Unmasking Long COVID: Dr Noah Greenspan on Recovery, Research Gaps, and the Future of Treatment

COVID-19

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Long COVID (LC) remains one of the most perplexing and persistent challenges of the post-pandemic era, leaving millions struggling with lingering symptoms and few clear answers. Noah Greenspan, DPT, PT, CCS, EMT-B, a leading expert in cardiovascular and pulmonary rehabilitation, has dedicated his career to helping long COVID patients regain their quality of life.

In this interview, he shares his insights on the latest research, the most effective rehabilitation strategies, and the ongoing fight for recognition and resources in the medical community.

Greenspan is a leading expert in cardiovascular and pulmonary physical therapy and serves as the primary director of the Pulmonary Wellness & Rehabilitation Complex in New York City. As the founder of the Pulmonary Wellness Foundation, he has been at the forefront of LC rehabilitation, pioneering both in-person and virtual recovery programs.

Greenspan also shares insights on the evolving understanding of LC, the latest diagnostic criteria, and emerging treatment strategies. He discusses the long-term impact of LC, its parallels with other post-viral syndromes like myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and the pressing research gaps that still need to be addressed, and so much more.

Join us as we explore the challenges, advancements, and future of LC care with one of the field’s most dedicated experts.

ICT: How has our understanding of LC evolved over the past 5 years, and what are the most significant discoveries regarding its causes and risk factors?

Noah Greenspan, DPT, PT, CCS, EMT-B: Like COVID-19 itself, the answer to this question is that it varies from person to person, health care professional to HCP, and institution to institution. It varies based on access to education and by political affiliation, among many other variables. I think that one of the biggest determining factors regarding “the universal we’s” understanding of long-term COVID-19 is personal experience. In other words, have you or someone you know had LC? If the answer is yes, then there is about a million times greater chance that you will have anywhere from some understanding to an unbearably intimate understanding, depending upon the type of symptoms, the severity of symptoms, and the duration of time you have been suffering.

If you’ve never met 0someone who has had long-term COVID-19, there is a good chance that you will have little to no understanding, and you may be in complete denial that it even exists. I can assure you that it does. As far as health care professionals, I think some have had a lot of experience and are as up-to-speed as [possible]. There are behaviors that we have gotten better at modifying, and many of us have gotten better at avoiding mistakes.

But, as a whole, I don’t think that many of us are “experts” at being able to regularly and consistently target and treat LC at the present time, and so many of the treatments have been trial and error. And again, like everything LC, some treatments that work for some have been proven to be detrimental for others.

ICT: What progress has been made in diagnosing LC, and are there now standardized criteria or biomarkers that help distinguish it from other post-viral syndromes?

NG: Well, first and foremost, to have LC, you have to have had COVID-19, and the only way to ensure that you don’t get LC is not to have COVID-19 in the first place. This is also independent of the severity of your case of COVID-19. We know many people who have had very mild or even asymptomatic cases of acute symptoms whose symptoms have developed and/or changed over time. I think the biomarkers are similar to many other inflammation-based conditions.

ICT: What treatment options or management strategies have emerged for LC, and how effective have they been in improving patients' quality of life?

NG: In my experience as a rehabilitation specialist, we have found 4 things we recommend to every LC patient. 1) Manage physical activity very carefully. This means when in doubt, err on the side of doing less than doing more, which applies to exercise and everyday activity. This also applies to emotional and cognitive activities, as we have found that for many people, all 3 of these domains pull from the same energy source. It is also crucial to realize that people can feel perfectly find during an activity and then experience what are known as post-exertional malaise (PEM) and post-exertional symptom exacerbation (PESE), in which the symptoms don’t appear until hours or days later, but that can be severe and last for a prolonged period or worsen the baseline permanently. 2) We have found that increasing fluids and electrolytes can be beneficial for people. 3) We have found that using compression garments like socks (good), stockings (better), and hose (best) can help manage symptoms of autonomic dysfunction. 4) Oxygen Therapy. We have used high-concentration oxygen in the past with many other cardiopulmonary conditions and found that in many patients, it helps with recovery and helps to decrease post-exertional symptoms.

ICT: How has LC research influenced our broader understanding of post-viral illnesses, and has it led to new insights into conditions like ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome)?

NG: I think it has shined a light on many conditions previously ignored or chalked up to being emotional or psychological. I think a big part of the reason for this is the sheer number of people that have been disabled by LC as well as who those particular people are. An incredible amount of the knowledge that has been discovered regarding LC came from the community itself. There are several advocacy groups that have been started and led by patients, and their voices have been powerful.

ICT: What are the current gaps in LC research, and what key questions still need to be answered to improve patient care and outcomes? What final thoughts do you want the public and health care workers to know about LC?

NG: I think that there are still many, many gaps in knowledge, in funding, in belief (or care) that LC exists. For many patients, this has become their existence. We have many patients who got sick in 2020 and are still sick today. Many have not returned to work. There are still several very dedicated patients and professionals who have dedicated their lives to figuring out the answers to many of these questions, but the majority have gone back to business as usual.