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Long Covid

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.”

Individuals who have had multiple Covid-19 infections appear prone to contracting Long Covid, which may include symptoms such as fatigue, respiratory distress and mental fog.

Study published in The Lancet provides a basis for investigating Long Covid in the post-pandemic era

A new study that identified 475 patients with post-acute sequelae of Covid-19 (PASC), also known as Long Covid, revealed that nearly 85 percent (403) of these patients had multiple Covid-19 infections over the course of a four-year period (March 2020 to February 2024). Additionally, vaccination independently reduced the risk of Long Covid in patients who had received the vaccination prior to contracting the infection.

Conducted by a team of researchers at the Renaissance School of Medicine (RSOM) at Stony Brook University, in conjunction with the Stony Brook World Trade Center (WTC) Health and Wellness Program, the study may serve as a foundational assessment of Long Covid patients in the post-pandemic era. To date there are few studies with such a patient sample size that investigates what puts patients at risk for Long Covid and what causes this chronic condition.

The findings are published early online in the February edition of The Lancet Regional Health – Americas.

“While it is possible that the causes of Long Covid could be many and variable depending on the patient population studied, with this cohort the evidence is clear that by having Covid numerous times, patients became more at-risk for developing Long Covid,” says lead author Sean Clouston, PhD, Professor, Department of Family, Population and Preventive Medicine in the RSOM, and Program in Public Health.

He adds that after adjusting for relevant demographic, lifestyle, and clinical variables, the findings reveal a statistically significant association between experiencing multiple Covid-19 infections and the risk of experiencing PASC (aka Long Covid).

The patients were identified from a group of more than 2,500 first responders who previously had Covid and are prospectively monitored for infection complications by the Stony Brook WTC Health and Wellness Program. The 475 identified with Long Covid by the Program’s physicians, led by Benjamin Luft, MD, Director of the Program, continually experienced Long Covid symptoms ranging from fatigue, mental fog, other neurological conditions, as well as multiple respiratory problems and gastrointestinal symptoms.

Given that some of the first responder patients have had symptoms over the years related to their environmental exposures, such as respiratory illnesses, Long Covid symptoms were identified and charted separately and after each subsequent Covid infection.

Since there is no diagnostic test for Long Covid, the researchers followed the World Health Organization’s guidelines as to identifying Long Covid. They identified participants with Long Covid as having experienced the continuation or development of at least one new symptom that emerged within three months after their initial Covid-19 infection and persisted for at least two months without other concurrent medical explanation. In contrast, those without such experiences after having Covid were placed in the non-Long Covid group.

“There are some possible pathogenic mechanisms that cause Long Covid, but the entire spectrum of its risk factors remains unknown,” explains Dr. Luft, a co-author, the Edmund D. Pellegrino Professor of Medicine in the RSOM, and an infectious diseases specialist. “This is why our study and future ones are so important. Identifying specific risk factors such as re-infection or lack of vaccination can assist in better understanding and managing the condition.”

The authors point out that the safest way to avoid contracting Long covid is to prevent the infection in the first place. However, they emphasize that the role of vaccination in the risk of developing Long Covid cannot be underestimated. They wrote, “Among those who later developed PASC, we found that the risk of PASC was much higher among individuals who were unvaccinated at the time of their first (Covid-19) infection.”

Dr. Luft adds that the vaccine is imperfect, and of those who develop Covid – even though vaccinated – are at risk and should take measures to mitigate the severity of infection.

This research was supported in part by the National Institutes of Health’s National Institute on Aging (NIA) and National Institute for Occupational Safety and Health (NIOSH) – grants (NIH/NIA R01 AG049953), and the Centers for Disease Control and Prevention – grants (CDC/NIOSH U01 OH011864) and (CDC/NIOSH U01 OH012275).