From the Guidelines
Lingering headaches, dyspnea, and fatigue are indeed common symptoms of post-viral Long COVID syndrome, as supported by recent studies 1. These symptoms often persist for weeks or months after the initial COVID-19 infection has resolved. Long COVID, also called Post-Acute Sequelae of SARS-CoV-2 infection (PASC), typically includes these symptoms along with others like brain fog, joint pain, and sleep disturbances.
Key Symptoms and Management
- Headaches, dyspnea, and fatigue are prevalent in Long COVID patients, with studies indicating a significant proportion of patients experiencing these symptoms 1.
- Management typically involves symptomatic treatment: acetaminophen or NSAIDs for headaches, pulmonary rehabilitation exercises for breathing difficulties, and pacing activities with scheduled rest periods for fatigue.
- Patients should stay hydrated, maintain good sleep hygiene, and gradually increase physical activity as tolerated.
Pathophysiology and Recommendations
The exact mechanisms behind Long COVID are still being researched, but it is believed that COVID-19 can trigger prolonged inflammation, immune system dysregulation, and possibly microscopic blood vessel damage throughout the body 1. Given the current state of knowledge, it is essential for patients experiencing persistent symptoms to consult a healthcare provider for proper evaluation, as they can develop specialized treatment plans and rule out other potential causes of these symptoms 1. This approach prioritizes the patient's morbidity, mortality, and quality of life, ensuring the best possible outcome in the management of Long COVID syndrome.
From the Research
Symptoms of Post-Viral Long COVID
- Lingering headaches, dyspnea, and fatigue are common symptoms reported by patients with post-viral long COVID 2, 3, 4.
- These symptoms can persist beyond 28 days after the initial COVID-19 infection and can fluctuate or persist and relapse and remit 2.
- The presentation of long COVID is variable, and symptoms can include abdominal pain, anosmia, chest pain, cognitive impairment, dizziness, dyspnea, fatigue, headache, insomnia, mood changes, palpitations, paresthesias, and postexertional malaise 2.
Prevalence of Symptoms
- Fatigue is a dominant feature of both acute and convalescent COVID-19, with up to 46% of patients reporting fatigue that lasts from weeks to months 3.
- Persistent fatigue was reported by a significant minority of patients, ranging from 13% to 33% at 16-20 weeks post-symptom onset 3.
- Dyspnea was most frequently reported in populations with high rates of diabetes, but at the same time in the average percentage of people with arterial hypertension 4.
- Chronic fatigue and cough were higher in populations with a high incidence of diabetes and hypertension than in other analyzed groups 4.
Management and Treatment
- Holistic treatment strategies for long COVID include discussion of pacing and energy conservation, individualized, symptom-guided, phased return to activity programs, maintaining adequate hydration and a healthy diet, and treatment of underlying medical conditions 2.
- Although several medications have been suggested for the treatment of fatigue related to long COVID, the evidence for their use is currently lacking 2.
- Ibuprofen can be used for managing COVID-19 symptoms, including fever and pain, without increasing the risk of severe disease or mortality 5, 6.