June 2, 2025 • 29 mins
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
Pharmacist Members, REDEEM YOUR CPE HERE!
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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.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:07):
Hey, ce Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, and, as always, I'm super excited
about our conversation today.
Long COVID is leaving millionsof patients with lingering
symptoms that disrupt daily life, yet many struggle to find
effective treatment and support.
In this episode, we'll discusshow pharmacists can help
(00:30):
identify patients with longCOVID, recommend symptom
management strategies and play akey role in improving their
long-term health.
And it's so great to have DanMajerzyk with us today for our
guest for today's episode.
Dan, welcome.
Thanks for joining us, hi.
Speaker 2 (00:45):
Josh, thanks so much.
Thanks for having me.
I'm Dan Majerzyk.
I'm an associate professor ofclinical sciences and chair of
teaching and academic excellenceat Roosevelt University College
of Science, health and Pharmacyhere in Schaumburg, illinois.
I also serve as a clinicalpharmacy specialist with Loyola
Medicine's McNeil FamilyMedicine Residency Program and
(01:08):
I'm really honored to join youfor this discussion of long
COVID today.
It's a complex, evolvingcondition that really continues
to affect millions of people andmany of whom are still
searching for answers, supportand, most importantly, relief.
Speaker 1 (01:24):
Yeah yeah, no, it's importantly relief.
Yeah, yeah, no, it's great.
Thanks, we really appreciateyou taking time out of your
apparent busy schedule.
It sounds like you wear manyhats, so we really appreciate it
.
And I mean, dan, before wereally jump in, I think it's
also interesting that you knowhow often do we get a new
disease.
You know what I mean?
We don't.
(01:46):
It's very, very rare that wehave this new long-term
condition that's still so newand so unknown.
So I think this is just itreally kind of adds to the
mystery of it all, the fact thatthere's still so much that
we're learning and so manythings that are going on.
So I think, in my opinion,that's what makes this topic so
fascinating is because it'salmost like discovery every day,
(02:07):
something new every day.
So anyway, before we getstarted, I always like to make
sure that I lay the foundationfor our listeners and just to
remind them exactly what we'retalking about.
Let's take a few minutes tojust define long COVID.
What exactly is it now?
What's the prevalence?
What are we seeing happening inpatients?
Just kind of give us some ofthose foundational pillars there
.
What exactly is it now?
(02:27):
What's the prevalence?
Speaker 2 (02:28):
What are we seeing happening in patients?
Just kind of give us some ofthose foundational pillars there
.
Yeah, sure, josh.
Yeah, so you're absolutelyright about these new long
disease chronic conditions thatare kind of surfacing post our
COVID area, but specifically forlong COVID.
You know this is referred to askind of a post-acute sequelae
of that SARS, you know 2 virus.
So this long COVID reallyincludes a wide range of
(02:53):
symptoms that persist for atleast three months after the
COVID-19 infection.
These symptoms also kind of waxand wane and may be, you know,
relapsing or ongoing.
The statistics so you know CDCreports roughly around you know
7 to 8% of US adults or aroundyou know 17 to 18 million people
(03:17):
are living with long COVIDthese days.
Speaker 1 (03:20):
Wow, that's quite significant.
Yeah, so, and this may not beknown as far as like specific
data points or whatever, but arewe seeing it with patients that
had in, patients that have hadit a while back initially, but
it is still ongoing in anyonethroughout this kind of a span,
(04:03):
throughout this kind of a spanof health?
So the current strain thatwe're seeing of COVID is not
like better, in a sense, thatit's not giving us long COVID.
We're still seeing that comeout.
We're still seeing all of that.
Yeah Well, let's talk a littlebit about what are some of those
symptoms and affected systemsthat we're seeing with long
COVID.
So, when a patient is stated tohave long COVID, what's
(04:24):
happening?
What are we seeing?
Speaker 2 (04:27):
Absolutely so.
Some of the symptoms arefatigue, brain fog.
One unique one that we may haveheard of before is anosmia, or
loss of smell, headaches,neurologic pain.
Loss of smell, headaches,neurologic pain and even
respiratory and cardiovascularsymptoms.
(04:48):
So those are pretty significantand all of them can happen at
the same time as well, notnecessarily just one singled out
symptom.
Speaker 1 (05:02):
Yeah, cause you know, when you started off with
fatigue and brain fog, I wasraising my hand on those.
So maybe, maybe I need to bechecked out, or I think.
That's just in general, butyeah, so when you talk about
cardiovascular effects, are wetalking about, like, are we
affecting blood pressure, heartrate, like what?
What sort of things are weseeing with the cardiovascular
effects?
Speaker 2 (05:22):
Yeah, so all of those , josh, that those are
absolutely a lot moreexacerbations difficulty
breathing, you know,dysregulated blood pressure, you
know being out of breath,shortness of breath, a lot of, a
lot of those.
You know those symptoms thatyou know we're seeing typically,
(05:45):
you know, are patients withrespiratory and cardiovascular
problems.
Speaker 1 (05:50):
Sure, sure, and like I said, you know I was joking,
but those symptoms they do seemgeneral, right, like those are
things that patients may beexperiencing regardless.
So how do we kind of?
Do we just kind of track backand say have you had COVID, when
did you have it?
Like, how are we saying thatthe fatigue and the brain fog
(06:12):
and the hypertension is longCOVID, as opposed to just these
are things that this patient isexperiencing.
Speaker 2 (06:19):
Josh, let me take a step back and I'll tell you a
little bit about, kind of like,the behind the mechanisms of
some of this.
So, from the neurologicalperspective, over 80% of the
patients report some of thecognitive impairment associated
with long COVID.
So memory issues, difficultyconcentrating, even exercise
(06:45):
functioning is diminished inthese patients, and that's also
where that respiratory,cardiovascular component of
symptoms comes in.
But in terms of these cognitivedysfunction systems, we have
what we call neuroinflammation.
That's happening and this isdue to the cytokines,
(07:05):
specifically interleukin-6 andTGF-beta.
They really interfere with theway that neurons communicate and
so, for example, tgf-betaregulates immune responses, but
when it is elevated chronicallyit contributes actually to
inflammation and scarring.
(07:27):
So lots of different stuffhappening in the background that
we may not even be thinkingabout.
Speaker 1 (07:35):
Sure and that cytokine surge is a direct
correlation to COVID-19infection.
Correct Right right.
Speaker 2 (07:45):
On the other hand, vegf, or vascular endothelial
growth factor, also plays reallya big role in altering blood
flow in the brain and then thatis thought to further, you know,
worsen inflammation.
So this kind of an inflammatoryenvironment with neuronal kind
(08:07):
of signaling now being impairedbecause of the level of
information in that environment.
This is where the cognitiveissues are kind of arising.
Interesting, that's with that,yeah.
So can I say a little bit moreabout the loss of smell?
Yeah, no, that'd be great.
Yeah, let's do it.
(08:27):
Yeah, so the loss of smell, orthe anosmia, is really
persistent and really persistentloss of smell, and it's yet
another quite common symptom oflong COVID and it's truly not
due to the residual virus butrather that again,
pro-inflammatory environment inthe olfactory epithelium and
(08:52):
that increases the T cells andwith kind of that reduced
anti-inflammatory macrophages,interfere with our sensory
neuron generation and we can'treally smell how we used to or
at all, which is, I think,pretty bad.
Speaker 1 (09:09):
Terrible.
That, to me, is.
Thank goodness that is not aside effect I had when I was
infected with COVID.
Because I don't know, smell.
To me it just is so importantbecause it brings back, it's
directly attached to so manymemories and just, yeah, I just,
I don't know, I really I can'timagine not having the ability
(09:32):
to smell for a long period oftime.
Like, I just think that isterrible.
Obviously, some of these otherside effects are also terrible
as well, but to me the anosmiais just, it's just right up
there.
To me, the anosmia is just,it's just right up there.
So I guess what I was kind ofgoing with.
The background information isgreat, so helpful, but like, if
you have a patient presentingwith a few things, how are we
(09:55):
really set At what point?
How do we determine like, okay,this is, this is long COVID.
Is it like you must have threeof these five or something like
that, or is it more of justreally digging into it?
And we're still learning thatprocess, josh, great point.
Speaker 2 (10:11):
I think it's a little bit of both and I would say
maybe the latter a little bitmore.
You know, we see patients thatcome in with symptoms such as
these that we just said and thatI just talked about, and often
it's puzzling.
We think, well, maybe it'sallergy season, you're fatigued
(10:35):
because you're overworked andoverstressed.
So putting those piecestogether and kind of looking at
the patient holistically andgetting their you know thorough
history about, you know theirCOVID infection, and really then
can kind of help guide whetherwe're approaching that long
(10:57):
COVID territory versus.
Is it something else?
That, or maybe a combination ofall of those things?
Speaker 1 (11:04):
Yeah, a combination of all of those things?
Sure, yeah, a combination ofall the above.
Yeah, exactly so.
Um, so I think this is a greatsegue to start talking about the
pharmacist role in all of this.
So you mentioned, you know,getting a good history and
understanding exactly whatthey're going through, asking
the right questions.
So what, what are some of theways that pharmacists can really
kind of help with that?
(11:25):
And I guess the other questionand I'll back up just briefly is
are we officially like, arepeople officially being
diagnosed with long COVID, likeis there a diagnosis code you
know like?
Or are we like you're diagnosedwith diabetes, or you know
you're diagnosed with heartdisease?
Or is it just more of stillthis whole concept of like you
(11:48):
got a lot of things going on andit seems to check the boxes and
you have long-term Josh, greatpoints.
Speaker 2 (11:53):
Yeah, let me tell you about the.
You know the pharmacist'spivotal role, I guess, in all of
this, but also from what I'mseeing in practice in terms of
the diagnosis.
I think four key opportunitiesfor pharmacists I think are here
at stake.
(12:14):
And I think earlyidentification I think asking
about that lingering fatigue,soliciting information about
sensory issues or mental fogduring either counseling
sessions or MTM visits crucial.
And that is a opportunity whereyou are seeing, looking,
conversing with your patientsand you can really tell Right.
(12:38):
Yeah, and I kind of like namingthat experience helps patients
seek appropriate, you know, careas well.
I think the other keyopportunity is medication
management.
So really adjusting thosetherapies for chronic conditions
that kind of have beenexacerbated by long COVID is
(12:59):
crucial, is crucial.
So you know, for example, youknow and we did a little bit of
research on looking at you knowwhat other medications could
kind of worsen some symptoms.
Right, and this is a verycommon antibiotic.
You know, azithromycin.
It could actually worsen somesymptoms, believe it or not.
(13:19):
So, that was something thatwe've found really puzzling in
literature when we that wassomething that we've found
really puzzling in literaturewhen we were digging.
Interesting Third one educationand coaching.
I think teaching your patientshow to track symptoms, how to
structure, rest and kind ofmaybe pace their cognitive and
(13:41):
physical activity is alsocrucial.
Their cognitive and physicalactivity is also crucial and you
know, we as pharmacists,educators, have the opportunity
to really tap into that andreally educate our patients and
counsel our patients and coachour patients in many ways.
And just lastly, I think,collaborating with providers.
(14:01):
And I know that when I left forthe last, but specifically and
strategically, uh, you know,pharmacists, we really can
initiate referrals, coordinatecare plans and, you know, share
treatment evidence and andadvice with pcps and others.
So I think all of those arecrucial for, I think,
(14:23):
opportunities for thispharmacist to jump in.
And, yeah, it's definitely hardto diagnose and pinpoint that
one diagnosis of lung COVID,especially as these symptoms may
not be clear-cut.
Speaker 1 (14:39):
Right.
Or, like I said, you know they,just you know, seeing one or
two of them, it's like oh, youhave hypertension, oh you're
fatigued, oh you have shortnessof breath.
But really kind of being Ialways tell people and when I
taught I always told thestudents you have to be you know
that investigator, you have toreally put all the pieces
(15:01):
together, you have to be thatsleuth.
That's like asking all thequestions and putting all the
pieces together.
So I think it's more of likeit's taking a step back and
looking at the bigger picturetoo, with a patient and being
like okay, hold on a second.
They all of a sudden havehypertension, they say they have
fatigue and they have, you know, some respiratory distress.
So maybe maybe there's a biggerpicture here, Maybe it's not
(15:22):
just you know that three thingsjust happen to be simultaneously
happening.
So, okay, that was what I waswondering was you know, are we?
Is there a checklist of like?
Okay, when you reach this,you're diagnosed with long COVID
, or is it just still more of awork in progress?
Speaker 2 (15:40):
Josh, what a great observation.
Josh, what a great observation.
And honestly, this leads intosome of those, you know,
challenges that we'reencountering, not only as
pharmacists but as healthcareprofessionals.
You know, lack of thatstandardized treatment evidence.
There's nothing standardized atthe moment.
Evidence is still evolving andyou know we really it's trial
(16:07):
and error at this point.
Speaker 1 (16:08):
Yeah, and there's no medication to treat long COVID.
It's that you have to treat allthe different symptoms you know
based on what's happening.
So, yeah, while we're talkingabout the lack of standardized
treatment, I want to jump back alittle bit and dig more into,
like, the medication management,if you don't mind.
So that was an opportunity forpharmacists was to really kind
(16:30):
of focus on that medicationmanagement.
So let's talk about some of thethings that you know.
We obviously it's going to bepatient specific and we want to
be sure that we're, you know,tailoring the care that we're
offering to patients, becausenot everybody takes the same
hypertension medication, youknow.
But like what?
What have we seen?
(16:51):
What have you all seen greatsuccess with in treating certain
things?
Like, are we seeing, well, wecan get hypertension under
control, or is it one of thosethat's like we throw six drugs
at it and we still don't get itunder control?
You know, like what?
What are some of the thingsthat we're seeing success wise
as far as, like, what we canmanage with medication?
Speaker 2 (17:08):
Yeah, Josh, that's, that's really great point and a
great question.
I think one thing that we haveto also keep in mind is that
overlapping conditions andsymptoms will really mimic some
of those same symptoms of longCOVID, so that chronic fatigue,
perhaps the fibromyalgia andeven anxiety.
(17:29):
So, you know, we tend to focuson treating and managing that
one or two specific conditionsthat are kind of coexisting.
You know we're not going to be,you know, looking at throwing
seven or eight new medicationson board in addition to what
your chronic, you knowmedications are already on, you
(17:54):
know.
So I think this is again wherethat access is important.
You know, and you know patientsmay like coverage.
They, you know, may lack kindof the this, you know, access to
specialists, and again we aspharmacists here can kind of
(18:14):
jump in and play that role innavigating these systems.
Speaker 1 (18:19):
Absolutely, especially, like you mentioned,
you know, with with an MTM orwith just a general med sync
conversation, you know, likelooking to see are there any
overlaps of things?
Or, you know, is theresomewhere that we can change a
medicine or change a dose or adda combo product or something
like that?
So yeah, that's great points,okay.
(18:40):
So now back to I just wanted tobe sure that I touched on some
more of the medicationmanagement component.
So, as you mentioned, one ofthe challenges is lack of
standardized treatment.
Again, there's no long COVIDdrug that's knocking out
everything that it's throwingour way.
It is more of asymptom-specific kind of
(19:00):
management per se, based onwhatever's going on with that
patient.
So that is a challenge that wehave because, let's face it, we
love a good flow chart and adefinitive answer, right.
So we'd love to be able to sayif this happens, do this.
And so I feel like with longCOVID, that's not really
(19:22):
happening.
It's more of lots of trial anderror.
So that's one challenge that Ithink we're definitely seeing as
pharmacists.
What other challenges have yourecognized in this space?
Speaker 2 (19:32):
Yeah, Josh, you kind of made a really good point with
we love algorithms and we couldstick to them, right, that
would make our life a lot easier.
Right, that would make our lifea lot easier.
Unfortunately, other thingsthat you know that I've seen,
you know things that we do inpractice.
For example, we do a lot ofscreenings, right.
(20:00):
So we're using kind of brief,open-ended symptom questions to
kind of like solicit a goodhistory from our patients and
then we use kind of specificsymptom specific strategies as
well.
So, for example, for that lossof smell, you know there's
olfactory training that couldpotentially be used and a lot of
our clinicians recommend, youknow, where patients are exposed
to certain scents and you, youknow, once or twice a day for
(20:26):
several weeks, and you know, seeif they are regaining any kind
of a component of their sense ofsmell.
For cognitive dysfunction, youknow we're kind of recommending,
or a lot of our clinicians areintroducing cognitive pacing to
their patients.
You know, scheduling mentalbreaks, avoiding kind of
(20:46):
multitasking things that youknow, josh, you and I were
constantly doing, you know whichis a lot and even sometimes
building recovery periods intoour daily routines.
I think that's really importantand we have to be, you know,
really aware that these patientsmay not know what to do.
So those are, you know.
Those are, you know, some ofthe modalities that I've seen
(21:10):
used in practice.
Speaker 1 (21:13):
Yeah, and it may not.
It may not be commonplace forthem.
You mentioned a word and I havealready lost what.
When you were talking abouttreatment options, peace breaks
or something, what did?
Speaker 2 (21:24):
you say, oh yeah, cognitive pacing or mental
breaks.
Speaker 1 (21:30):
Okay, cognitive pacing.
I thought you said cognitivepiecing and that was gonna be
new for me and I wanted you togo deeper into that.
Okay, so cognitive pacing gotit.
But yeah, I think that that's agreat point is that, again,
while that is a challenge, in asense of like, how are we
treating it?
Because there isn't a wonderdrug that's knocking everything
(21:51):
out it's also an opportunity forpharmacists to really show our
value and to say like, hey, youknow, I have stress and fatigue
from the job and I, you know,have these moments of neurologic
, you know, issues or whateverbecause of that.
And here are things that I doand here are things that I found
(22:11):
, and so I think that that'sanother great opportunity for us
to really kind of jump in withtreatment options.
I'll use quotes around thatbecause, you know, we're not a
psychologist or anything likethat, but still there are
modalities, like you mentioned,that can kind of help with that.
Speaker 2 (22:26):
And Josh, I have a couple more pharmacological
options that I can share withyou.
Yes, please do.
Yes.
So, specifically for brain fog,you know there's some research
out there that NAC orN-acetylcysteine could
potentially be a good option,especially as it reduces
oxidative stress.
Guanfacine is another one.
(22:48):
Improves focus kind of byworking on norepinephrine and
modulating that.
For headaches, we have ourtraditional NSAIDs or
acetaminophen, but for chronicmaybe headaches or migraines,
you could consider, you know,TCAs and then kind of like
neuropathic pain, you know youcould think about SNRIs or
(23:14):
things along those lines,especially if there's any
coexisting depression oranything like that.
Speaker 1 (23:19):
So we're seeing a lot of those utilized as well.
Or anxiety.
I mean, sometimes you might canhit multiple births.
Yeah, yeah, yeah, sounds good,okay.
So another challenge then thatyou know, obviously we see is
access to care and resources,access to the information.
(23:39):
Again, that's why it's soimportant for pharmacists to be
in this space, because we arethe most accessible healthcare
you know provider out there andso you know referrals and
coverage options and justeducation in general.
So I think if you can kind ofspeak to that and maybe how
you're seeing some of thosechallenges overcome, that'd be
(24:01):
great, josh.
Speaker 2 (24:02):
A lot of it is, you know, unfortunately, and you
know I have students onrotations with me and I'm very
lucky enough to have a partnerat my site too.
That helps me.
But a lot of what we do isactually look at formulary,
seeing what is covered ahead oftime, so that we can be really
proactive.
(24:22):
So when we're going in for thatpatient visit and making a
recommendation, we've alreadykind of looked at the patient's
formulary ahead of time and knowmaybe what we want to recommend
at some point or can quicklylook it up.
Otherwise, again, it's a missedopportunity because patients
will go to the pharmacy, pick upthe medication it may be a
(24:43):
really high copay or not coveredand then we're back to kind of
square one and then we may losethat patient.
Speaker 1 (24:49):
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 notgoing to do that, so forget it.
Speaker 2 (24:57):
So that's a big one um, and you know, trying to
coordinate referrals and um, youknow, looking to see where else
we could potentially uh, youknow refer patients.
What else is covered on thereas part of their insurance as
well?
Speaker 1 (25:37):
no-transcript community, how you kind of make
sure that your patients aretaken care of in that way.
So if you're listening andyou're thinking about how can
you do a further outreach,consider cross-training some of
your technicians as CHWs.
You can find that informationin our catalog too, so that's
(25:59):
great.
So, dan, we're wrapping up.
I told you in the beginning Ialways tell the guests time
flies, so we're wrapping up.
Is there anything specificallythat we didn't cover?
That you feel like is superimportant for our pharmacist
listeners to hear?
Speaker 2 (26:15):
I just want to let everybody know that remember
that long COVID is complex.
It really affects the mind, thebody, the daily functioning of
everybody involved andpharmacists.
We really are uniquelypositioned to kind of bridge
that gap between evidence andpatient experience.
(26:35):
So don't forget, we'remedication experts, but also
educators, advocates and reallygood listeners.
So I'm really happy to be partof this as well.
Speaker 1 (26:50):
Yeah, no, that's great.
And again, I think I know we'vesaid it, we've alluded to it
and I think we've specificallystated it but this is also an
ongoing, evolving disease andtreatment around it, and so
there are going to be timeswhere we're frustrated as
pharmacists and providersbecause something may be new and
(27:13):
this patient may be presentingdifferent than somebody who
something worked on previouslyor you know whatever.
So I think it's also key tounderstand that.
You know this is not as easy.
As you know, 6 million peoplehave been cured of this by
taking this and that and youknow doing these steps.
So I guess what I'm trying toget at is it's okay if you have
(27:35):
frustrating moments when you'retrying to treat your patients
and help your patients who havelong COVID, because it is such
an evolving disorder.
You know that we're still alllearning about it.
So, yeah, yeah, well, dan, Iguess I'm assuming that I didn't
officially encapsulate it, butwhat would you say?
(27:55):
You gave some great send-offpoints there.
What would you define as theactual game changer here?
Like, what is the game changerfor long COVID in this?
Speaker 2 (28:04):
space backed by evidence, that is truly powerful
, I think.
Ask the extra question, offerthe small insight and start the
hard kind of conversations.
I think all of this is becauseoften we, as pharmacists, were
the first person to believe inthe patient.
Speaker 1 (28:27):
Yeah, yeah, I love that empathy backed with
evidence.
I'm gonna have to play off thatand create a course or
something.
I'll give you credit back forit, but I love that.
That's great, is it or isn't ita thing?
(28:53):
And how are we treating it andwhat's happening?
And so I think it's reallyimportant that we're talking
about it and giving it time,because it is really affecting
our patients and we need to makesure that we're there for them.
So thank you again, dan.
This has been great.
Josh, thank you for having me.
Yeah, if you're a CE plansubscriber, be sure to claim
your CE credit for this episodeof Game Changers by logging in
at ceimpactcom.
(29:14):
And, as always, have a greatweek and keep learning.
I can't wait to dig intoanother game-changing topic with
you all again next week.
Hey, ce Impact subscribers, Welcome to the Game
Changers Clinical Conversationspodcast.
I'm your host, josh Kinsey, and, as always, I'm super excited
about our conversation today.
Long COVID is leaving millionsof patients with lingering
symptoms that disrupt daily life, yet many struggle to find
effective treatment and support.
In this episode, we'll discusshow pharmacists can help
(00:30):
identify patients with longCOVID, recommend symptom
management strategies and play akey role in improving their
long-term health.
And it's so great to have DanMajerzyk with us today for our
guest for today's episode.
Dan, welcome.
Thanks for joining us, hi.
Speaker 2 (00:45):
Josh, thanks so much.
Thanks for having me.
I'm Dan Majerzyk.
I'm an associate professor ofclinical sciences and chair of
teaching and academic excellenceat Roosevelt University College
of Science, health and Pharmacyhere in Schaumburg, illinois.
I also serve as a clinicalpharmacy specialist with Loyola
Medicine's McNeil FamilyMedicine Residency Program and
(01:08):
I'm really honored to join youfor this discussion of long
COVID today.
It's a complex, evolvingcondition that really continues
to affect millions of people andmany of whom are still
searching for answers, supportand, most importantly, relief.
Speaker 1 (01:24):
Yeah yeah, no, it's importantly relief.
Yeah, yeah, no, it's great.
Thanks, we really appreciateyou taking time out of your
apparent busy schedule.
It sounds like you wear manyhats, so we really appreciate it
.
And I mean, dan, before wereally jump in, I think it's
also interesting that you knowhow often do we get a new
disease.
You know what I mean?
We don't.
(01:46):
It's very, very rare that wehave this new long-term
condition that's still so newand so unknown.
So I think this is just itreally kind of adds to the
mystery of it all, the fact thatthere's still so much that
we're learning and so manythings that are going on.
So I think, in my opinion,that's what makes this topic so
fascinating is because it'salmost like discovery every day,
(02:07):
something new every day.
So anyway, before we getstarted, I always like to make
sure that I lay the foundationfor our listeners and just to
remind them exactly what we'retalking about.
Let's take a few minutes tojust define long COVID.
What exactly is it now?
What's the prevalence?
What are we seeing happening inpatients?
Just kind of give us some ofthose foundational pillars there
.
What exactly is it now?
(02:27):
What's the prevalence?
Speaker 2 (02:28):
What are we seeing happening in patients?
Just kind of give us some ofthose foundational pillars there
.
Yeah, sure, josh.
Yeah, so you're absolutelyright about these new long
disease chronic conditions thatare kind of surfacing post our
COVID area, but specifically forlong COVID.
You know this is referred to askind of a post-acute sequelae
of that SARS, you know 2 virus.
So this long COVID reallyincludes a wide range of
(02:53):
symptoms that persist for atleast three months after the
COVID-19 infection.
These symptoms also kind of waxand wane and may be, you know,
relapsing or ongoing.
The statistics so you know CDCreports roughly around you know
7 to 8% of US adults or aroundyou know 17 to 18 million people
(03:17):
are living with long COVIDthese days.
Speaker 1 (03:20):
Wow, that's quite significant.
Yeah, so, and this may not beknown as far as like specific
data points or whatever, but arewe seeing it with patients that
had in, patients that have hadit a while back initially, but
it is still ongoing in anyonethroughout this kind of a span,
(04:03):
throughout this kind of a spanof health?
So the current strain thatwe're seeing of COVID is not
like better, in a sense, thatit's not giving us long COVID.
We're still seeing that comeout.
We're still seeing all of that.
Yeah Well, let's talk a littlebit about what are some of those
symptoms and affected systemsthat we're seeing with long
COVID.
So, when a patient is stated tohave long COVID, what's
(04:24):
happening?
What are we seeing?
Speaker 2 (04:27):
Absolutely so.
Some of the symptoms arefatigue, brain fog.
One unique one that we may haveheard of before is anosmia, or
loss of smell, headaches,neurologic pain.
Loss of smell, headaches,neurologic pain and even
respiratory and cardiovascularsymptoms.
(04:48):
So those are pretty significantand all of them can happen at
the same time as well, notnecessarily just one singled out
symptom.
Speaker 1 (05:02):
Yeah, cause you know, when you started off with
fatigue and brain fog, I wasraising my hand on those.
So maybe, maybe I need to bechecked out, or I think.
That's just in general, butyeah, so when you talk about
cardiovascular effects, are wetalking about, like, are we
affecting blood pressure, heartrate, like what?
What sort of things are weseeing with the cardiovascular
effects?
Speaker 2 (05:22):
Yeah, so all of those , josh, that those are
absolutely a lot moreexacerbations difficulty
breathing, you know,dysregulated blood pressure, you
know being out of breath,shortness of breath, a lot of, a
lot of those.
You know those symptoms thatyou know we're seeing typically,
(05:45):
you know, are patients withrespiratory and cardiovascular
problems.
Speaker 1 (05:50):
Sure, sure, and like I said, you know I was joking,
but those symptoms they do seemgeneral, right, like those are
things that patients may beexperiencing regardless.
So how do we kind of?
Do we just kind of track backand say have you had COVID, when
did you have it?
Like, how are we saying thatthe fatigue and the brain fog
(06:12):
and the hypertension is longCOVID, as opposed to just these
are things that this patient isexperiencing.
Speaker 2 (06:19):
Josh, let me take a step back and I'll tell you a
little bit about, kind of like,the behind the mechanisms of
some of this.
So, from the neurologicalperspective, over 80% of the
patients report some of thecognitive impairment associated
with long COVID.
So memory issues, difficultyconcentrating, even exercise
(06:45):
functioning is diminished inthese patients, and that's also
where that respiratory,cardiovascular component of
symptoms comes in.
But in terms of these cognitivedysfunction systems, we have
what we call neuroinflammation.
That's happening and this isdue to the cytokines,
(07:05):
specifically interleukin-6 andTGF-beta.
They really interfere with theway that neurons communicate and
so, for example, tgf-betaregulates immune responses, but
when it is elevated chronicallyit contributes actually to
inflammation and scarring.
(07:27):
So lots of different stuffhappening in the background that
we may not even be thinkingabout.
Speaker 1 (07:35):
Sure and that cytokine surge is a direct
correlation to COVID-19infection.
Correct Right right.
Speaker 2 (07:45):
On the other hand, vegf, or vascular endothelial
growth factor, also plays reallya big role in altering blood
flow in the brain and then thatis thought to further, you know,
worsen inflammation.
So this kind of an inflammatoryenvironment with neuronal kind
(08:07):
of signaling now being impairedbecause of the level of
information in that environment.
This is where the cognitiveissues are kind of arising.
Interesting, that's with that,yeah.
So can I say a little bit moreabout the loss of smell?
Yeah, no, that'd be great.
Yeah, let's do it.
(08:27):
Yeah, so the loss of smell, orthe anosmia, is really
persistent and really persistentloss of smell, and it's yet
another quite common symptom oflong COVID and it's truly not
due to the residual virus butrather that again,
pro-inflammatory environment inthe olfactory epithelium and
(08:52):
that increases the T cells andwith kind of that reduced
anti-inflammatory macrophages,interfere with our sensory
neuron generation and we can'treally smell how we used to or
at all, which is, I think,pretty bad.
Speaker 1 (09:09):
Terrible.
That, to me, is.
Thank goodness that is not aside effect I had when I was
infected with COVID.
Because I don't know, smell.
To me it just is so importantbecause it brings back, it's
directly attached to so manymemories and just, yeah, I just,
I don't know, I really I can'timagine not having the ability
(09:32):
to smell for a long period oftime.
Like, I just think that isterrible.
Obviously, some of these otherside effects are also terrible
as well, but to me the anosmiais just, it's just right up
there.
To me, the anosmia is just,it's just right up there.
So I guess what I was kind ofgoing with.
The background information isgreat, so helpful, but like, if
you have a patient presentingwith a few things, how are we
(09:55):
really set At what point?
How do we determine like, okay,this is, this is long COVID.
Is it like you must have threeof these five or something like
that, or is it more of justreally digging into it?
And we're still learning thatprocess, josh, great point.
Speaker 2 (10:11):
I think it's a little bit of both and I would say
maybe the latter a little bitmore.
You know, we see patients thatcome in with symptoms such as
these that we just said and thatI just talked about, and often
it's puzzling.
We think, well, maybe it'sallergy season, you're fatigued
(10:35):
because you're overworked andoverstressed.
So putting those piecestogether and kind of looking at
the patient holistically andgetting their you know thorough
history about, you know theirCOVID infection, and really then
can kind of help guide whetherwe're approaching that long
(10:57):
COVID territory versus.
Is it something else?
That, or maybe a combination ofall of those things?
Speaker 1 (11:04):
Yeah, a combination of all of those things?
Sure, yeah, a combination ofall the above.
Yeah, exactly so.
Um, so I think this is a greatsegue to start talking about the
pharmacist role in all of this.
So you mentioned, you know,getting a good history and
understanding exactly whatthey're going through, asking
the right questions.
So what, what are some of theways that pharmacists can really
kind of help with that?
(11:25):
And I guess the other questionand I'll back up just briefly is
are we officially like, arepeople officially being
diagnosed with long COVID, likeis there a diagnosis code you
know like?
Or are we like you're diagnosedwith diabetes, or you know
you're diagnosed with heartdisease?
Or is it just more of stillthis whole concept of like you
(11:48):
got a lot of things going on andit seems to check the boxes and
you have long-term Josh, greatpoints.
Speaker 2 (11:53):
Yeah, let me tell you about the.
You know the pharmacist'spivotal role, I guess, in all of
this, but also from what I'mseeing in practice in terms of
the diagnosis.
I think four key opportunitiesfor pharmacists I think are here
at stake.
(12:14):
And I think earlyidentification I think asking
about that lingering fatigue,soliciting information about
sensory issues or mental fogduring either counseling
sessions or MTM visits crucial.
And that is a opportunity whereyou are seeing, looking,
conversing with your patientsand you can really tell Right.
(12:38):
Yeah, and I kind of like namingthat experience helps patients
seek appropriate, you know, careas well.
I think the other keyopportunity is medication
management.
So really adjusting thosetherapies for chronic conditions
that kind of have beenexacerbated by long COVID is
(12:59):
crucial, is crucial.
So you know, for example, youknow and we did a little bit of
research on looking at you knowwhat other medications could
kind of worsen some symptoms.
Right, and this is a verycommon antibiotic.
You know, azithromycin.
It could actually worsen somesymptoms, believe it or not.
(13:19):
So, that was something thatwe've found really puzzling in
literature when we that wassomething that we've found
really puzzling in literaturewhen we were digging.
Interesting Third one educationand coaching.
I think teaching your patientshow to track symptoms, how to
structure, rest and kind ofmaybe pace their cognitive and
(13:41):
physical activity is alsocrucial.
Their cognitive and physicalactivity is also crucial and you
know, we as pharmacists,educators, have the opportunity
to really tap into that andreally educate our patients and
counsel our patients and coachour patients in many ways.
And just lastly, I think,collaborating with providers.
(14:01):
And I know that when I left forthe last, but specifically and
strategically, uh, you know,pharmacists, we really can
initiate referrals, coordinatecare plans and, you know, share
treatment evidence and andadvice with pcps and others.
So I think all of those arecrucial for, I think,
(14:23):
opportunities for thispharmacist to jump in.
And, yeah, it's definitely hardto diagnose and pinpoint that
one diagnosis of lung COVID,especially as these symptoms may
not be clear-cut.
Speaker 1 (14:39):
Right.
Or, like I said, you know they,just you know, seeing one or
two of them, it's like oh, youhave hypertension, oh you're
fatigued, oh you have shortnessof breath.
But really kind of being Ialways tell people and when I
taught I always told thestudents you have to be you know
that investigator, you have toreally put all the pieces
(15:01):
together, you have to be thatsleuth.
That's like asking all thequestions and putting all the
pieces together.
So I think it's more of likeit's taking a step back and
looking at the bigger picturetoo, with a patient and being
like okay, hold on a second.
They all of a sudden havehypertension, they say they have
fatigue and they have, you know, some respiratory distress.
So maybe maybe there's a biggerpicture here, Maybe it's not
(15:22):
just you know that three thingsjust happen to be simultaneously
happening.
So, okay, that was what I waswondering was you know, are we?
Is there a checklist of like?
Okay, when you reach this,you're diagnosed with long COVID
, or is it just still more of awork in progress?
Speaker 2 (15:40):
Josh, what a great observation.
Josh, what a great observation.
And honestly, this leads intosome of those, you know,
challenges that we'reencountering, not only as
pharmacists but as healthcareprofessionals.
You know, lack of thatstandardized treatment evidence.
There's nothing standardized atthe moment.
Evidence is still evolving andyou know we really it's trial
(16:07):
and error at this point.
Speaker 1 (16:08):
Yeah, and there's no medication to treat long COVID.
It's that you have to treat allthe different symptoms you know
based on what's happening.
So, yeah, while we're talkingabout the lack of standardized
treatment, I want to jump back alittle bit and dig more into,
like, the medication management,if you don't mind.
So that was an opportunity forpharmacists was to really kind
(16:30):
of focus on that medicationmanagement.
So let's talk about some of thethings that you know.
We obviously it's going to bepatient specific and we want to
be sure that we're, you know,tailoring the care that we're
offering to patients, becausenot everybody takes the same
hypertension medication, youknow.
But like what?
What have we seen?
(16:51):
What have you all seen greatsuccess with in treating certain
things?
Like, are we seeing, well, wecan get hypertension under
control, or is it one of thosethat's like we throw six drugs
at it and we still don't get itunder control?
You know, like what?
What are some of the thingsthat we're seeing success wise
as far as, like, what we canmanage with medication?
Speaker 2 (17:08):
Yeah, Josh, that's, that's really great point and a
great question.
I think one thing that we haveto also keep in mind is that
overlapping conditions andsymptoms will really mimic some
of those same symptoms of longCOVID, so that chronic fatigue,
perhaps the fibromyalgia andeven anxiety.
(17:29):
So, you know, we tend to focuson treating and managing that
one or two specific conditionsthat are kind of coexisting.
You know we're not going to be,you know, looking at throwing
seven or eight new medicationson board in addition to what
your chronic, you knowmedications are already on, you
(17:54):
know.
So I think this is again wherethat access is important.
You know, and you know patientsmay like coverage.
They, you know, may lack kindof the this, you know, access to
specialists, and again we aspharmacists here can kind of
(18:14):
jump in and play that role innavigating these systems.
Speaker 1 (18:19):
Absolutely, especially, like you mentioned,
you know, with with an MTM orwith just a general med sync
conversation, you know, likelooking to see are there any
overlaps of things?
Or, you know, is theresomewhere that we can change a
medicine or change a dose or adda combo product or something
like that?
So yeah, that's great points,okay.
(18:40):
So now back to I just wanted tobe sure that I touched on some
more of the medicationmanagement component.
So, as you mentioned, one ofthe challenges is lack of
standardized treatment.
Again, there's no long COVIDdrug that's knocking out
everything that it's throwingour way.
It is more of asymptom-specific kind of
(19:00):
management per se, based onwhatever's going on with that
patient.
So that is a challenge that wehave because, let's face it, we
love a good flow chart and adefinitive answer, right.
So we'd love to be able to sayif this happens, do this.
And so I feel like with longCOVID, that's not really
(19:22):
happening.
It's more of lots of trial anderror.
So that's one challenge that Ithink we're definitely seeing as
pharmacists.
What other challenges have yourecognized in this space?
Speaker 2 (19:32):
Yeah, Josh, you kind of made a really good point with
we love algorithms and we couldstick to them, right, that
would make our life a lot easier.
Right, that would make our lifea lot easier.
Unfortunately, other thingsthat you know that I've seen,
you know things that we do inpractice.
For example, we do a lot ofscreenings, right.
(20:00):
So we're using kind of brief,open-ended symptom questions to
kind of like solicit a goodhistory from our patients and
then we use kind of specificsymptom specific strategies as
well.
So, for example, for that lossof smell, you know there's
olfactory training that couldpotentially be used and a lot of
our clinicians recommend, youknow, where patients are exposed
to certain scents and you, youknow, once or twice a day for
(20:26):
several weeks, and you know, seeif they are regaining any kind
of a component of their sense ofsmell.
For cognitive dysfunction, youknow we're kind of recommending,
or a lot of our clinicians areintroducing cognitive pacing to
their patients.
You know, scheduling mentalbreaks, avoiding kind of
(20:46):
multitasking things that youknow, josh, you and I were
constantly doing, you know whichis a lot and even sometimes
building recovery periods intoour daily routines.
I think that's really importantand we have to be, you know,
really aware that these patientsmay not know what to do.
So those are, you know.
Those are, you know, some ofthe modalities that I've seen
(21:10):
used in practice.
Speaker 1 (21:13):
Yeah, and it may not.
It may not be commonplace forthem.
You mentioned a word and I havealready lost what.
When you were talking abouttreatment options, peace breaks
or something, what did?
Speaker 2 (21:24):
you say, oh yeah, cognitive pacing or mental
breaks.
Speaker 1 (21:30):
Okay, cognitive pacing.
I thought you said cognitivepiecing and that was gonna be
new for me and I wanted you togo deeper into that.
Okay, so cognitive pacing gotit.
But yeah, I think that that's agreat point is that, again,
while that is a challenge, in asense of like, how are we
treating it?
Because there isn't a wonderdrug that's knocking everything
(21:51):
out it's also an opportunity forpharmacists to really show our
value and to say like, hey, youknow, I have stress and fatigue
from the job and I, you know,have these moments of neurologic
, you know, issues or whateverbecause of that.
And here are things that I doand here are things that I found
(22:11):
, and so I think that that'sanother great opportunity for us
to really kind of jump in withtreatment options.
I'll use quotes around thatbecause, you know, we're not a
psychologist or anything likethat, but still there are
modalities, like you mentioned,that can kind of help with that.
Speaker 2 (22:26):
And Josh, I have a couple more pharmacological
options that I can share withyou.
Yes, please do.
Yes.
So, specifically for brain fog,you know there's some research
out there that NAC orN-acetylcysteine could
potentially be a good option,especially as it reduces
oxidative stress.
Guanfacine is another one.
(22:48):
Improves focus kind of byworking on norepinephrine and
modulating that.
For headaches, we have ourtraditional NSAIDs or
acetaminophen, but for chronicmaybe headaches or migraines,
you could consider, you know,TCAs and then kind of like
neuropathic pain, you know youcould think about SNRIs or
(23:14):
things along those lines,especially if there's any
coexisting depression oranything like that.
Speaker 1 (23:19):
So we're seeing a lot of those utilized as well.
Or anxiety.
I mean, sometimes you might canhit multiple births.
Yeah, yeah, yeah, sounds good,okay.
So another challenge then thatyou know, obviously we see is
access to care and resources,access to the information.
(23:39):
Again, that's why it's soimportant for pharmacists to be
in this space, because we arethe most accessible healthcare
you know provider out there andso you know referrals and
coverage options and justeducation in general.
So I think if you can kind ofspeak to that and maybe how
you're seeing some of thosechallenges overcome, that'd be
(24:01):
great, josh.
Speaker 2 (24:02):
A lot of it is, you know, unfortunately, and you
know I have students onrotations with me and I'm very
lucky enough to have a partnerat my site too.
That helps me.
But a lot of what we do isactually look at formulary,
seeing what is covered ahead oftime, so that we can be really
proactive.
(24:22):
So when we're going in for thatpatient visit and making a
recommendation, we've alreadykind of looked at the patient's
formulary ahead of time and knowmaybe what we want to recommend
at some point or can quicklylook it up.
Otherwise, again, it's a missedopportunity because patients
will go to the pharmacy, pick upthe medication it may be a
(24:43):
really high copay or not coveredand then we're back to kind of
square one and then we may losethat patient.
Speaker 1 (24:49):
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 notgoing to do that, so forget it.
Speaker 2 (24:57):
So that's a big one um, and you know, trying to
coordinate referrals and um, youknow, looking to see where else
we could potentially uh, youknow refer patients.
What else is covered on thereas part of their insurance as
well?
Speaker 1 (25:37):
no-transcript community, how you kind of make
sure that your patients aretaken care of in that way.
So if you're listening andyou're thinking about how can
you do a further outreach,consider cross-training some of
your technicians as CHWs.
You can find that informationin our catalog too, so that's
(25:59):
great.
So, dan, we're wrapping up.
I told you in the beginning Ialways tell the guests time
flies, so we're wrapping up.
Is there anything specificallythat we didn't cover?
That you feel like is superimportant for our pharmacist
listeners to hear?
Speaker 2 (26:15):
I just want to let everybody know that remember
that long COVID is complex.
It really affects the mind, thebody, the daily functioning of
everybody involved andpharmacists.
We really are uniquelypositioned to kind of bridge
that gap between evidence andpatient experience.
(26:35):
So don't forget, we'remedication experts, but also
educators, advocates and reallygood listeners.
So I'm really happy to be partof this as well.
Speaker 1 (26:50):
Yeah, no, that's great.
And again, I think I know we'vesaid it, we've alluded to it
and I think we've specificallystated it but this is also an
ongoing, evolving disease andtreatment around it, and so
there are going to be timeswhere we're frustrated as
pharmacists and providersbecause something may be new and
(27:13):
this patient may be presentingdifferent than somebody who
something worked on previouslyor you know whatever.
So I think it's also key tounderstand that.
You know this is not as easy.
As you know, 6 million peoplehave been cured of this by
taking this and that and youknow doing these steps.
So I guess what I'm trying toget at is it's okay if you have
(27:35):
frustrating moments when you'retrying to treat your patients
and help your patients who havelong COVID, because it is such
an evolving disorder.
You know that we're still alllearning about it.
So, yeah, yeah, well, dan, Iguess I'm assuming that I didn't
officially encapsulate it, butwhat would you say?
(27:55):
You gave some great send-offpoints there.
What would you define as theactual game changer here?
Like, what is the game changerfor long COVID in this?
Speaker 2 (28:04):
space backed by evidence, that is truly powerful
, I think.
Ask the extra question, offerthe small insight and start the
hard kind of conversations.
I think all of this is becauseoften we, as pharmacists, were
the first person to believe inthe patient.
Speaker 1 (28:27):
Yeah, yeah, I love that empathy backed with
evidence.
I'm gonna have to play off thatand create a course or
something.
I'll give you credit back forit, but I love that.
That's great, is it or isn't ita thing?
(28:53):
And how are we treating it andwhat's happening?
And so I think it's reallyimportant that we're talking
about it and giving it time,because it is really affecting
our patients and we need to makesure that we're there for them.
So thank you again, dan.
This has been great.
Josh, thank you for having me.
Yeah, if you're a CE plansubscriber, be sure to claim
your CE credit for this episodeof Game Changers by logging in
at ceimpactcom.
(29:14):
And, as always, have a greatweek and keep learning.
I can't wait to dig intoanother game-changing topic with
you all again next week.
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