Credit: (Courtesy of Michelle Edelstein)

As New Jersey and other parts of the country continue to experience a surge in COVID-19 cases, many people initially infected by the disease continue to live with lingering symptoms.

Known as “long COVID,” these symptoms can include respiratory, neurological, psychological and cardiac problems that some people experience four or more weeks after an initial infection by SARS-CoV-2, the virus that causes COVID-19, according to Yale Medicine. The symptoms, which may last for weeks, months, or years, can be new — meaning they were not present initially but developed later — or persistent, which means they developed during an acute COVID-19 illness and haven’t gone away. Additionally, symptoms can be recurrent, which means they went away after an initial illness and then returned, according to Yale Medicine.

Long COVID can range in severity from mild to debilitating. Some people report that their symptoms prevent them from returning to work or school, while others have difficulty performing everyday chores or even walking short distances.

An estimated 17 million adults in the U.S. have long COVID, according to an April report from the Kaiser Family Foundation. Among adults with long COVID, 79% reported having activity limitations due to the disease and 25% reported that long COVID limited their activities “a lot,” according to the report. Additionally, long COVID is most common among adults who are transgender or who have disabilities, groups that already experience greater difficulties in accessing health care, according to the report.

NJ Spotlight News spoke with Dr. Perry N. Halkitis, dean of the Rutgers School of Public Health, about common mental health conditions associated with long COVID and how loved ones and employers can better support people suffering from the disease. This conversation has been edited for length and clarity.

NJ Spotlight News: With the surge in COVID-19 cases this summer, can you explain the symptoms of long COVID and the impact those symptoms have on people over time?

Dr. Perry N. Halkitis:  The surge we’re seeing right now, which we’re seeing pretty much around the world above the equator, is potentially tied to long COVID. I want to make that point early on because I think that at least one of the hypotheses about long COVID is that people who get infected more than one time … are more likely to develop symptoms. Let’s just start there by saying that getting infected multiple times [is] potentially a problem for long COVID.

Long COVID is a cluster … of physiological and psychiatric symptoms that manifest for a person after they’ve been infected and usually exist for periods of time from four weeks on [and] indefinitely for some people. Some of the symptoms include … fatigue and feeling tired, weakness, brain fog, headaches, … some cardiovascular stuff like rapid heartbeat [and] dizziness upon standing … cough, chest pains, shortness of breath. It’s usually a constellation of these things happening together. And just to put it very simply, a person doesn’t feel like their “normal selves” in terms of their health.

With long COVID, it’s not so dissimilar from people with other chronic diseases like multiple sclerosis, or HIV (human immunodeficiency virus), or what have you. Often having to deal with those debilitating effects of those diseases, and again those can be managed to some extent, but a person is not functioning in their complete one-hundred-percent normal self. They are going to have impacts on that person’s … mental health, their social health, for sure. And those are going to intersect with each other and potentially make the situation even worse.

NJSN: What are some common mental health symptoms that could come from having long COVID and how could those symptoms impact people who have the illness and their loved ones?

PH: Anxiety and depression for sure, cognitive impairment and brain fog. We hear that a lot from people who are experiencing long COVID. Some people have indicated, about 20%, some kind of OCD [obsessive-compulsive disorder], although it’s not clear if the long COVID causes the OCD or this is probably people who have obsessive-compulsive disorder that’s not managed [and] that’s made worse by having long COVID. Sleep disorders, PTSD (post-traumatic stress disorder), potential substance use disorders.

Substance use doesn’t happen in a vacuum. People are living in conditions that are problematic, [or] they feel really sick and they have a lot of pain, they turn to substances to alleviate those things. Long COVID-19 could be one of those situations that … creates situations where people seek out substances just to mask the feelings they’re having from their long COVID. So, uncontrolled, unbridled, continued use of substances can lead to substance use disorders. Those are just some of the mental health issues that people experience. And again, not just one, but probably some combination of those things.

NJSN: What more needs to be done to address long COVID symptoms and their mental health impact here in New Jersey?

PH: New Jersey is a leader when it comes to COVID-19 and it has been a leader for a very long time, from the very beginning of the pandemic. Nonetheless, when we think about long COVID,  there’s this tendency to think about, ‘Oh, there’s the physical and then there’s the mental.’ And what I think needs to happen is a better understanding that these things are not separate from each other. Just because you’re having heart palpitations doesn’t mean you’re not depressed. So creating programs that marry the two is critically important. I’m not just saying that [for] New Jersey, I’m saying that for the world.

Number two, I think always more research is needed. The thing that has to happen is continuing to follow people who have these symptoms, try and understand how it manifests [and] try and understand how they’re managing it.

Number three is the prevention piece, which is this. I said earlier in our conversation that having COVID many times may be one of the reasons that people actually develop long COVID. So, what we want to do is make sure people do not get long COVID and how do you prevent that? Well, you prevent people from getting sick again. How do you prevent people from getting sick again? Continuing to stay updated on your vaccinations.

NJSN: How can loved ones and workplaces better support people who are suffering from the mental health impacts of long COVID here in New Jersey?

PH: Empathy is always the key to success both in terms of care and in terms of prevention. [It is] very important for loved ones to not dismiss the psychological issues that people are facing.

Number two — preventing the person from being isolated. I don’t care if the person has long COVID, or HIV, or multiple sclerosis, or complicated diabetes or any other chronic disease, you don’t want those people to be alone. Or just living in the heat, for example, like so many elderly people do. Socializing with those people, checking in with them is incredibly, incredibly important.

Legislators can work with local businesses and larger companies within our state and also in other parts of the country to get them to recognize that these symptoms are real — they’re not fictitious. They’re not people making excuses for not coming to work. And start to acknowledge and make some accommodations for people who are having long COVID symptoms.