that’s very frustrating, especially three years into the pandemic. You know, we need to have, we have these tools, you know, we need to use them, so.

Speaker 2    50:11

Well Doctor Parikh, we have so many questions left, I’m going to have to try to pick and choose them carefully. So here’s the next one. Are there any treatment guidelines? Currently I’ve only seen symptom management based guidelines through a brief search.

Speaker 1    50:27

Oh, right. That’s a great question. So treatment guidelines, no, they don’t exist yet because we have yet to agree on what the best treatments are since so many are being studied. So, for example, I just found out today Stanford is studying Paxlovid in long COVID.  Oh, I’m sorry, first let me clarify. Are they asking treatment guidelines for acute COVID or long COVID? I just assumed long covid i can’t tell from the question.

Speaker 1    50:53

Oh, OK yeah so I mean for that, for acute COVID we had good treatment guidelines. The one thing is, you know for children some of the treatment options are limited because you know Paxlovid and aren’t approved for all pediatric groups. But for long COVID there aren’t clear treatment guidelines for kids or adults and many centers are studying various treatments. So one center setting Paxilovid another other centers are studying other antivirals and other anti-inflammatory drugs like Cholesterol medicine have shown to help, like statins or steroids or what have you. So yeah, right now there’s not enough data to really have that consensus, to make proper guidelines on medication treatment, if that makes sense.

Speaker 2    51:42

Oh it does. Our next question is a little bit different, says how often have you seen Guyon Beret syndrome after COVID?

Speaker 1    51:49

Oh, that is interesting. So I have seen a few cases after both COVID. I’ve seen also a few, like a handful I would say like, but so by few I mean like you know, three or less after even the vaccination as well. But you remember Guillain Barre can even occur with other vaccines too. It’s very rare like the food with the flu shot as well. We’ve seen it in the past but we have seen with COVID higher incidences of  Guillain Barre but luckily it is rare. As it can be quite a devastating disease, more commonly we’ve seen Bells palsy which is as you know very benign. It’s kind of a facial paralysis of half of your face and it resolves on its own. Notably you may have Justint Bieber had it and talked about it, you know, very publicly, but that is much more common with both the virus and vaccine and luckily it’s very benign and self resolved.

Speaker 2    52:47

Ok, the next question is the use of nebulizers was discouraged at the height of COVID in school health offices. At this point do you what is your recommendation about nebulizers in school health offices?

Speaker 1    52:59

Yeah, you know, that’s always tricky in general, you know, nebulizer use should be limited in school health offices because remember, if somebody is very sick and symptomatic, they shouldn’t be in school. Period. You know, so the fact that they’re that sick and symptomatic usually should mean that they should be nebulizing at home or in a healthcare setting, right? If they’re very sick. But you know, as we have said on previous webinars, if nebulization can be done in a safe way, meaning. In a room where there is good ventilation, coastal window where others may not be exposed, you can do it. And in the school setting. So, but it’s tricky, you know, so of course you know. It should be minimized and used sparingly I would say. And in those safe settings and hopefully the nurse or whoever is administering it has appropriate PPE, so medical grade mask and gloves and gown and all that stuff too.

Speaker 2    53:58

Well, I just took a look at when everybody was writing in and it really is almost half and half of people that do have COVID tests in their schools and half that don’t. So thank you everybody for offering that information because it’s, you know, we don’t always have that information unless you’re the ones that give it to us. Ok. Our last question is going to be what if you received the bivalent vaccine and found out the next day you were positive for Kodak COVID will the vaccine? work.

Speaker 1    54:30

Ah, that’s a great question. We see this a lot. So yes, the vaccine will work. It’s just basically didn’t have time yet to work because it seems like you caught the virus before the vaccine kicked in. But yes the vaccine will still work, so you don’t have to worry. But you know, unfortunately you got COVID, which is fine, but at least you’re vaccinated so that you’re protected now with the vaccine and natural immunity for, you know, foreseeable future.

Speaker 2    54:58

Well, Doctor Parikh, thank you so much for spending so much time with us on questions today. You really offer such great insight. And I know you’re on the front lines fighting this every day and we just so appreciate the wealth of knowledge you have and how you’re so willing to share it with everybody. So thank you again for being here today.

Speaker 1    55:18

Thank you. And before we move on I also I wanted to say thank you. Umm, this is sadly Sally’s last webinar with us. She’s going to be enjoying her much deserved retirement very soon. And I just want everybody who’s listening to know that, you know, she’s the backbone of these webinars. She helps create the slides, the content. She keeps all of us in line and stays on top of the plethora of changing data on a daily basis. So I just really want to take time to recognize Sally is not enough time. But thank you so much for what you’ve done, not just during the pandemic, but your entire career. You know, we’re very grateful for you.

Speaker 1    55:58

Well, Purvi, I appreciate you so much and thank you for that. I have one more webinar, it’s not, it’s not a COVID webinar, but I have one more webinar to go and it’s the one that’s up on the screen right now and that’s how can we make anaphylaxis less scary for patients. This is going to air on Wednesday, December 7th at 4PM and we’re going to be joined by Doctor David Stukas and he is such an expert on these things and I’m so excited that we’re going to have them with us. You can register for this webinar on our home page. scroll to the bottom of the home page to register and view any webinars that we have presented. So please remain online for just two to three minutes to complete an evaluation survey. And we thank you again for joining us. This is Sally Schoessler for the staff at Allergy & Asthma Network. We wish you a really healthy and a peaceful holiday season and we’ll continue our work each day so we can all breathe Better Together.