From the Guidelines
Long COVID symptoms can persist for weeks or months after the initial COVID-19 infection, and the most effective approach is to work with healthcare providers for personalized treatment plans, as research is still evolving on the most effective approaches. Common symptoms include fatigue, shortness of breath, brain fog, chest pain, joint pain, headaches, heart palpitations, and sleep problems. According to a recent study 1, there are likely multiple, potentially overlapping, causes of long COVID, including persisting reservoirs of SARS-CoV-2 in tissues, immune dysregulation, and autoimmunity.
Some key findings from recent studies include:
- Fatigue was found in 32% and cognitive impairment was found in 22% of patients with COVID-19 at 12 weeks after infection 1
- Cognitive impairments in long COVID are debilitating, at the same magnitude as intoxication at the UK drink driving limit or 10 years of cognitive ageing, and may increase over time 1
- Activation of the kynurenine pathway has been identified in long COVID, and is associated with cognitive impairment 1
- Possible mechanisms for these neuropathologies include neuroinflammation, damage to blood vessels by coagulopathy and endothelial dysfunction, and injury to neurons 1
For fatigue, pacing activities and gradually increasing exercise tolerance can help. Brain fog may improve with cognitive exercises and adequate rest. Over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) can help manage headaches and joint pain. Sleep issues might respond to good sleep hygiene practices and sometimes melatonin (1-3mg before bedtime). Breathing exercises and pulmonary rehabilitation may benefit those with respiratory symptoms.
It's essential to note that long COVID affects people differently, and research is still evolving on the most effective approaches. Therefore, working with healthcare providers to develop a personalized treatment plan is crucial. Additionally, being aware of the potential risk factors, such as female sex, type 2 diabetes, and EBV reactivation, can help identify individuals who may be more susceptible to long COVID 1.
From the Research
Long Covid Symptoms
- The symptoms of Long Covid can vary widely and may include exaggerated fatigue, diminished energy windows, postexertional malaise, cognitive impairment, dysautonomia, pain, and smell and taste alterations 2.
- A study found that hospitalized patients most frequently reported dyspnea, followed by anosmia/ageusia, fatigue, and cough, while non-hospitalized patients commonly reported cough, followed by fever and myalgia/arthralgia 3.
- Long Covid symptoms can last for months and may have a significant impact on a person's quality of life 4.
Management of Long Covid
- Current management strategies for Long Covid focus on symptom-based supportive care, including energy conservation strategies and addressing comorbidities and modifiable risk factors 2.
- A multidisciplinary approach to management is recommended, including physiatrists, primary care physicians, pulmonologists, cardiologists, psychiatrists, and other healthcare professionals 2, 3.
- Medication management for Long Covid is limited, and treatment recommendations should be delivered with humility due to the many unknowns related to the condition 2.
- Some studies suggest that selective serotonin reuptake inhibitors (SSRIs) may be used to prevent or treat Long Covid, particularly in patients with depression 5.
Diagnosis of Long Covid
- Long Covid is defined as a condition that occurs after SARS-CoV-2 infection and is present for at least 3 months as a continuous, relapsing, and remitting, or progressive disease state that affects one or more organ systems 2.
- A positive COVID-19 test during acute SARS-CoV-2 infection is not required to diagnose Long Covid, and currently, there is no single laboratory finding that is definitively diagnostic for confirming or ruling out the diagnosis of Long Covid 2.
- A holistic assessment, including a traditional history, physical examination, and additional diagnostic testing, is recommended for patients with possible Long Covid 2.