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Long COVID May Affect Pilot Health

Doctors have found that some COVID-19 patients may continue to experience symptoms long after resolution of their initial infection. These “Long COVID” symptoms can be particularly troubling for pilots.

Dr. Greg Vanichkachorn, a senior aviation medical examiner (AME) and the medical director for the COVID Activity Rehabilitation Program at Mayo Clinic, noted he sees “a quite profound and unique fatigue” in many Long COVID patients. “They may take out the trash and then need to take a two-hour nap,” he explained, “or experience worsening symptoms for days after going for a short walk.”

Other COVID patients may experience headaches, tremors, coughing, shortness of breath or ringing in the ears. More severe cases may result in heart complications, lung scarring or blood clots.

“Many people also report trouble thinking clearly,” added Vanichkachorn. “They have ‘brain fog,’ difficulties with short-term memory, multitasking or finding the right word in a conversation.'”

Symptoms may also afflict otherwise healthy people, and even those who may not have experienced severe symptoms during their initial COVID-19 infection.

“We’re seeing [Long COVID in] individuals who are very active and who exercise regularly, with no other medical conditions or illnesses of note,” said Dr. Clayton Cowl, a senior AME and pulmonologist at Mayo Clinic.

Another common malady is anosmia, or lack of smell. “The FAA is obviously concerned that a pilot unable to detect smoke or other certain odors could be a safety issue,” Cowl said.

Dr. Quay Snyder, president of Aviation Medicine Advisory Service (AMAS) and aeromedical advisor for the Air Line Pilots Association International, noted “about 15” pilots have come to his organization with Long COVID symptoms. “In most cases, they’re concerned most about medical certification and aviation safety implications,” he noted.

Severe Long COVID cases, including those involving hospitalization, may involve deferral and consultations with a specialist before the AME can issue a pilot’s medical. However, “the vast majority of cases” should not pose any difficulities, Cowl said, “as long as they’re fully recovered and don’t have symptoms.”
Furthermore, most Long COVID symptoms are relatively mild and are eventually resolved. Physical and occupational therapy may help patients recover more quickly, although Vanichkachorn cautioned against overexertion.

“Patients are sick of being sick and want to immediately bounce back to normal,” he said. “That often causes worsening symptoms, and patients can get themselves stuck in this sort of vicious cycle.”

Overall statistics of the risk for developing Long COVID are favorable. Snyder noted a recent analysis of worldwide COVID-19 cases in the Journal of Infectious Disease that found “only about 1/2 to 1/3 of a percent of people who acquired COVID developed Long COVID symptoms,” with a lower percentage across North America.

“There’s a lot of doom and gloom out there, and we’re only at the very beginning of starting to scratch the surface of this condition,” Snyder concluded. “But it’s important to realize that people are still getting better slowly over the long term.”

For more information listen to the NBAA Flight Plan podcast: Pilots & Long COVID.

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