Marshall doctors work on long COVID treatment as WV holds highest disease prevalence in U.S.

The Marshall Long COVID Clinic is located at 1305 Elm St. in Huntington, W.Va. The clinic opened last year and has seen about 100 patients so far. (Marshall Health News photo)

In West Virginia, where the prevalence for long COVID in adults outpaces every other state in the nation, doctors at Marshall University are leading the effort to educate and treat patients living with the complex ailments.

Long COVID, according to the Centers for Disease Control and Prevention, includes a wide range of health issues that emerge or persist following an acute COVID-19 infection. Specifically, it applies to people whose daily activities are impeded by symptoms or problems arising from that infection for more than three months after contracting the virus.

Dr. Imran Khawaja, the chief of pulmonary, critical care and sleep medicine at Marshall Health and a professor at the Marshall University Joan C. Edwards School of Medicine, said medical professionals are still learning about the illness and how to treat patients that present with it.

Khawaja is one of two doctors leading Marshall’s long COVID clinic , which started last year and so far has seen about 100 patients come through its doors.

“There’s a whole slew of things that we see with these patients, and it really varies person to person,” Khawaja said. “While we have patients we’re seeing, guiding in rehabilitation from the illness, we know there are many more out there who don’t know [such services] exist, who aren’t aware. Especially in West Virginia, where specialists and those sorts of programs aren’t as available.”

Some patients travel from up to two-and-a-half hours away to receive the specialized services at the clinic, Khawaja said.

“That tells me, people don’t have the resources closer to home to help them with these symptoms,” Khawaja said.

According to a February analysis from the CDC, between 8.9% and 10.6% of adults in West Virginia who previously had COVID-19 reported in 2022 that their symptoms persisted past three months and interrupted their daily lives. That was the highest rate of all states and territories in the U.S. and much higher than the 6.6% of adults who reported the same nationally.

Dr. Steven Eshenaur, public health director at the Kanawha-Charleston Health Department, said he wasn’t surprised to hear of long COVID’s heightened prevalence in West Virginia given the state’s already challenging health outcomes.

“We know the big three things that can exacerbate [a COVID-19 infection]: older age, higher body mass index and comorbidities or underlying conditions,” Eshenaur said. “Well, in West Virginia, we have those three things across the board at higher rates than almost every other state.”

West Virginia is one of the oldest states in the nation, according to Census data. It regularly reports some of the highest rates of obesity. Underlying illnesses — like lung disease, heart disease and more — are more common than in other states and regions.

“All those things together, with the [COVID-19 virus], well that’s a concerning mix,” Eshenaur said. “It doesn’t help that we’re really just starting to understand what long COVID is and how it can impact patients.”

Khawaja said one of the best things that a physician can do for someone who is suffering from a long COVID diagnosis is also one of the most basic: acknowledging the disease and the real effect it is having on their life.

For years now, questions have circulated in the medical community and beyond about the legitimacy of long COVID illnesses and what they could do to one’s body. There’s still some confusion and a lack of recognition by family care and general practitioners, who haven’t necessarily had the training to recognize the illness, much less treat someone who is living with it, Khawaja.

“I think we need a lot of education for everyone — long COVID is something that exists, it’s a true phenomenon and this is something people are truly suffering through,” Khawaja said. “It’s not anyone’s fault, no, but there are a lot of patients that could have seen us but aren’t referred because of that lack of recognition.”

The recognition also gives patients a piece of mind about what they’ve been experiencing.

“Having a name, something to call what’s happening to your body, I think that goes a long way with [patients],” Khawaja said.

But even with recognition and more education, the science on and response to long COVID is still developing. There is no medication currently available for people living with it and the symptoms can affect nearly every system in the body in different ways, making a clinical treatment plan more difficult to compose.

At Marshall’s long COVID clinic — the only one in the state — Khawaja and his team are working under guidelines from the national RECOVER initiative that separate symptoms and the illness into different categories determined by what part of the body they affect.

Since long COVID has been reported as including more than 200 different symptoms — respiratory issues, brain fog and fatigue, exercise intolerance, digestive complications, disrupted sleep patterns, cardiac issues and more — determining an appropriate treatment plan is complicated.

Khawaja said it’s crucial to ensure patients entering the rehab program are put on an appropriate treatment plan for what they’re experiencing. So far, the clinic has had luck implementing specialized exercise plans for people with fatigue and exercise intolerance and they’re starting to work more on sleep-related symptoms, which Khawaja specializes in.

“We’re combining what we know about other illnesses and we’re making some headway in what works, but is this the gold standard for what we should be doing with long COVID? Well, probably not, but it’s what we have right now,” Khawaja said.

Eshenaur previously served as the director of the emergency department and outpatient clinics at WVU-Jackson General Hospital, and still takes rounds at the hospital weekly. He said the hospital is “absolutely” seeing patients regularly who are living with symptoms spurring from COVID-19 infections.

When one walks in seeking help with these conditions, he said it’s important to take a diagnosis step by step.

“We need to make sure we’re referring to the right specialists, we’re listening to what they’re feeling and how it’s impacting their lives,” Eshenaur said. “We need to get an accurate workup, an accurate medical history to understand what comorbidities they may have and eliminate other illnesses that could be underlying and causing these symptoms. It’s a lot of work diagnostically.”

Khawaja said there is some hope on the horizon as the National Institutes of Health commission more research and studies on the variances within long COVID infections that medical professionals hope will help guide both diagnoses and treatment.

There are also trials underway through RECOVER attempting to study the efficacy of different interventions on patients who are living with different kinds of symptoms. Khawaja said he’s hopeful that in the next few years, a standard treatment model — potentially with tailored medication — will be developed internationally to help lessen the impact of long COVID illnesses.

“This is all a bright spot because the more we know, the better we can help people,” Khawaja said. “Right now, all we can do is try some form of therapy to help people with their symptoms and give them whatever hope we can, whether that’s recognizing that what they’re feeling is real or that they aren’t alone in feeling it. We’re doing the absolute best we can with the information and resources we have.”

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