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Q&A with long COVID patient-researcher: Treatments lagging as cases rise


 

For Julia Moore Vogel, PhD, a cup of peppermint tea marked the moment her life would change forever.

One morning in early July 2020, she took a sip of her favorite strongly flavored pick-me-up and couldn’t taste it. She knew loss of taste and smell were symptoms of COVID-19, and she suspected she had contracted the virus. A doctor’s visit confirmed her fears.

“I remember trying the tea and just being so shocked and thinking: How can this be happening to me?” said Dr. Moore Vogel, a COVID-19 researcher with the Scripps Research Translational Institute in San Diego. “I’d been so incredibly careful.”

Her physician assured her that as a healthy woman in her mid-30s, she’d be “back to normal” in 2 weeks’ time and that her loss of taste and smell “very likely will be your only symptom,” she recalled.

But within a week, Dr. Moore Vogel started having trouble breathing. She couldn’t work, and she experienced crushing fatigue, brain fog, and migraines. Now, 2½ years later, Dr. Moore Vogel is among the tens of millions of Americans with long COVID.

As a COVID-19 patient-researcher who still struggles with fatigue and migraines, she has learned to cope with her condition. She directs the Participant Center for the All of Us Research Program, a National Institutes of Health collaboration to build the largest, most diverse health database in history. She relies on a practice called pacing, which helps conserve physical, mental, and emotional energy, to avoid making her symptoms worse.

And she is a coauthor of a landmark 200-study review of long COVID published Jan. 13 in the journal Nature, with Scripps Executive Vice President and Medscape Editor-in-Chief Eric Topol, MD. Two other institute long COVID researchers and patient advocates who have the condition coauthored the review – Lisa McCorkell and Hannah E. Davis, cofounders of the Patient-Led Research Collaborative , a group of long COVID patients who study the virus.

Dr. Moore Vogel discussed the key findings of the new review and her personal experiences with this news organization.

Q: When you contracted COVID, no treatments or vaccines existed. Can you talk about what the experience was like for you?

A: “It was July 2020. The loss of taste and smell was the first symptom, and what was interesting was that was my only symptom for a little bit. Being the goal-oriented, work-oriented person that I am, I just worked the rest of the week and hoped that it wasn’t real.

“But that was a Wednesday, and by Friday, I was just getting really tired, and it was really hard to finish my workday. I ended up taking 3 weeks off to recover from the acute phase. At the time, I had read early discussions about long COVID, and it was always on my [mind] – how long was it going to take to recover?”

Q: You went to see a doctor that first week?

A: “I called them when I had the loss of taste and smell, and they said, ‘It’s very likely this will be your only symptom.’ And when I first talked to a physician, they were saying, ‘Oh, you’re young and healthy, in 2 weeks you’ll be back to normal.’ But of course that turned out not to be true.

“It’s hard to remember what it was like at that time. There were so few treatments, it was all about rationing ventilators, and it was absolutely terrifying at the time to just not know what was going to happen.”

Q: How are you managing your condition today?

A: “I have myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), one of the really common diagnoses that come out of long COVID. So, that’s the biggest thing for me to manage now, and the main management is pacing.

“I also have medications for migraine management. I’ve always had some degree of migraines, like 2 a month, but now it’s like 15 a month, so it’s a totally different scale of management.”

Q: It must be frustrating, personally and professionally, that long COVID treatments remain elusive.

A: “I’m disappointed at the pace of testing things in clinical trials. There was so much progress made, so much innovation in the early stages of the pandemic to treat the acute phase, and it led to amazing things. We have all these monoclonal antibodies, the steroids are really effective, not to mention the antivirals and the vaccines, of course, on the prevention side. It’s been amazing.

“But for some reason, long COVID treatment is really lagging. What I hypothesize as part of the reason for that is that it doesn’t feel as dramatic. When you see someone on a ventilator or hear about death, it feels very dramatic, and people really worry about that.”

Q: So, let’s talk about the research. How did your personal experiences – and those of the two other coauthors with long COVID – help inform this review?

A: “I work with Eric Topol on a regular basis, and it was amazing that he invited patients to work with him on this review ... I have to say of my other long COVID patient coauthors, Hannah Davis and Lisa McCorkell, it was amazing to work with them.

“It was my first time working with people who have long COVID on a big project. The understanding that we had of each other [where] one of us might say, Oh, I’m crashing today, I can’t work on this. Can you help get us across the finish line for this deadline? That was really amazing to me in terms of how a workplace can be with real disability accommodations.

“It’s really changed my personal outlook on how important it is to have patients involved in the process.”

Q: What was the most surprising or significant finding of the review, in your view?

A: “I would say the most impactful thing to me in the process of writing this review is how much research has been done in such a short time. We started with over 250 studies that we wanted to reference in the review, and we actually had to cut out 50 in the editorial process, which was really hard!

“There’s just been so much progress that’s been made in the past couple of years. And then thinking about the progress on long COVID in general, the other things that’s important to acknowledge is all the work that’s been done on other postviral illnesses that present very similarly to long COVID in many patients, ME/CFS, and postural orthostatic tachycardia syndrome (POTS).”

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