People with Pre-existing Conditions Must Still Beware of Long COVID

On March 2, Pan Bowen, a trauma surgeon at the Children's Hospital of Zhejiang University, collapsed while playing basketball and died at 22:15 that evening, aged only 32. According to Dr. Pan's family, his death is highly suspected to be related to post-COVID sequelae (long COVID).

On November 2 last year, my own cousin also died suddenly; before his death, hospital tests found massive pleural effusion. My cousin was also a doctor, and until then he had not noticed his own symptoms. In fact, many people have long COVID after the infection, but they may have dismissed mild symptoms such as fatigue, cough, low-grade fever or no fever, brain fog, slowed responses, or mild chest tightness.

Patients' families have told me one after another that a loved one died after COVID from cardiovascular or cerebrovascular disease or massive pleural effusion. Some patients have told me that after mild chest tightness or cough, hospital checks surprisingly revealed pleural effusion (white lung), which even they found unexpected. Others have developed brain effusions after COVID.

The COVID virus's impact on human health continues, and medicine's understanding of long COVID is clearer than before. Huge numbers of patients worldwide still suffer from long COVID. Because the virus keeps mutating and many people are repeatedly infected, those with multiple infections are more prone to long COVID.

So far there is no particularly good solution for long COVID, and few doctors can treat it. Most long-COVID patients recover or adapt within a year, but millions worldwide remain trapped in COVID's suffering, unable to recover.

The Lancet Respiratory Medicine once published a British multi-organ study of 259 hospitalized COVID patients in 2020-2021. It showed that nearly one-third of hospitalized COVID patients had abnormalities in one or more organs within an average of five months after discharge, including the brain, heart, liver, kidneys, and lungs. Lung abnormalities were 14 times more likely than in uninfected people, and brain abnormalities 3 times more likely. COVID patients with multi-organ abnormalities were four times more likely than uninfected people to have severe mental and physical impairments that prevented them from carrying out daily activities.

Long COVID also causes cognitive impairment. A previous King's College London study of over 5,100 infected people showed that those with long COVID had relatively severe cognitive impairment and memory decline—equivalent to aging ten years. Long-COVID patients also showed mild or moderate psychological distress.

The long-term inflammatory response caused by long COVID also persists for a long time. A*STAR ID Labs and the National Centre for Infectious Diseases in Singapore studied post-COVID long-term inflammation; the study showed that in some long-COVID patients the inflammatory response takes 24 months to subside and return to pre-infection levels.

So far I have encountered every kind of long-COVID patient and every long-COVID problem reported to date. As far as I know, many patients still have dyspnea, tachycardia or bradycardia, reduced physical capacity, high or low blood pressure, brain fog, depression and anxiety, and listlessness.

From my direct experience, people with a family history of obesity, a family history of hypertension or hypotension, COPD, a family history of heart disease, cancer patients, diabetics, and chronic kidney disease patients are all high-risk groups for long COVID. The COVID virus weakens their already frail immune systems; with slight overexertion they easily develop severe post-COVID sequelae. They catch colds more easily than before COVID, recover from colds more slowly, and the symptoms are more severe and harder to treat.

When some immunocompromised chronic-disease patients with post-COVID status catch another cold, even ordinary doctors cannot cure their cold complications. Their symptoms may linger for a long time—cough or fever lasting over a month without relief—or quickly progress to pneumonia and pleural effusion. Arterial plaques and pulmonary nodules also appear easily, and a minority develop liver or kidney insufficiency.

In my experience, immunocompromised long-COVID patients cannot be treated routinely; routine treatment easily leads to uncontrolled, rapid progression and life-threatening danger. Earlier U.S. research showed that long-COVID patients have about a 63% higher risk of dying from cardiovascular/cerebrovascular disease and cor pulmonale.

Many long-COVID patients who appear to die suddenly have simply been careless, failing to notice subtle bodily changes. Had they noticed, they would have realized they were actually in a long-COVID state, requiring health monitoring and controlled work and exercise intensity.

People with obesity, abnormal blood pressure, high blood sugar, high blood lipids, high cardiac risk, cancer, diabetes, or kidney disease should monitor their health even without symptoms, avoiding overwork and excessive exercise. If a family member after COVID becomes slow, listless, or depressed, we should also monitor their health. Some people have clearly reduced stamina after COVID; family members should not urge them to build fitness through exercise, as this can easily trigger sudden death.

When doctors see long-COVID patients, they should take health monitoring seriously, asking patients or families to report changes once or twice daily to detect sudden deterioration, because such patients are at risk of sudden death. In my experience, treatment intensity must be raised: for ordinary patients I dose 2-3 times a day; for these patients I dose 4-6 times a day. With high fever or severe pleural effusion, dose every 1-2 hours to maintain continuous drug effect.

Most drugs are metabolized within 2 hours. After a cold, long-COVID patients' immunity cannot fight the pathogen. For such patients, dosing every routine 4-6 hours leads to relapsing-remitting disease that drags on and on. This is high-risk, because they can die suddenly from sudden deterioration at any moment; they must be treated as emergencies and observed closely.

Zhang Zhongjing in the Han dynasty already stressed this: "observe through the full cycle, know what adverse course has occurred, and treat according to the pattern." In modern terms: closely observe the patient's bodily changes, judge progression, and adjust treatment as symptoms dictate. In treating acute infectious disease, Zhang did not have patients take medicine 2-3 times a day as modern doctors do; rather, he allowed medication throughout the day and night without a fixed limit. Long-COVID patients and their families need to shift this mindset during treatment.

But even more important is daily care. Immunocompromised people should conserve their strength, keep warm, sleep enough, eat moderately, and avoid crowded places during infection peaks. If they sweat heavily after exercise or labor, they should dry off quickly and change underwear. After coming home chilled from outside, they should quickly drink ginger-scallion water or use a hairdryer on the cervical and coccygeal vertebrae until a faint sweat appears, to dispel cold. Those with chronic cold intolerance may use warming patches or moxibustion patches near the coccyx; this health practice can boost resistance to infection.

I will gradually publish my medical cases of long-COVID patients, using concrete cases to illustrate my treatment approach for patients and families.