From the Guidelines
The management of long COVID should prioritize a multidisciplinary approach, focusing on symptom-specific treatments and considering physical and respiratory rehabilitation, as recommended by the most recent guidelines 1. The treatment plan should be tailored to each patient's specific symptoms, which can include fatigue, respiratory issues, cardiovascular problems, neurological symptoms, pain, and sleep disturbances. For patients with persistent respiratory symptoms at 3 months, routine blood tests, chest imaging, and pulmonary function tests are conditionally recommended 1. Other tests should be performed mainly to exclude other conditions according to symptoms. Given the limited evidence, physical and respiratory rehabilitation should be considered as part of the management plan. Additionally, treatments such as cognitive behavioral therapy for coping with symptoms, pulmonary rehabilitation exercises for respiratory symptoms, and nutritional support focusing on anti-inflammatory foods and hydration may be beneficial. It is essential to regularly monitor and adjust the treatment plan as our understanding of long COVID continues to evolve. The use of medications like beta-blockers for cardiovascular symptoms, acetaminophen or NSAIDs for pain, and melatonin for sleep disturbances may be considered on a case-by-case basis, taking into account the individual patient's needs and the potential benefits and risks of these treatments 1. Overall, the management of long COVID requires a comprehensive and individualized approach, addressing the diverse range of symptoms and focusing on improving quality of life, reducing morbidity, and minimizing mortality.
From the Research
Management of Long COVID
- Long COVID, or post-acute sequelae of COVID-19 (PASC), is a complex condition with persistent symptoms following SARS-Cov-2 infection, including fatigue, dyspnoea, cognitive impairment, and decreased quality of life 2.
- The symptoms of long COVID can vary in severity and include dyspnoea, anosmia/ageusia, fatigue, cough, fever, myalgia/arthralgia, cognitive impairment, memory loss, anxiety, and sleep disorders 3, 4.
- Potential mechanisms behind long COVID include vascular damage, immune dysregulation, and viral persistence 2.
Diagnosis and Treatment
- Diagnosing long COVID involves medical evaluation by a multidisciplinary team and assessment of persistent symptoms with scoring systems in development 2.
- Treatment strategies for long COVID are symptom-focused, encompassing multidisciplinary care, rehabilitation, and tailored exercise programmes 2, 3.
- Pulmonary rehabilitation is an effective and critical component of long COVID management, particularly for patients with respiratory symptoms such as dyspnoea, and has shown promise in improving symptoms, quality of life, and overall recovery 2, 5.
Innovative Technologies and Therapies
- Innovative technologies, such as telemedicine, wearable devices, and telerehabilitation, are transforming long COVID management by facilitating consultations and interventions, eliminating healthcare access barriers, and enabling remote and continuous monitoring of patients during their rehabilitation activities 2.
- Low Dose Naltrexone (LDN) has been explored as a potential pharmacotherapy for long COVID, with a study showing improvement in 6 of 7 parameters measured, including recovery from COVID-19, limitation in activities of daily living, energy levels, pain levels, levels of concentration, and sleep disturbance 6.
Multidisciplinary Approach
- A multidisciplinary approach is essential in the diagnosis and treatment of long COVID, involving long-term monitoring of symptoms, physical rehabilitation, mental health, and social services support 3, 4.
- Rehabilitation care plans and community healthcare plans are necessary for COVID-19 patients before discharge, and remote programmes can facilitate the monitoring and screening of people with long COVID 3.