Long COVID Update

Long COVID Update

Jake Anderson, DO and Heidi James, MD

Many patients experience symptoms that persist far beyond those of the acute COVID-19 illness. To help us help our patients with these ongoing symptoms, Jake Anderson joins Heidi James to bring us the latest information on Long COVID.

• Background
• Many terms are being used to describe these constellations of symptoms
• Long COVID
• Post-acute COVID syndrome
• Post-acute sequela of COVID-19
• Post-COVID
• The World Health Organization published a clinical case definition in October of 2021:
• Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.
• ICD 10 code is U09.9
• Symptoms 
• Symptoms are broad and varied
•  80% of people with COVID-19 continue to not be back to baseline at least 2 weeks after illness. 
• 55 long-term effects have been identified in the literature; the most common are
• Fatigue - 58%
• Headache - 44%
• Attention disorder - 27%
• Hair loss - 25% 
• Dyspnea - 24%. 
• Pain - 5-20%
• Mental Health - 12-13%
• There are similarities between Long COVID and Chronic Fatigue Syndrome/Myalgic encephalitis and Post Intensive Care Syndrome.
• Prevention
• 2 dose of vaccine can decrease risk of Long COVID by 50%
• Vaccination also decreases likelihood of developing COVID 19
• Management
• The NICE guidelines on Managing the Long Term Effects of COVID-19 is a useful resource and is updated regularly.
• Do a thorough history and physical, focussing on timeline of symptoms
• Use a validated cognitive screening tool if memory loss, confusion, or brain fog. 
• Use exercise testing like the sit-to-stand test to gather more information in someone with weakness or fatigue.
• Further evaluation with labs and imaging should be guided by the symptoms of course, and aimed at ruling out other, new pathology.
• Note that imaging and lab abnormalities can persist for months post acute illness
• Rule out thyroid disease, diabetes, or anemia with many of the common long COVID symptoms
• Inquire about mental health, particularly in patients with fatigue as fatigue can be symptom of depression
• Empower patients in self-monitoring with symptom journals or home measured vitals, while also giving them specific precautions to look out for.
• Consider olfactory retraining for sense of smell loss
• Vaccination after COVID-19 illness does not have an effect on persistent symptoms or quality of life
• The most important aspect of management continues to be regular follow-up. 

REFERENCES:

Symptoms After COVID-19 Vaccination in Patients With Persistent Symptoms After Acute Infection: A Case Series.
Arnold, David T et al. Annals of internal medicine vol. 174,9 (2021): 1334-1336. doi:10.7326/M21-1976. https://pubmed.ncbi.nlm.nih.gov/34029484/

A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021
World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1

Clinical Spectrum of SARS-CoV-2 Infectionwww.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum/

Risk for Newly Diagnosed Diabetes 30 Days After SARS-CoV-2 Infection Among Persons Aged 18 Years—United States, March 1, 2020–June 28, 2021.
Barrett, Catherine E. MMWR. Morbidity and mortality weekly report 71 (2022). https://www.cdc.gov/mmwr/volumes/71/wr/mm7102e2.htm?s_cid=mm7102e2_w

More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis.
Lopez-Leon, S., Wegman-Ostrosky, T., Perelman, C. et al. Sci Rep 11, 16144 (2021). https://doi.org/10.1038/s41598-021-95565-8

Long-term effects of COVID-19 (Visual)
https://www.nature.com/articles/s41598-021-95565-8/figures/2

Time course prevalence of post-COVID pain symptoms of musculoskeletal origin in patients who had survived to severe acute respiratory syndrome coronavirus 2 infection: a systematic review and meta-analysis.
Fernández-de-Las-Peñas, César et al. Pain, 10.1097/j.pain.0000000000002496. 23 Sep. 2021, doi:10.1097/j.pain.0000000000002496
https://pubmed.ncbi.nlm.nih.gov/34561390/

Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: A systematic review and meta-analysis with comparison to the COVID-19 pandemic.
Rogers, J. P. et al. Lancet Psychiatry 7, 611–627.
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30203-0/fulltext

Radiological and functional lung sequelae of COVID-19: a systematic review and meta-analysis.
So, M., Kabata, H., Fukunaga, K., Takagi, H., & Kuno, T. (2021). BMC pulmonary medicine, 21(1), 97.
https://bmcpulmmed.biomedcentral.com/articles/10.1186/s12890-021-01463-0

Long COVID and Post-infective Fatigue Syndrome: A Review.
Sandler, C. X., Wyller, V., Moss-Morris, R., Buchwald, D., Crawley, E., Hautvast, J., Katz, B. Z., Knoop, H., Little, P., Taylor, R., Wensaas, K. A., & Lloyd, A. R. (2021). Open forum infectious diseases, 8(10), ofab440.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8496765/