Most people infected with SARS-CoV-2 experience resolution of symptoms within weeks of infection, but many will experience new, returning, or persistent symptoms 4 or more weeks after infection. This is known as long COVID. Symptoms of long COVID encompass a variety of body systems, from physical to neuropsychiatric, and it is unclear which patients are at risk of developing this syndrome. There is rapidly emerging research on the various clinical presentations of long COVID, which can help guide diagnosis and management decisions.
Presentation and risk factors of Long COVID
Long-term Covid-19 infection is a medical mystery with symptoms that can vary depending on the individual. Symptoms may include fatigue, anxiety, brain fog, chest discomfort, heart palpitations, depression, dyspnea, headaches, and myalgias. Joint pain, nausea and vomiting, hair loss, and skin rash are also commonly reported. The National Institute for Health and Care Excellence (NICE) recommends a multimodal approach to diagnosis and treatment, which may include pharmacological therapies, physical therapy, and psychological intervention. Children may present with a lack of concentration, short-term memory loss, and/or difficulty performing everyday tasks up to 4 weeks after acute COVID-19 illness. Cardiac and respiratory symptoms appear to be less common in children than in adults. MIS-C, a development associated with COVID-19, has been reported in children.
The study found that people who had gotten the vaccine were less likely to have symptoms for 28 days or more.
Diagnosing Long COVID and POTS differential
Health care providers should obtain a comprehensive medical history and perform a complete physical examination in order to elicit symptoms, examine for clinical signs of disease, and assess the impact of symptoms on quality of life. Additionally, diagnostic tests may be ordered based on the patient’s symptoms and based on the suspected condition. For patients with more advanced symptoms, additional tests may be ordered, such as laboratory tests for troponin, D-dimer, and fibrinogen levels and studies checking for rheumatologic conditions. Patients with postural symptoms may be evaluated for blood pressure and heart rate. A doctor might recommend blood pressure testing when a patient has postural symptoms (dizziness or pain when standing). The doctor might also recommend heart rate testing (for orthostatic hypotension or POTS) or other forms of orthostatic intolerance.
Managing Long COVID
The most common symptoms of COVID are exercise intolerance, fever, muscle aches, and headache. Other symptoms can include shortness of breath, chest pain, confusion, seizures, and seizures in adults. The symptoms of COVID can vary depending on which organs are affected. For example, people with COVID in the heart may experience chest pain, trouble breathing, and fever. People with COVID in the brain may experience confusion, seizures, and fever. People with COVID in the lungs may experience shortness of breath, fever, and muscle aches. The most important thing for people with COVID is to rest and stay hydrated. People with COVID should also avoid strenuous activity and stay warm. People with COVID should also see a doctor if they have any of the following symptoms: shortness of breath, muscle aches, fever, or confusion. The World Health Organization (WHO) and other forums have emphasized the importance of improving patients’ clinical characteristics. However, the lack of COVID-19 dedicated treatment facilities impedes access to appropriate care for patients with long COVID. The NICE guidelines suggest using a holistic approach to identifying and diagnosing long COVID, but offer limited guidance on management. Many patients experience spontaneous improvement in symptoms between 4 and 12 weeks after COVID-19 infection and should be offered self-management support and monitoring; those who do not improve should be referred for further services. Treatment should focus on providing symptomatic relief as data is lacking on pharmacologic interventions to treat the condition itself. Because of the breadth of long COVID symptoms, this review will focus on the 3 most common systems affected: cardiovascular, neuropsychiatric, and pulmonary. Patients with signs or symptoms of acute or life-threatening complications should be immediately referred for acute services. These symptoms include the following: Hypoxemia or oxygen desaturation during exercise Signs of severe lung disease Cardiac chest pain Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS)
Cardiovascular Symptoms
The health care provider should consider a patient’s exercise tolerance and the presence of any type of orthostatic changes in pulse or blood pressure before starting physical reconditioning. Depending on the presenting clinical symptoms and physical examination findings, NICE also recommended the use of medications such as beta-blockers for symptoms of non-COVID-related angina, arrhythmias, and acute coronary syndrome. Myocarditis may resolve spontaneously over time, but for those with POTS, patient education, structured exercise programs, and increased water and salt intake (2 to 4 L of water and 10 to 12 g of sodium) may be recommended. If these measures do not work, an acute intravenous infusion of up to 2 L of saline and medications including fludrocortisone, pyridostigmine, midodrine, or low-dose propranolol may be used.
Lee, L. (2022). Long COVID: Understanding the Many Faces of a Medical Mystery.
