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Long COVID: Welcome!

   

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 Diagnosis Patient & Practice Management  Specialties Information for Patients

Post-acute sequelae of SARS-CoV-2 Infection, a.k.a. "Long COVID":
Persistent symptoms and/or delayed or long-term
complications beyond 4 weeks from the onset of symptoms.

Long COVID is the popular term coined by members of the public to describe how they were experiencing prolonged COVID-19 symptoms well after they were considered recovered.  "Long" refers to the unexpected length of time -- weeks to months -- these debilitating problems persist.

As our knowledge has evolved, the term long COVID is used less in the medical literature and we see more accurate and descriptive terminology.  Currently the term most frequently used in formal communications is Post-acute sequelae of COVID-19, or PASC. 

Other terms you may see:  Post COVID-19, Post-acute COVID-19 syndrome, Long-Haul COVID, Chronic COVID syndrome.

For reliable recommendations and guidelines, see the BMJ article published 22-JAN-2021, "Managing the long term effects of covid-19: summary of NICE, SIGN, and RCGP rapid guidelines.

HonorHealth librarians have created an extensive resource collection for COVID-19, including a special tab for long COVID articles.

Timeline summary of common symptoms
observed in post-acute COVID-19.  Figure from BMJ https://rdcu.be/chqr5

From Post-acute COVID-19 Syndrome, 
Nature Medicine 22-MAR-2021

  Persistent symptoms (MMWR)

  • Fatigue
  • Cough, congestion, SOB
  • Loss of taste or smell
  • Headache / body aches
  • Diarrhea / nausea
  • Chest / abdominal pain
  • Confusion

Summary of post-acute COVID-19 by organ system 

 Pulmonary

  • Dyspnea, decreased exercise capacity and hypoxia are commonly persistent symptoms and signs
  • Reduced diffusion capacity, restrictive pulmonary physiology, and ground-glass opacities and fibrotic changes on imaging have been noted at follow-up of COVID-19 survivors
  • Assessment of progression or recovery of pulmonary disease and function may include home pulse oximetry, 6MWTs, PFTs, high-resolution computed tomography of the chest and computed tomography pulmonary angiogram as clinically appropriate

 Hematologic

  • Thromboembolic events have been noted to be <5% in post-acute COVID-19 in retrospective studies
  • The duration of the hyperinflammatory state induced by infection with SARS-CoV-2 is unknown
  • Direct oral anticoagulants and low-molecular-weight heparin may be considered for extended thromboprophylaxis after risk–benefit discussion in patients with predisposing risk factors for immobility, persistently elevated D-dimer levels (greater than twice the upper limit of normal) and other high-risk comorbidities such as cancer

 Cardiovascular

  • Persistent symptoms may include palpitations, dyspnea and chest pain
  • Long-term sequelae may include increased cardiometabolic demand, myocardial fibrosis or scarring (detectable via cardiac MRI), arrhythmias, tachycardia and autonomic dysfunction
  • Patients with cardiovascular complications during acute infection or those experiencing persistent cardiac symptoms may be monitored with serial clinical, echocardiogram and electrocardiogram follow-up

 Neuropsychiatric

  • Persistent abnormalities may include fatigue, myalgia, headache, dysautonomia and cognitive impairment (brain fog)
  • Anxiety, depression, sleep disturbances and PTSD have been reported in 30–40% of COVID-19 survivors, similar to survivors of other pathogenic coronaviruses
  • The pathophysiology of neuropsychiatric complications is mechanistically diverse and entails immune dysregulation, inflammation, microvascular thrombosis, iatrogenic effects of medications and psychosocial impacts of infection

 Renal

  • Resolution of AKI during acute COVID-19 occurs in the majority of patients; however, reduced eGFR has been reported at 6 months follow-up
  • COVAN may be the predominant pattern of renal injury in individuals of African descent
  • COVID-19 survivors with persistent impaired renal function may benefit from early and close follow-up in AKI survivor clinics

 Endocrine

  • Endocrine sequelae may include new or worsening control of existing diabetes mellitus, subacute thyroiditis and bone demineralization
  • Patients with newly diagnosed diabetes in the absence of traditional risk factors for type 2 diabetes, suspected hypothalamic–pituitary–adrenal axis suppression or hyperthyroidism should undergo the appropriate laboratory testing and should be referred to endocrinology

 Gastrointestinal and hepatobiliary

  • Prolonged viral fecal shedding can occur in COVID-19 even after negative nasopharyngeal swab testing
  • COVID-19 has the potential to alter the gut microbiome, including enrichment of opportunistic organisms and depletion of beneficial commensals

 Dermatologic

  • Hair loss is the predominant symptom and has been reported in approximately 20% of COVID-19 survivors

 MIS-C

  • Diagnostic criteria: <21 years old with fever, elevated inflammatory markers, multiple organ dysfunction, current or recent SARS-CoV-2 infection and exclusion of other plausible diagnoses
  • Typically affects children >7 years and disproportionately of African, Afro-Caribbean or Hispanic origin
  • Cardiovascular (coronary artery aneurysm) and neurologic (headache, encephalopathy, stroke and seizure) complications can occur

 From Post-acute COVID-19 Syndrome, Nature Medicine 22-MAR-2021.