Monitors and IV stands sit in a patient’s room in the COVID wing at Tulsa’s Saint Francis Hospital in April.
COVID-19 isn’t simply a disease in which a person either recovers or dies. There is a subset of cases in which varied health problems persist after a typical recovery timetable.
The Healthier Oklahoma Coalition on Tuesday dedicated a portion of its weekly virtual news conference to the subject of what is commonly referred to as long-haul syndrome, or long COVID, or long-haulers. The majority of people do recover as outpatients, but not all.
“It’s important to remember that COVID’s a serious infection that doesn’t just involve the respiratory tract and the lungs, but all of the major internal organs: heart, kidneys, pancreas, major blood vessels,” said Dr. Stan Schwartz. “You’ve heard that people get strokes during COVID, even young people that have no risk of getting strokes.”
Schwartz holds a fellowship from the Infectious Diseases Society of America. He said the virus either circulates and attacks organs — it’s been found in organs other than the lungs — or the virus causes an inflammatory reaction in which the body begins to destroy itself in those inflamed areas.
He said most experts agree that a person who is significantly sick but doesn’t necessarily need hospitalization on average can take a full month for “a so-called normal recovery.” About 10% of people who have “recognized but not highly severe infections” don’t resolve their symptoms by that month and have some degree of impairment afterward, he said.
Severely sick people are expected to take longer, he said, but some stay ill much longer than anticipated based on their infection’s acuteness.
“We don’t know how long this is going to go on because COVID’s only been around in the United States for a bit over a year,” Schwartz said.
Healthier Oklahoma Coalition is a group of health care professional organizations throughout the state. Schwartz also is a Fellow of the American College of Physicians.
Schwartz listed off typical long-haul symptoms: Shortness of breath; persistent discomfort in the chest and cough; alteration or loss of smell and taste; a “brain fog” or memory impairment that makes it more difficult to think; psychological symptoms such as anxiety; or symptoms characteristic of post-traumatic stress disorder.
There can be permanent damage to lungs after COVID-19. Kidney damage has led to dialysis treatments, he said, and attacks to the pancreas have resulted in new onset diabetes or a worsening of the condition.
Some people who are very sick or in intensive care lose tremendous bone and muscle mass, which lead to persistent fatigue and loss of endurance that can last for months, he said.
There also are cases of people who have multiple symptoms for which doctors can’t find specific organ damage, he said.
“In a way these people resemble folks that have chronic fatigue syndrome — something I’ve been interested in for years — another long-term syndrome that can go on months or years after certain infections,” Schwartz said.
Schwartz said that about one-third of people whose infection is significant enough to be sick will have some involvement of the heart, such as mild inflammation.
He said anyone who has had a serious COVID infection and will perform high-intensity activities or partake in sports should undergo a cardiology evaluation before resuming.
“I think it’s really important to distinguish between the kind of damage you can get to the internal organs from COVID, and the persistent symptoms that some people get who never really had that bad of a condition,” Schwartz said. “It’s going to be something we’re going to be seeing a lot of I think, considering the millions of people who have had COVID in this country.
“I think we’ll see quite a few folks with these long-haul symptoms, we’ll be learning a whole lot about it as we go along.”
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More guidance for Oklahomans signing up through the state COVID-19 vaccine portal during Phase 2
Who is eligible currently?
On Feb. 11, Gov. Kevin Stitt announced teachers and school staff would become eligible Feb. 22 for COVID-19 vaccines, as well as Oklahomans of all ages with co-morbidities. The comorbidities, or medical conditions that denote high risk of death from COVID-19, include but are not limited to hypertension, diabetes, chronic vascular disease and other heart- and liver-related conditions
Officials have assured pre-K-12 school staff who are not classified as teachers, such as bus drivers, that they will be covered due to their high-risk positions; about 89,000 individuals are estimated to be eligible in this category.
Still eligible to make appointments: health care workers and those 65 and older
I have comorbidities - what do I need to do?
Beginning Feb. 22, residents under 65 with comorbidities will be eligible for a vaccine, estimated at 1 million Oklahomans.
The state plan include lists of issues that put people at increased risk of severe illness if they were to contract COVID-19. Those include asthma, cancers, cardiovascular disease, chronic kidney disease, chronic liver or renal disease, chronic lung disease, diabetes, Down syndrome, heart disease, high blood pressure (hypertension), obesity, suppressed immune system.
No documentation is required by the state to prove a comorbidity. Patients being vaccinated through pandemic providers including doctor's offices and pharmacies may have their records checked to confirm eligibility.
What determines how many appointments are available?
The state is reliant on COVID-19 vaccines supplied by the federal government; officials reportedly are notified of shipments one week at a time. The limited supplies make it logistically impossible to schedule vaccinations weeks in advance. Oklahoma officials hope for a policy change that resupplies be based on states' “burn rate,” of how many shipped doses are distributed promptly.
States and tribal leaders are receiving federal shipments of vaccines based on population, OSDH leaders have said. Oklahomans with a CDIB card would go to a tribal health care center for vaccines.
I signed up at vaccinate.oklahoma.gov but never got an email confirmation of any kind — what should I do?
Confirmation emails are sent out in batches; users should receive one within 24-48 business hours of registering. “Emails are sent out over a span of time in the order in which registrations occurred,” the state said. “As a result, some emails may be delayed.” If you've waited at least 48 hours without having gotten a response, it could mean a data-entry error was made by the user during registration.
State and county health officials also have said most of these issues are resolved when the user checks their junk mail folder for messages flagged as spam.
I’ve been told I can make an appointment, but I went to the portal and there were none available within 100 miles — what do I do now?
First, if the portal has a link that says "No appointments available," click anyway. Possible glitches in the system might result in that message showing up even when appointments might be open outside the user's immediate area.
If you're still coming up empty, bookmark and keep checking the “Click here” link emailed to you, says deputy OSDH commissioner Keith Reed. The link does not expire and is the only method to check for appointment availability. No further emails will be sent.
When will new appointments be added to the online portal as the state is updated on the supply of vaccines expected to ship from the federal government?
A new round of scheduling should be available on the portal every Thursday. Starting 5 p.m. Wednesday through Thursday morning, new appointments are uploaded for distribution pods, said Mindy Spohn, OSDH vaccine facilitator.
Tulsa Health Department did not add appointments Feb. 10-11 for the coming week due to inclement weather.
Someone I know is unable to go online to access the vaccination portal — how can they make sure to get an appointment?
The state recommends that those unable to access the online portal ask a family member or friend with internet capabilities to assist them with the registration process.
Some churches have stepped up to help people without internet access register on the portal, as well as those who need a foreign-language interpreter. State officials have said a Spanish translation is forthcoming for the online vaccine portal.
How are 211 and LIFE Senior Services trying to help?
Call center staff at 211 can help Oklahomans connect to resources they may need to physically access the vaccine distribution sites, but they cannot schedule appointments. OSDH helped add to 211 staff, who can collect patients' contact info to pass on to local health departments for phone scheduling.
LIFE Senior Services is helping callers get scheduled by signing them up on the portal and receiving emails for the patient. Pictured: LIFE Senior Services activities director Amberly Villegas and Geneva Boling.
Who else is trying to help people book appointments?
Josh Wright, software developer from Norman, developed a text-alert system for Oklahomans as a companion site for the state's COVID-19 vaccine portal.
The vaccine-alerts.com site has 41,000 users, who have received 1.25 million text alerts, as of Feb. 5.
Can I show up at a vaccination site without an appointment to wait for someone to miss their scheduled time?
No, Tulsa Health Department and other sites say those without appointments are not welcome at known vaccination sites. THD says if someone does miss their appointment, those shots may be offered to first-responders in the area who have not been able to get vaccinated yet.
What happens if I am unable to make my scheduled appointment? Can it be changed?
Asking that residents strive to keep their bookings as time slots are in high demand, the state has said that those who miss their scheduled time will need to make a new appointment. Cancellations or scheduling changes can be made through the portal. “There’s been some difficulty with that,” Spohn said. “Sometimes you have to wait 24 hours to be able to get back in and redirect your appointment because it locks up. … That’s among fixes we’re working on on our end.”
At what point do I schedule my second dose or "booster shot"?
The answer seems to change depending on which site a patient received their first dose.
Second-dose appointments may be scheduled at the time of the first shot. It is not required to schedule booster doses through the portal. “Follow the instructions given when you got your first shot,” OSDH Deputy Commissioner Keith Reed said.
Second-dose appointments may also be made via the state portal, and users will be asked whether they need the Pfizer or Moderna shot. Some clinics have had scheduling issues for second doses, Spohn said, so officials are working to ensure those sites aren’t filling up with only first-dose appointments.
Tulsa Health Department says: “You are able to walk in for your second dose without an appt, provided you come at the same time as your first dose. Must bring your vaccination card with you.” Director Bruce Dart said those who got a Pfizer vaccine through Tulsa Health Department should try to come back to the same site 21 days after the prime dose; those who got Moderna should walk back into the same site 28 days after.
In Wagoner County, second-dose appointments cannot be made until one week before the patient is due for the booster shot.
I can't get an appointment for my booster dose when I am supposed to — is it OK to take it any later?
Those concerned about getting appointments exactly 21 or 28 days after their first dose don’t need to worry; if you’re a little late, it doesn’t cause you to have to restart the shots. You may just take a few more days to reach 95% immunity.
The state says it may take longer for second-dose appointments to show up in the system as those cannot be entered into the system weeks in advance. Because the timing of booster doses means a three- or four-week delay, those scheduling their booster dose via the online portal are told not expect to set the schedule right after the prime dose.
Can I choose whether I receive a Moderna or Pfizer shot?
Some clinics have both Pfizer and Moderna available, but basically it’s whatever is available at the time of the appointment at the site.
Will I be able to drive-through to get my vaccination or will I have to go inside a facility?
Mindy Spohn said the state is trying at each location to help patients with accessibility issues to be able to drive-through. “The problem with drive-throughs … it does limit our throughput because you have a 15-minute observation period.” She said some sites may have found ways to offer drive-through with observation, "but their ability to reach large numbers is limited because of that."
If I have already had COVID-19, do I still need to consider getting the vaccine?
The short answer is yes. Dr. Jennifer Clark, who leads Project ECHO’s COVID-19 data sessions, said the human body’s natural immunity isn’t fully reliable and can be erratic. She said the response a person’s body will have from the vaccine will be more reliable and robust relative to the body’s natural immune response. Monks recommends waiting 90 days after recovering, especially if those who received monoclonal antibodies or convalescent plasma.
Do I still need to practice the three W’s after getting my vaccination?
Yes, it is vital for Oklahomans to continue to wear masks, wash their hands and watch their distance even after being vaccinated. The vaccine effectively protects recipients, but recipients may still be able to spread the virus to others. The CDC has not yet determined if or when it will stop recommending that people wear masks and avoid close contact with others to help prevent community spread.
Can you be a carrier of the virus after receiving a vaccination?
"We have to assume the answer is yes, you can. In other infectious diseases, this happens pretty commonly, though in others it does not. It won’t be known for another few months as we’ve gotten lots of people vaccinated and then tested with viral swabs," Oklahoma Medical Research Foundation President Dr. Stephen Prescott said.
Why do I have to wait 15 minutes before being able to leave after my vaccination, and what side effects are common?
Any adverse reaction that could endanger the patient's health should be evident within 15 minutes, so those receiving the vaccine must agree to observation during that time. Dr. George Monks, president of the Oklahoma State Medical Association, said possible side effects include mild pain or swelling at the injection site, true of any medicine injected into skin. Other possible side effects include mild fever, chills, tiredness and headache. Monks said side effects are almost always mild and are more common in younger people or when receiving the boost dose. Monks said one can think of the symptoms as a sign that the vaccine is working.
How many vaccine doses have gone to waste in Oklahoma?
State officials say there is no problem with expiring vaccines; doses arriving each week are already scheduled to be distributed the following week. “We don’t have any vaccine that’s sitting on the shelf,” says deputy OSDH commissioner Keith Reed. On Feb. 9, he said only 247 cumulative doses had been wasted due to broken or leading needles and vials.
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Corey Jones
Staff Writer
I am a general assignment reporter who predominately writes about public health, public safety and justice reform. I'm in journalism to help make this community, state, country and, ultimately, world a better place.
