As the COVID positivity rate drops throughout Orange County, along with the rest of California, there’s still questions on what effects long term virus symptoms can have on people and the healthcare system overall. 

Known as “Long COVID”, many people who’ve had the virus still battle ongoing symptoms like 

shortness of breath, chronic fatigue and brain fog for months. 

“We have a huge array of symptoms we’re seeing, those are just the main ones,” said Dr. Natalia Covarrubias-Eckardt, who treats long COVID patients at St. Jude’s Hospital. 

She also said some of the most severe cases of long COVID are people struggling to walk because of nerve damage, while others have had strokes. 

As of Aug 4 – the latest available data –  Orange County’s positivity rate sat at 16.5% – down from the nearly 20% positivity rate a couple weeks ago, according to state data.

“Just from how busy my clinic is and how busy the therapists are, I wouldn’t say there’s a decrease in the amount of long hauler patients that we’re seeing. And usually we’ll get an increase a month or two after the surge,” said Covarrubias-Eckardt, who’s the medical director of the hospital’s long COVID rehabilitation program.

There were 269 people hospitalized as of Aug. 5, with 34 in intensive care units, according to state data. That’s a decrease from 350 people hospitalized on July 27.

Figuring out what long COVID is and exactly who has it is challenging – especially because its definitions can change. 

Dr. Vanessa Wu, a physician with UC Irvine’s COVID recovery service, said that makes it difficult to understand what the implications of studies on long term symptoms are.

“Different studies will have used different definitions for what counts as long COVID – that makes it hard to compare studies,” Wu said. 

She also said it’s still unclear what drives long COVID, which makes it difficult to treat. 

“The good news is we do know generally over time, people will have improvement on their symptoms, but the question is how much improvement or how quickly,” Wu said. 

People who’ve had severe virus infections tend to have a higher chance at experiencing long term symptoms, Wu said. 

“One factor we do know generally is that people who have a more severe COVID infection, it seems to be more common for them to have lingering symptoms, versus people who have more mild symptoms or no symptoms of COVID,” Wu said, adding that she’s seen damage to organs like scars on the lungs or kidney disease. 

Both Wu and Covarrubias-Eckhardt said they consider people having long COVID if they’re still experiencing symptoms more than a month after the initial infection. 

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Doctors, epidemiologists and public health experts say the COVID vaccines, along with previous infections, help reduce the severity of illness and are a major reason why hospitalizations have been relatively low during the current surge.

Sanghyuk Shin, UCI epidemiologist and public health expert, said a recent study from Israel shows how vaccines can prevent people from being hospitalized for the virus. 

“There was a significantly higher level of respiratory function among people who were vaccinated. And this is adding onto a growing body of evidence that vaccinations reduce the burden or can help prevent long COVID,” Shin said in a phone interview.  

Dr. Lance Brunner, physician director of patient safety and quality at Kaiser Orange County, said people who’ve had severe COVID infections look to have a higher chance of developing long term symptoms. 

“People who are hospitalized for long COVID or heaven forbid they end up in the ICU, those people have a very, very increased risk of long COVID,” Brunner said in a phone interview.

He also said between 30 to 50% of people hospitalized with severe COVID could experience long term symptoms.

Covarrubias-Eckardt said she’s noticed vaccines seem to help prevent long COVID. 

“Patients who have had their vaccinations already are less likely to get severe COVID and less likely to be long haulers,” she said. 

But at the same time, Covarrubias-Eckardt said the clinic has seen a recent influx in younger patients who weren’t hospitalized. 

All the doctors interviewed said if someone’s had a mild COVID infection before, that doesn’t mean it will be mild next time, which could increase the chances of becoming a longhauler patient. 

“Every time you get a COVID infection, we think you do run the risk of a severe infection and potentially developing long COVID,” Wu said. 

Shin said vaccinations have not only helped keep hospitalizations low since they began rolling out to the general public last summer, the shots also help decrease the number of deaths.

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The virus has killed 7,235 Orange County residents since the pandemic kicked off in March 2020, according to the OC Health Care Agency. 

For comparison, OC saw 1,590 flu deaths from 2018 to 2020, according to state data.

During that same time, cancer killed 14,183 people and heart disease killed 8,549 Orange County residents.  

In 2020, the COVID virus killed 2,707 people – before vaccines were available – according to detailed data from the county Health Care Agency. 

In 2021 the virus killed 3,331 people. The majority of those deaths, 2,225, happened in the winter surge during January and February – months before the vaccines were widely distributed.

Since the start of 2022, COVID has killed 1,176 people in Orange County. 

The CDC estimates nearly 20% of people who’ve had the virus are dealing with long term symptoms based on a survey of roughly 60,000 people. 

At the beginning of the year, the Brookings Institution found that long COVID is impacting the country’s workforce, which put as many as 1.1 million people out of work, while millions of other people had to work reduced hours. 

“In other words, under reasonable assumptions given the data available, long Covid could account for 15% of the nation’s 10.6 million unfilled jobs,” the institution found.

Shin said the rapid case increases seen in the recent surge will lead to more long COVID cases, putting more burden on an already strained public health response. 

“I have students and colleagues who are practicing nurses, many of them are very much burnt out,” he said. “I do think that the policy makers need to understand that the situation health care providers are in — greater resources are needed to support our health care system.” 

Spencer Custodio is the civic editor. You can reach him at scustodio@voiceofoc.org. Follow him on Twitter @SpencerCustodio.

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