Independent Insights, a Health Mart Podcast

The Impact of Long COVID

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Long COVID continues to affect millions, leaving patients with persistent symptoms that impact daily life and overall health. Pharmacists are uniquely positioned to recognize these patients, recommend supportive treatments, and provide guidance on symptom management. Tune in to learn how you can help improve the quality of life for those struggling with this complex condition.
 
HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Dan Majerczyk, Pharm.D., Ed.M., FCCP, BCPS, BCADM, CACP
Associate Professor of Clinical Sciences/Chair of Teaching and Academic Excellence
Roosevelt University College of Science, Health and Pharmacy

Pharmacists, REDEEM YOUR CPE HERE!
CPE is available to Health Mart franchise members only
To learn more about Health Mart, click here: https://join.healthmart.com/

CPE INFORMATION
 Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1.  Identify common symptoms of Long COVID and the pharmacist's role in recognizing patients who may need further evaluation or support.
2. Describe strategies for managing Long COVID symptoms, including pharmacologic and non-pharmacologic approaches.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-198-H01-P
Initial release date: 6/2/2025
Expiration date: 6/2/2026
Additional CPE details can be found here.

Speaker 1:

Hi, health Mart pharmacists From your education partner, ce Impact. This is Game Changers, and each week we have a conversation on a hot clinical topic that will keep you current in practice and position you as a resource for prescribers and patients. Thanks for listening in.

Speaker 2:

Welcome to the Game Changers Clinical Conversations podcast. I'm your host, josh Kinsey, and, as always, I'm super excited about our conversation today. Long COVID is leaving millions of patients with lingering symptoms that disrupt daily life, yet many struggle to find effective treatment and support. In this episode, we'll discuss how pharmacists can help identify patients with long COVID, recommend symptom management strategies and play a key role in improving their long-term health. And it's so great to have Dan Majerzyk with us today for our guest for today's episode. Dan welcome. Thanks for joining us, hi.

Speaker 3:

Josh, thanks so much. Thanks for having me. Yeah, so I'm Dan Majerzyk. I'm an associate professor of clinical sciences and chair of teaching and academic excellence at Roosevelt University College of Science, health and Pharmacy here in Schaumburg, illinois. I also serve as a clinical pharmacy specialist with Loyola Medicine's McNeil Family Medicine Residency Program and I'm really honored to join you for this discussion of long COVID today. It's a complex, evolving condition that really continues to affect millions of people and many of whom are still searching for answers, support and, most importantly, relief.

Speaker 2:

Yeah, yeah, no, it's great. Thanks, we really appreciate you taking time out of your apparent busy schedule. It sounds like you wear many hats, so we really appreciate it. And I mean, dan, before we really jump in, I think it's also interesting that you know how often do we get a new disease? You know what I mean. We don't.

Speaker 2:

It's very, very rare that we have this, a new long-term condition that's still so new and so unknown, you know. So I think this is just it really kind of adds to the mystery of it all, the fact that there's still so much that we're learning and so many things that are going on. So I think, in my opinion, that's what makes this topic so fascinating is because it's almost like discovery every day, something new every day. So anyway, before we get started, I always like to make sure that I lay the foundation for our listeners and just to remind them exactly what we're talking about. Let's take a few minutes to just define long COVID. What exactly is it now? What's the prevalence? What are we seeing happening in patients? Just kind of give us some of those foundational pillars there.

Speaker 3:

Yeah, sure, josh, yeah, so you're absolutely right about these new long disease chronic conditions that are kind of surfacing post our COVID area. But specifically for long COVID you know this is referred to persist for at least three months after the COVID-19 infection. These symptoms also kind of wax and wane and may be, you know, relapsing or ongoing. So you know CDC reports roughly around you know 7 to 8% of US adults or around you know, 17 to 18 million people are living with long COVID these days.

Speaker 2:

Wow, that's quite significant. Yeah, so and this may not be known as far as like specific data points or whatever but are we seeing it with patients that had COVID early on, or is it more prominent with patients who are getting COVID now? Does that make sense?

Speaker 3:

Yeah, great question. I think we're seeing it in a mix of both Obviously, the long COVID sequelae we're seeing with patients that, or in patients that have had it a while back initially, but it is still ongoing in anyone throughout this kind of a span.

Speaker 2:

So the current strain that we're seeing of COVID is not like better. In a sense that it's not giving us long COVID, it's still. We're still seeing that come out. We're still seeing all of that come out. Yeah Well, let's talk a little bit about what are some of those symptoms and affected systems that we're seeing with long COVID. So, when a patient is stated to have long COVID, what's happening? What are we seeing? Absolutely? So some of the symptoms are fatigue brain fog.

Speaker 3:

So some of the symptoms you know are fatigue brain fog. One unique one that we may have heard of before is anosmia or loss of smell, headaches, neurologic pain and even respiratory and cardiovascular symptoms. So those are pretty, and all of them can happen at the same time as well, not necessarily just one singled out symptom.

Speaker 2:

Yeah, because when you started off with fatigue and brain fog, I was raising my hand on those, so maybe I need to be checked out or I think. That's just in general, but yeah, so when you talk about cardiovascular effects, are we talking about, like, are we affecting blood pressure, heart rate, like? What sort of things are we seeing with the cardiovascular effects?

Speaker 3:

Yeah, so all of those, josh, that those are absolutely a lot more exacerbations. Difficulty breathing, you know dysregulated blood pressure, you know being out of breath, shortness of breath, a lot of those. You know those symptoms that you know we're seeing typically.

Speaker 2:

You know our patients with respiratory and cardiovascular Sure sure, and like I said, you know I was joking, but those symptoms they do seem general, right, Like those are things that patients may be experiencing regardless. So how do we kind of? Do we just kind of track back and say have you had COVID, when did you have it? Like, how are we saying that the fatigue and the brain fog and the hypertension is long COVID, as opposed to just these are things that this patient is experiencing.

Speaker 3:

Josh, let me take a step back and I'll tell you a little bit about kind of like% of the patients report, some of the cognitive impairment associated with long.

Speaker 3:

COVID. So memory issues, difficulty concentrating, even exercise functioning is diminished in these patients, and that's also where that respiratory, cardiovascular component of symptoms comes in. But in terms of these cognitive dysfunction systems, we have what we call neuroinflammation. That's happening and this is due to the cytokines, specifically interleukin-6 and TGF-beta. They really interfere with the way that neurons communicate and so, for example, tgf beta regulates immune responses, but when it is elevated chronically it contributes actually to inflammation and scarring. So lots of different stuff happening in the background that we may not even be thinking about.

Speaker 2:

Sure and that cytokine surge is a direct correlation to COVID-19 infection. Correct, right, right.

Speaker 3:

On the other hand, vegf, or vascular endothelial growth factor, also plays really a big role in altering blood flow in the brain and then that is thought to further, you know, worsen inflammation. So this kind of an inflammatory environment with neuronal kind of signaling now being impaired because of the level of information in that environment. This is where the cognitive issues are kind of arising. Interesting that's with that. Yeah, can I say a little bit more about the loss of smell?

Speaker 2:

Yeah, no, that'd be great. Yeah, let's do it.

Speaker 3:

Yeah, so the loss of smell or the anosmia is really persistent and really persistent loss of smell, and it's yet another quite common symptom of long COVID and it's truly not due to the residual virus but rather that again, pro-inflammatory environment in the olfactory epithelium environment in the olfactory epithelium and that increases the T cells and with kind of that reduced anti-inflammatory macrophages, interfere with our sensory neuron generation and we can't really smell how we used to or at all, which is, I think, pretty bad.

Speaker 2:

Terrible. That, to me, is. Thank goodness that is not a side effect I had when I was infected with COVID. Because I don't know smell. To me it just is so important because it brings back, it's directly attached to so many memories and just, yeah, I just, I don't know, I really I can't imagine not having the ability to smell for a long period of time. Like, I just think that is terrible. Obviously some of these other side effects are also terrible as well, but to me the anosmia is just it's just right up there. So I guess what I was kind of going with and the background information is great, so helpful, but like, if you have a patient presenting with a few things, how are we really set? At what point? How do we determine like, okay, this is, this is long COVID, is it like you must have three of these five or something like that, or is it more of just really digging into it? And we're still learning that process?

Speaker 3:

Josh, great point. I think it's a little bit of both and I would say maybe the latter a little bit more. You know, we see patients that come in with symptoms such as these that we just said and that I just talked about, and often it's puzzling. We think, well, maybe it's allergy season, you're fatigued because you're overworked and overstressed. So putting those pieces together and kind of looking at the patient holistically and getting their you know thorough history about, you know their COVID infection and really then can kind of help guide whether we're approaching that long COVID territory versus. Is it something else that? Or maybe a combination of all of those things?

Speaker 2:

Yeah, a combination of all the above. Yeah, exactly so. So I think this is a great segue to start talking about the pharmacist role in all of this. So you mentioned, you know, getting a good history and understanding exactly what they're going through, asking the right questions. So what, what are some of the ways that pharmacists can really kind of help with that? And I guess the other question and I'll back up just briefly is are we officially like, are people officially being diagnosed with long COVID, like is there a diagnosis code you know like, or are we like you're diagnosed with diabetes, or you know you're diagnosed with heart disease, or is it just more of still this whole concept of like you got a lot of things going on and it seems to check the boxes? Yeah, josh, great points.

Speaker 3:

Yeah, let me tell you about the. You know the pharmacist's pivotal role, I guess, in all of this, but also from what I'm seeing in practice in terms of the diagnosis, I think four key opportunities for pharmacists I think are here at stake. And I think early identification I think asking about that lingering fatigue, soliciting information about sensory issues or mental fog during either counseling sessions or MTM visits crucial. And that is a opportunity where you are seeing, looking, conversing with your patients and you can really tell Right. Yeah, and I kind of like naming that experience helps patients seek appropriate, you know, care as well. I think the other key opportunity is medication management. So really adjusting those therapies for chronic conditions that kind of have been exacerbated by long COVID is crucial, is crucial. So you know, for example, you know and we did a little bit of research on looking at you know what other medications could kind of worsen some symptoms. Right, and this is a very common antibiotic. You know, azithromycin. It could actually worsen some symptoms, believe it or not.

Speaker 3:

So, that was something that we've found really puzzling in literature when we that was something that we've found really puzzling in literature when we were digging. Interesting Third one education and coaching. I think teaching your patients how to track symptoms, how to structure, rest and kind of maybe pace their cognitive and physical activity is also crucial. Their cognitive and physical activity is also crucial and you know, we as pharmacists, educators, have the opportunity to really tap into that and really educate our patients and counsel our patients and coach our patients in many ways. And just lastly, I think, collaborating with providers. And I know that when I left for the last, but specifically and strategically, uh, you know, pharmacists, we really can initiate referrals, coordinate care plans and, you know, share treatment evidence and and advice with pcps and others. So I think all of those are crucial for, I think, opportunities for this pharmacist to jump in. And, yeah, it's definitely hard to diagnose and pinpoint that one diagnosis of lung COVID, especially as these symptoms may not be clear-cut.

Speaker 2:

Right. Or, like I said, you know they. Just you know, seeing one or two of them, it's like oh, you have hypertension, oh you're fatigued, oh you have shortness of breath. But really kind of being I always tell people and when I taught I always told the students you have to be you know that investigator, you have to really put all the pieces together, you have to be that sleuth. That's like asking all the questions and putting all the pieces together. So I think it's more of like it's taking a step back and looking at the bigger picture too, with a patient and being like okay, hold on a second. They all of a sudden have hypertension, they say they have fatigue and they have, you know, some respiratory distress. So maybe maybe there's a bigger picture here, Maybe it's not just you know that three things just happen to be simultaneously happening. So, okay, that was what I was wondering was you know, is there a checklist of like, okay, when you reach this, you're diagnosed with long COVID, or is it just?

Speaker 3:

still more of a work in progress. Josh. What a great observation. Josh, what a great observation and honestly, this leads into some of those challenges that we're encountering, not only as pharmacists but as healthcare professionals. You know, lack of that standardized treatment evidence. There's nothing standardized at the moment. Evidence is still evolving and you know we really it's trial and error at this point.

Speaker 2:

Yeah, and there's no medication to treat long COVID. It's that you have to treat all the different symptoms you know based on what's happening. So, yeah, while we're talking about the lack of standardized treatment, I want to jump back a little bit and dig more into, like, the medication management, if you don't mind. So that was an opportunity for pharmacists was to really kind of focus on that medication management. So let's talk about some of the things that you know. We obviously it's going to be patient specific and we want to be sure that we're, you know, tailoring the care that we're offering to patients, because not everybody takes the same hypertension medication, you know. But like what? What have we seen? What have you all seen great success with in treating certain things? Like, are we seeing, well, we can get hypertension under control, or is it one of those that's like we throw six drugs at it and we still don't get it under control? You know, like what? What are some of the things that we're seeing success wise as far as, like, what we can manage with medication?

Speaker 3:

Yeah, Josh, that's, that's really great point and a great question. I think one thing that we have to also keep in mind is that overlapping conditions and symptoms will really mimic some of those same symptoms of long COVID, so that chronic fatigue, perhaps the fibromyalgia and even anxiety. So, you know, we tend to focus on treating and managing that one or two specific conditions that are kind of coexisting. You know we're not going to be, you know, looking at throwing seven or eight new medications on board in addition to what your chronic, you know medications are already on, you know. So I think this is again where that access is important. You know, and you know patients may like coverage. They, you know, may lack kind of the this, you know, access to specialists, and again we as pharmacists here can kind of jump in and play that role in navigating these systems.

Speaker 2:

Absolutely, Especially, like you mentioned, you know, with with an MTM or with just a general med sync conversation, you know, like looking to see are there any overlaps of things? Or, you know, is there somewhere that we can change a medicine or change a dose or add a combo product or something like that? So yeah, that's great points, Okay. So now back to I just wanted to be sure that I touched on some more of the medication management component. So, as you mentioned, one of the challenges is lack of standardized treatment.

Speaker 2:

Again, there's no long COVID drug that's knocking out everything that it's throwing our way. It is more of a symptom-specific kind of management per se, based on whatever's going on with that patient. So that is a challenge that we have because, let's face it, we love a good flow chart and a definitive answer, right. So we'd love to be able to say if this happens, do this. And so I feel like with long COVID, that's not really happening. It's more of lots of trial and error. So that's one challenge that I think we're definitely seeing as pharmacists. What other challenges have you recognized in this space?

Speaker 3:

Yeah, Josh, you kind of made a really good point with we love algorithms and we could stick to them, right, that would make our life a lot easier. Right, that would make our life a lot easier. Unfortunately, other things that you know that I've seen, you know things that we do in practice. For example, we do a lot of screenings, right. So we're using kind of brief, open-ended symptom questions to kind of like solicit a good history from our patients and then we use kind of specific symptom specific strategies as well. So, for example, for that loss of smell, you know there's olfactory training that could potentially be used and a lot of our clinicians recommend, you know where patients are exposed to certain scents and you, you know once or twice a you know a day for several weeks and you know see if they are regaining any kind of a component of their sense of smell.

Speaker 3:

For cognitive dysfunction, you know we're kind of recommending, or a lot of our clinicians are introducing cognitive pacing to their patients. You know scheduling mental breaks, cognitive pacing to their patients, you know scheduling mental breaks, avoiding kind of multitasking things that you know, josh, you and I were constantly doing, you know which is a lot and even sometimes building recovery periods into our daily routines. I think that's really important and we have to be, you know, really aware that these patients may not know what to do. So those are, you know, those are, you know, some of the modalities that I've seen used in practice.

Speaker 2:

Yeah, and it may not. It may not be commonplace for them. You mentioned a word and I have already lost what when you were talking about treatment options, piece breaks or something, what?

Speaker 3:

did you say, oh yeah, cognitive pacing or mental breaks?

Speaker 2:

Okay, cognitive pacing I thought you said cognitive piecing and that was gonna be new for me and I wanted you to go deeper into that. Okay, so cognitive pacing got it. But yeah, I think that that's a great point is that, again, while that is a challenge, in a sense of like, how are we treating it? Because there isn't a wonder drug that's knocking everything out it's also an opportunity for pharmacists to really show our value and to say like, hey, I have stress and fatigue from the job and I have these moments of neurologic issues or whatever because of that, and here are things that I do and here are things that I've found, and so I think that that's another great opportunity for us to really kind of jump in with treatment options. I'll use quotes around that because you know we're not a psychologist or anything like that, but still there are modalities, like you mentioned, that can kind of help with that, and Josh.

Speaker 3:

I have a couple more pharmacological options that I can share with you. Yes, please do. Yes. So, specifically for brain fog, you know there's some research out there that NAC or N-acetylcysteine could potentially be a good option, especially as it reduces oxidative stress. Guanfacine is another one. Improves focus kind of by working on norepinephrine and modulating that. For headaches, we have our traditional ansets or acetaminophen, but for chronic maybe headaches or migraines, you could consider, you know, tcas, um, and then kind of like neuropathic pain, you know you could think about SNRIs or things along those lines, especially if there's any coexisting depression or anything like that.

Speaker 2:

So we're seeing a lot of those utilized as well.

Speaker 2:

Or anxiety. I mean, sometimes you might can hit multiple birds. Yeah, yeah, yeah, sounds good, okay. So another challenge then that you know, obviously we see, is access to care and resources, access to the information. Again, that's why it's so important for pharmacists to be in this space, because we are the most accessible healthcare you know provider out there and so you know referrals and coverage options and just education in general. So I think if you can kind of speak to that and maybe how you're seeing some of those challenges overcome, that'd be great.

Speaker 3:

Yeah, josh, a lot of it is, you know, unfortunately, and you know I have students on rotations with me and I'm very lucky enough to have a partner at my site too. That helps me. But a lot of what we do is actually look at formularies, seeing what is covered ahead of time, so that we can be really proactive. So when we're going in for that patient visit and making a recommendation, we've already kind of looked at the patient's formulary ahead of time and know maybe what we want to recommend at some point or can quickly look it up. Otherwise, again, it's a missed opportunity because patients will go to the pharmacy, pick up the medication it may be a really high copay or not covered and then we're back to kind of square one and then we may lose that patient.

Speaker 2:

I was going to say or you lose them. Follow up. Because they say, yeah, well, the thing you gave me was 500 a month and I'm not going to do that, so forget it.

Speaker 3:

So that's a big one um, and you know, trying to coordinate referrals and um, you know, looking to see where else we could potentially uh, you know refer patients. What else is covered on there as part of their insurance as well?

Speaker 2:

So those are all really important. That's great. That's great and I'll do a I often do a shameless plug for other products and things that you know we have in the catalog. And you know one thing that we do is we cross train pharmacy technicians as community health workers or CHWs. I don't know how familiar you are with that, but you know CHWs and placing them in a pharmacy in that technician dual role really allows for again understanding more of what resources and opportunities exist in the community, how you kind of make sure that your patients are taken care of in that way. So so, if you're listening and and you're thinking about how can you do a further outreach, consider cross-training some of your technicians as CHWs. You can find that information in our catalog too, so that's great. So, dan, we're wrapping up. I told you in the beginning I always tell the guests time flies, so we're wrapping up. Is there anything specifically that we didn't cover that you feel like is super important for our pharmacist listeners to hear?

Speaker 3:

I just want to let everybody know that remember that long COVID is complex. It really affects the mind, the body, the daily functioning of everybody involved and pharmacists. We really are uniquely positioned to kind of bridge that gap between evidence and patient experience. So don't forget, we're medication experts, but also educators, advocates and really good listeners. So I'm really happy to be part of this as well.

Speaker 2:

Yeah, no, that's great. And again, I think I know we've said it, we've alluded to it and I think we've specifically stated it but this is also an ongoing, evolving disease and treatment around it, and so there are going to be times where we're frustrated as pharmacists and providers because something may be new and this patient may be presenting different than somebody who something worked on previously or you know whatever. So I think it's also key to understand that. You know this is not as easy. As you know, 6 million people have been cured of this by taking this and that and you know, doing these steps.

Speaker 2:

So I guess what I'm trying to get at is it's okay if you have frustrating moments when you're trying to treat your patients and help your patients who have long COVID, because it is such an evolving disorder that we're still all learning about it. Absolutely yeah, yeah, well, dan, I guess I'm assuming that I didn't officially encapsulate it, but what would you say? You gave some great send-off points there. What would you define as the actual game changer here? Like, what is the game changer for long COVID?

Speaker 3:

in this space by evidence. That is truly powerful, I think. Ask the extra question, offer the small insight and start the hard kind of conversations. I think all of this is because often we as pharmacists, we're the first person to believe in the patient.

Speaker 2:

Yeah, yeah, I love that Empathy backed with evidence. I'm going to have to play off that and create a course or something. I'll give you credit back for it, but I love that. That's great, is it or isn't it a thing? And how are we treating it and what's happening? And so I think it's really important that we're talking about it and giving it time, because it is really affecting our patients and we need to make sure that we're there for them. So thank you again, dan. This has been great. Josh, thank you for having me.

Speaker 1:

And that's it for this week. Be sure to log in to Health Mart University to claim your CE credit for this episode. As always, have a great week and keep learning. We'll talk to you next week.