From the Guidelines
Long COVID is a multisystemic condition that requires a comprehensive treatment approach focusing on managing individual symptoms to improve quality of life, as there is no specific medication regimen that cures the condition. The symptoms of Long COVID can vary widely among individuals but commonly include fatigue, shortness of breath, brain fog, joint pain, chest pain, and mood changes 1. According to recent studies, the incidence of Long COVID is estimated to be between 10% to 30% of non-hospitalized cases, affecting at least 65 million individuals worldwide 1.
Symptoms and Management
The management of Long COVID symptoms is crucial for improving the quality of life of affected individuals.
- For fatigue, pacing activities and gradual exercise are recommended.
- For respiratory symptoms, breathing exercises and possibly inhaled corticosteroids like budesonide (400mcg twice daily) may help.
- Brain fog might improve with cognitive exercises and adequate sleep.
- Pain can be managed with acetaminophen (up to 3000mg daily) or NSAIDs like ibuprofen (up to 1200mg daily) 1.
Risk Factors and Underlying Mechanisms
The risk factors for developing Long COVID symptoms include the severity of the acute COVID-19 infection and sex, with women having an estimated two-fold risk 1. The underlying mechanisms of Long COVID likely involve persistent inflammation, immune system dysregulation, and possibly viral reservoirs remaining in the body.
Multidisciplinary Care
Given the complex and multisystemic nature of Long COVID, multidisciplinary care involving primary care physicians, specialists, physical therapists, and mental health professionals often provides the best outcomes for managing this condition. Patients should seek medical evaluation to rule out other conditions and receive personalized treatment, as recovery time varies greatly among individuals 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 framework for assessment and management, symptom-specific considerations, and updates on prevalence, health equity, disability considerations, pathophysiology, and emerging evidence regarding treatments under investigation are necessary for effective management 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 may worsen other symptoms 2.
- A multidisciplinary approach, including physical rehabilitation, mental health, and social services support, is recommended for managing Long COVID 4, 3.
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.