What is Post-Acute COVID-19 (Coronavirus Disease 2019) Syndrome?

From the Guidelines

Post-Acute COVID-19 (Coronavirus Disease 2019) Syndrome, also known as long COVID, refers to a heterogeneous disorder with persistent symptoms that continue for weeks or months after the initial COVID-19 infection has resolved, with symptoms lasting at least 2 months and not explained by an alternative diagnosis.

Definition and Symptoms

The definition of Post-Acute COVID-19 Syndrome varies, but according to the most recent and highest quality study 1, it is a condition that occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, with symptoms that last for at least 2 months that are not explained by an alternative diagnosis. Some key points about Post-Acute COVID-19 Syndrome include:

• Symptoms can emerge or persist weeks to months after recovery from COVID-19 1
• The syndrome can occur in individuals with widely varying initial presentations, ranging from asymptomatic infection to critical illness 1
• Debilitating symptoms have been reported in individuals with mild SARS-CoV-2 infection without underlying cardiopulmonary disease, resulting in declines in health status and quality of life 1

Management and Treatment

Treatment for Post-Acute COVID-19 Syndrome focuses on symptom management and gradual recovery. Some key management strategies include:

• Pacing activities and gradual exercise for fatigue, starting with 5-10 minutes of light activity daily and slowly increasing as tolerated
• Breathing exercises like diaphragmatic breathing for respiratory symptoms
• Mental exercises and establishing routines for cognitive issues
• Over-the-counter medications like acetaminophen for pain and headaches
• Practicing good sleep hygiene for sleep disturbances Medical evaluation is important to rule out other conditions and develop a personalized recovery plan. The syndrome likely results from a combination of persistent inflammation, immune system dysregulation, and organ damage from the initial infection. Most patients see gradual improvement over time, though recovery timelines vary widely from weeks to many months. It is essential to note that individuals without symptoms in the days or weeks after infection can still develop Post-Acute COVID-19 Syndrome, and details related to a patient’s acute illness can help place persistent symptoms into context and identify alternative diagnoses 1.

From the Research

Definition of Post-Acute COVID-19 Syndrome

• Post-Acute COVID-19 Syndrome, also known as post-COVID syndrome (PCS) or Long COVID, refers to symptoms persisting beyond the acute and subacute phases of COVID-19 infection 2, 3, 4, 5.
• The syndrome is characterized by a variety of persistent symptoms, including fatigue, dyspnea, brain fog, and chest pain, which can impact multiple body systems 3, 5.

Clinical Spectrum and Incidence

• The incidence of post-COVID syndrome is estimated to be around 10-35% in the general population, and up to 85% in hospitalized patients 4.
• Common symptoms include fatigue (17.5-72%), residual dyspnea (10-40%), mental problems, chest pain, and olfactory and gustatory dysfunction 4, 6.
• Patients with pre-existing comorbidities, such as hypertension and diabetes mellitus, are more likely to experience post-COVID syndrome 4.

Management and Rehabilitation

• Pulmonary rehabilitation has been suggested as a potential treatment for patients with post-COVID syndrome to improve symptoms and quality of life 2, 3.
• A short-duration pulmonary telerehabilitation program may be effective in improving exercise capacity, symptoms, and health-related quality of life in patients with post-COVID syndrome 2.
• Primary healthcare professionals play a key role in the management of patients with post-COVID syndrome, and research is needed to elucidate the pathogenesis, clinical spectrum, and prognosis of the syndrome 4.

Risks and Complications

• Patients with post-COVID syndrome are at higher risk for postoperative respiratory complications and perioperative mortality for up to seven weeks after initial illness 5.
• A cautious multidisciplinary preoperative evaluation should be performed, and perioperative care should be viewed through the prism of best practices already in use 5.