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Dr. Sritha Rajupet

Dr. Sritha Rajupet. Photo from Stony Brook Medicine/Jeanne Neville

By Daniel Dunaief

While many people are fortunate enough to ignore Covid or try to put as much distance between themselves and the life altering pandemic, others, including people throughout Long Island, are battling long Covid symptoms that affect the quality of their lives.

Dr. Sritha Rajupet
 Photo from Stony Brook Medicine/Jeanne Neville

Sritha Rajupet, Director of the Post-Covid clinic at Stony Brook Medicine and Chair of Family, Population & Preventive Medicine, puts her triple-board certified experience to work in her efforts to provide relief and a greater understanding of various levels of symptoms from Covid including pain, brain fog, and discomfort.

Rajupet serves as co-Principal Investigator, along with Dr. Hal Skopicki, chief of cardiology and co-director of the Stony Brook Heart Institute, on a study called Recover-Autonomic.

This research, which uses two different types of repurposed treatments that have already received Food and Drug Administration approval in other contexts, is designed to help people who have an autonomic nervous system disorder called Postural Orthostatic Tachycardia Syndrome. People with this syndrome typically have a fast heart rate, dizziness or fatigue when they stand up from sitting down.

Stony Brook is contributing to a clinical trial for two different types of treatments, each of which has a control or placebo group. In one of the trials, patients receive Gamunex-C intravenous immunoglobulin. In the other, patients take Ivabradine by mouth.

Stony Brook has been enrolling patients in this study since the summer. The intravenous study is a nine-month trial.

Some improvements

Dawn Vogt, a 54-year-old Wading River resident, is enrolled in the intravenous trial.

While Vogt, who has been a patient of post Covid clinic since November of 2022, doesn’t know whether she’s getting the placebo or the intravenous treatment, she has been feeling better since entering the study.

Dawn Vogt in 2018.

The owner of a business called Office Solutions of Long Island, Vogt has been struggling for years with body aches, headaches, fever, stomach pain, fatigue and coughing.

“I’m definitely feeling better,” said Vogt, whose Covid fog can become so arduous on any given day that she struggles with her memory and her ability to put words together, as well as to engage in work that required multitasking.

“I’m a big puzzle person,” said Vogt. “[After Covid] I just couldn’t do it. It was and still is like torture.”

Still, Vogt, who was earning her undergraduate degree in women and gender studies at Stony Brook before she left to deal with the ongoing symptoms of Covid, feels as if several parts of her treatment, including the clinical trial, has improved her life.

Since her treatment that started during the summer, she has “definitely seen improvement,” Vogt said.

Dawn Vogt in 2023.

In addition to the clinical trial, Vogt, who had previously run a half marathon, received a pace maker, which also could be improving her health. “I’m starting to have more energy, instead of feeling exhausted all the time,” she said, and has seen a difference in her ability to sleep.

Vogt feels fortunate not only for the medical help she receives from Rajupet and the Stony Brook clinic, but also for the support of her partner Tessa Gibbons, an artist with whom Vogt developed a relationship and created a blended family in the years after Vogt’s husband died in 2018.

“My hope is that I can find a new normal and that I can become functional so that I can get back to doing some of what I love,” she said.

Vogt urges others not to give up. “If your doctors don’t believe you, find one who does,” she said. “My doctors at Stony Brook, including Dr. Rajupet and the whole team, are amazing. They listened, they are compassionate and they don’t ever say, ‘That’s crazy.’”

Indeed, in working with some of the over 1,500 unique patients who have come to Stony Brook Medicine’s post-Covid clinic, Rajupet said she “explores things together.” When her patients learn about something new that they find through their own research, she couples that knowledge with her own findings to develop a treatment plan that she hopes offers some comfort and relief.

Ongoing medical questions

Doctors engaged in the treatment of long Covid are eager to help people whose quality of life can and often is greatly diminished. 

People “haven’t been able to work, haven’t been able to do activities they enjoy whether that’s sports as a result of their fatigue or myalgia [a type of muscle pain]. Concentration may be affected, as people can’t read or perform their work-related activities,” said Rajupet.

At this point, long Covid disproportionately affects women.

During her family medicine residency, Rajupet learned about preventive medicine in public health. She worked with specific populations and completed an interdisciplinary women’s health research fellowship.

Her research background allowed her to couple her primary care experience with her women’s health background with a population approach to care.

The Stony Brook doctor would like to understand how many infections it takes to develop long Covid.

“For some, it’s that one infection, and for others, [long Covid] comes in on the third or fourth” time someone is battling the disease, Rajupet said.

She also hopes to explore the specific strains that might have triggered long Covid, and/ or whether something in a person’s health history affected the course of the disease.

Rajupet recognizes that the need for ongoing solutions and care for people who are managing with challenges that affect their quality of life remains high.

“There are still 17 million people affected by this,” she said. “We have to make sure we can care for them.”

As for Vogt, she is grateful for the support she receives at Stony Brook and for the chance to make improvements in a life she and Gibbons have been building.

Her hope is that “every day, week, month and even hour, I take one more breath towards being able to function as best as possible,” Vogt said. “My goal is to live the best life I can every day.”

Pixabay photo

By Daniel Dunaief

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The number of people battling significant symptoms from the flu and respiratory syncytial virus has been coming down since its peak in January, as these infections have run their course.

“This year, we experienced the most severe flu and RSV waves in decades, and our COVID wave wasn’t small either,” said Sean Clouston, associate professor of Public Health at Stony Brook University.

The number of these illnesses was high as people no longer wore masks in places like schools and after people experienced lower-than-usual illnesses in the months before the mask mandate was lifted, creating fertile ground for viruses to spread.

“The most likely reason that the current flu and RSV seasons have improved is that we have had such a bad season earlier on that we have hit a natural ceiling on the ability for these diseases to successfully infect more people,” Clouston said in an email.

As for COVID-19, the numbers of people who have developed significant illnesses has continued to decline as well, through a combination of the natural immunity people have after their bodies successfully fought off the infection and from the protection offered by the vaccine and boosters.

Doctors added that the vaccine and natural immunity hasn’t prevented people from getting infected, but they have helped people avoid severe and potentially life-threatening symptoms.

“All these people who run around saying, ‘My vaccine isn’t working because I got reinfected,’ are missing the point,” said Dr. Bettina Fries, chief of the Division of Infectious Diseases at Stony Brook Medicine. “It is working. It doesn’t protect you from infection, but [it does prevent] a bad outcome.”

Indeed, during the most recent COVID surge during the winter, Fries said the hospital continued to care for patients, most of whom recovered. 

Vaccine timing

Amid discussions from the Centers for Disease Control and Prevention and health organizations throughout the state and country about the timing of future booster shots, local health care providers indicated the increasing likelihood of an annual COVID booster.

Fries said we will get to an annual vaccination for COVID, adding, “It’s the same as we see with the flu.”

In general, people aren’t rushing off to get an updated COVID booster.

“To maximize the protective value of the vaccine while minimizing the number of vaccines you use, people should likely get the vaccine two weeks before they anticipate heavy exposure,” Clouston said.

For most people, that would mean getting the shot in early November to prepare for larger indoor gatherings, like Thanksgiving and the December holidays.

In a recent article in the journal Lancet, researchers conducted an extensive analysis of COVID reinfection rates.

The study dealt only with those people who had not had any vaccinations and addressed the effectiveness of natural immunity from preventing infections and from the worst symptoms of the disease.

Prior infections in general didn’t prevent people from getting reinfected, but it does “protect you from getting a really bad disease and dying,” Fries said.

Long COVID

Even with the number of people contracting COVID declining, the overall population of people battling symptoms of long COVID, which can still include anything from loss of smell and taste to chronic fatigue, continues to increase.

“There’s a plethora of symptoms of long COVID,” Fries said. “We’ll have to figure out how to classify this and hopefully come up with better therapy. Right now, we can only symptomatically treat these patients.”

Dr. Sritha Rajupet, director of the Stony Brook Medicine Post-COVID Clinic, explained in an email that some patients who have lost their sense of smell or have a distorted sense of taste have tried a process called a stellate ganglion block “after several case reports and early research have shown that it could be helpful.”

In such a procedure, doctors inject a local anesthetic on either side of the voice box into the neck. Rajupet said that “additional research and clinical trials still have to be performed.”

Newborns and COVID

As for children infected with COVID soon after birth, doctors suggested that the impact has been manageable.

“The great majority of young children who contract COVID do quite well and recover fully,” Dr. Susan Walker, pediatrician with Stony Brook Children’s Services, explained in an email. “The impact on their development from having actually experienced COVID illness is minimal.”

Children hospitalized with more significant illness from COVID might experience temporary developmental regression which is common in children hospitalized for any reason. The developmental impact seems more tied to social isolation.

“Children born during the pandemic spent their first years of life rarely seeing adults or children other than those in their immediate family,” Walker said. “The result is that many of these kids became excessively stranger anxious and timid around others.”

The lost social opportunities, the pediatrician said, resulted in delays in the personal/social domain of development. She added, “The good news is that kids are resilient and, in time, with appropriate social stimulation, [these children] should be able to regroup and catch up developmentally.”