From the Guidelines
COVID-19 long haulers require a comprehensive treatment approach that prioritizes symptom management, as there is no specific cure, and focuses on improving quality of life, reducing morbidity, and mortality. The most recent and highest quality study, 1, published in 2023 in Nature Reviews Microbiology, highlights the importance of addressing neurological and cognitive symptoms, which are a major feature of long COVID. These symptoms include sensorimotor symptoms, memory loss, cognitive impairment, paresthesia, dizziness, and balance issues, and can have a significant impact on daily living activities.
Key aspects of managing long COVID include:
- Gradual physical rehabilitation with paced activity increases to improve physical function and reduce fatigue
- Breathing exercises for respiratory symptoms to enhance lung function and overall respiratory health
- Medications targeting specific symptoms, such as acetaminophen or NSAIDs for pain, antihistamines for allergic reactions, and sometimes low-dose naltrexone at 1-4.5mg daily for inflammation, to alleviate symptoms and improve quality of life
- Mental health support, as many long haulers experience anxiety and depression, which is crucial for maintaining mental well-being and preventing long-term psychological damage
- Maintaining a healthy diet, ensuring adequate sleep, and staying hydrated to support overall health and recovery
According to 1, long COVID is associated with multiple adverse outcomes, including cardiovascular, thrombotic, and cerebrovascular disease, type 2 diabetes, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and dysautonomia. The study also highlights the importance of considering the potential causes of long COVID, including persisting reservoirs of SARS-CoV-2 in tissues, immune dysregulation, and autoimmunity.
The European Respiratory Review study, 1, published in 2022, suggests that SARS-CoV2 infection may result in specific damage to the respiratory muscles, which can lead to persistent dyspnea and other functional limitations. The study recommends respiratory muscle testing and training as a key component of rehabilitation for patients with COVID-19.
The ESCMID rapid guidelines, 1, published in 2022, provide a framework for the assessment and management of long COVID, emphasizing the importance of a multidisciplinary approach and the need for further research to inform evidence-based guidelines.
Overall, managing long COVID requires a comprehensive and individualized approach that takes into account the complex and varied symptoms experienced by patients. By prioritizing symptom management, improving quality of life, and reducing morbidity and mortality, healthcare providers can help patients with long COVID achieve the best possible outcomes.
From the Research
Definition and Prevalence of Long COVID
- Long COVID is defined as an infection-associated chronic condition (IACC) 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.
- The current global prevalence of Long COVID is estimated to be 6% 2.
- Higher prevalence has been identified among female gender, certain racial and ethnic groups, and individuals who live in nonurban areas 2.
Symptoms of Long COVID
- The most common symptoms of Long COVID include exaggerated fatigue and diminished energy windows, postexertional malaise (PEM)/postexertional symptom exacerbation (PESE), cognitive impairment (brain fog), dysautonomia, pain/myalgias, and smell and taste alterations 2.
- Long COVID symptoms can vary in nature, affect multiple functional areas, and often manifest as an "invisible disability" that may not be readily acknowledged by employers or coworkers 2.
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, neuropsychologists, neurologists, occupational therapists, physical therapists, speech and language pathologists, patients, and government representatives 2.
- Rehabilitation care plans and community healthcare plans are necessary for COVID-19 patients before discharge, and remote programs could facilitate the monitoring and screening of people with Long COVID 3.
Treatment and Return to Work
- There are limited data to guide medication management specifically in the context of Long COVID, and medication use generally follows standard practice regarding indications and dosing 2.
- The return-to-work process for individuals with Long COVID can be challenging, and clinicians can help patients return to work by identifying suitable workplace accommodations and resources, providing necessary documentation, and recommending occupational or vocational therapy when needed 2.
- Long COVID is recognized as a potential disability under the Americans with Disabilities Act, and applying for disability may be warranted if work significantly worsens Long COVID symptoms or impedes recovery 2.