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

From the Guidelines

Long COVID patients should be managed with a symptom-based approach, focusing on improving quality of life and reducing morbidity, as there is no specific medication regimen that treats all symptoms, according to the most recent study published in 2023 1. The management of Long COVID involves addressing various symptoms, including fatigue, brain fog, shortness of breath, chest pain, joint pain, and mood changes.

• For fatigue, a gradual return to activity with pacing strategies is recommended, as well as cognitive exercises and adequate sleep for brain fog.
• For respiratory symptoms, breathing exercises and pulmonary rehabilitation can help, while 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) may help manage pain symptoms.
• Patients should maintain good sleep hygiene, stay hydrated, eat a balanced diet, and avoid alcohol and smoking. The pathophysiologic mechanisms underlying Long COVID remain largely unknown, but available data implicate the multi-systemic nature of COVID-19, immune dysregulation, autoimmunity, and the neurotropism of SARS-CoV-2, as reported in a study published in 2022 1. Key risk factors for developing Long COVID symptoms include acute COVID-19 severity and sex, with women having an estimated two-fold risk of having Long COVID symptoms, and severe acute disease associated with an increased risk for Long COVID symptoms, particularly fatigue. A personalized treatment plan and regular follow-up with healthcare providers are essential for patients with persistent or worsening symptoms to improve quality of life and reduce morbidity, as suggested by the most recent evidence 1.

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.
• Other common symptoms include cognitive impairment, memory loss, anxiety, and sleep disorders 3.
• Symptoms can fluctuate, vary in nature, affect multiple functional areas, and often manifest as an "invisible disability" 2.

Management of Long COVID

• Current management strategies focus on symptom-based supportive care 2.
• A holistic assessment should include a traditional history, physical examination, and additional diagnostic testing, as indicated 2.
• Critical considerations include energy conservation strategies, addressing comorbidities and modifiable risk factors, and validating the patient's experience 2.
• Medication use generally follows standard practice regarding indications and dosing, with extra attention to prioritize patient preference via shared decision-making and cautious use of medications that may improve some symptoms but worsen others 2.

Treatment and Rehabilitation

• Numerous clinical trials are investigating additional treatments for Long COVID 2.
• A rehabilitation care plan and community healthcare plans are necessary for COVID-19 patients before discharge 4.
• Remote programs could facilitate the monitoring and screening of people with Long COVID 4.
• Selective serotonin reuptake inhibitors (SSRIs) may be used to prevent or treat Long COVID, as they increase synaptic serotonin availability, which may drive many Long COVID symptoms across a range of biological systems 5.

Return to Work and Disability

• The return-to-work process for individuals with Long COVID can be challenging due to fluctuating symptoms and "invisible disability" 2.
• 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 2.