Complex Persistent Symptoms after COVID

Complex Persistent Symptoms after COVID:
A model for understanding the relationship between psychiatric and somatic symptoms and the role of prior stress and trauma.



Rebecca Hendrickson, MD, Ph.D.
Assistant Professor, Department of Psychiatry and Behavioral Sciences,
University of Washington School of Medicine
VA Northwest Mental Illness Research, Education, and Clinical Center (MIRECC) 
VA Puget Sound Health Care System

Rebecca Hendrickson MD, PhD completed her undergraduate and psychiatry training at the University of Washington in Seattle, medical school and graduate school at Washington University in St. Louis, and her research fellowship at the VA Puget Sound in Seattle.  She is now a psychiatrist in the Seattle VA PTSD clinic, and runs a research program focused on PTSD biology and treatment. Her work explores how changes in the regulation of noradrenaline and other parts of our core stress-responses systems may underlie persistent physical and cognitive/emotional symptoms after traumatic stress, as well as other types of physiologic stressors, such as TBI or medical illness. She has run several clinical studies addressing the lasting impact of the COVID-19 pandemic, including studies addressing both the biological impact of COVID-19 infection, and the impact of working during the COVID-19 pandemic on healthcare workers and first responders.

After COVID infection, 10-50% of people experience persistent symptoms such as fatigue, palpitations, insomnia, cognitive problems, and headache – often with significant associated distress and functional impairment. The exact combination of symptoms varies from person to person, and it is expected that the specific causes vary from person to person as well.  Because of this variability, the current recommendation is for an evaluation by a multidisciplinary team. This creates a demand on our medical system that far outstrips current resources, and risks exposing patients to long, complex medical evaluations whose results are hard to interpret. In addition, clinical treatment trials that mix patients with similar symptoms but different underlying causes have high failure rates.

The RECOVERY study provides a detailed assessment of the patterns of symptoms caused by high amounts of adrenergic signaling that are seen in persistent post-COVID syndrome, how they change over time, and their association with objective measures of cognition and physiology. The project provides information needed to begin clinical treatment trials using existing, well-tolerated treatments that modulate adrenergic signaling. These results may also have strong relevance to other potentially related disorders such as Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia.