An Overview of Long Covid

SUMMARY:

Long Covid (LC) is an infection-associated (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. LC is known by other terms e.g., Post-Acute Sequelae of COVID (PASC), long-haul COVID, chronic COVID, post-acute COVID-19. The estimated incidence of cases worldwide is 400 million and remains a major public health concern. LC is a systemic disease that can affect any organ system. Anyone is at risk, however women, Hispanic and Latino people, unvaccinated individuals, those with underlying health conditions, adults age 65 and older or those with more severe COVID-19 illness are more at risk for developing LC.

Clinical Presentation

Can present in multiple ways and be comprised of multiple or single symptoms or diagnoses
- Most common symptoms include: Shortness of breath | Cough | Persistent Fatigue | Post-Exertional Malaise | Difficulty concentrating | Memory Changes | Headaches | Lightheadedness | Tachycardia | Insomnia | Dysgeusia| Anosmia | GI changes
- Common diagnoses: ILD and hypoxemia | CV disease and arrythmias| cognitive impairment mood disorders | anxiety | migraines| stroke | VTE | POTS |Dysautonomia | Myalgic Encephalitis/Chronic Fatigue Syndrome(ME/CFS) |Mast Cell Activation Syndrome (MCAS)| Fibromyalgia | Connective Tissue Disease | Autoimmune conditions i.e., SLE, RA, Sjogren’s | Diabetes

LC can follow asymptomatic, mild or severe SARS-CoV2 infection
Anyone at risk however these groups are more at risk:
- Women
- Hispanic and Latino People
- Unvaccinated individuals
- Those with underlying health conditions
- Adults age 65 and older
- Severe acute COVID-19 illness e.g., hospitalized or in ICU
Can be continuous from time of acute SARS-CoV-2 infection or delayed in onset for weeks or months following completely recovery from acute illness and persist for months to years
Prior health conditions may be exacerbated by LC

Diagnosis

There is no biomarker or imaging currently available to conclusively diagnosis LC
LC is a clinical diagnosis with ICD 10 Code: U09.9 (Post Covid-19 Condition, unspecified)
LC is considered a disability per the Americans with Disability Act

Pathophysiology

Different mechanisms likely account for various symptoms
Suspected mechanisms: persistent reservoirs of SARS-CoV-2 in tissues | Immune dysregulation with or without reactivation of underlying pathogens (e.g., herpesviruses) | microbiome perturbations | autoimmunity | microvascular blood clotting with endothelial dysfunction | dysfunctional brain signaling in the brainstem | serotonin deficiency | reduction of skeletal muscle mitochondria enzyme activity| accumulation of amyloid-containing deposits in skeletal muscle

Prevention

Decreasing risk of severe acute COVID-19 illness via vaccination (at least one dose)
Avoiding infection via masking or physical distancing in high-risk environments
Research studies that suggest treatment with anti-virals during the acute-COVID 19 phase can reduce risk of developing LC

Treatment

Treatment is directed at specific symptoms and can be pharmacologic and non-pharmacologic e.g., cognitive behavioral therapy, energy conservation strategies, physical therapy
- Physical activity recommendations must be tailored to patients’ activity tolerance to prevent post exertional malaise or post exertional symptom exacerbation
Validation of patient’s experience and reassurance of symptoms being taken seriously
Addressing comorbidities and modifiable risk factors e.g., uncontrolled diabetes,
Documentation for personalized work accommodations
Consider referring to clinical trials

KEY POINTS:

Long Covid is an infection associated chronic condition that occurs after a SARS-CoV-infection and is present for at least months as a continuous, relapsing and remitting or progressive disease state that affects one or more organ system
There is no biomarker, and the diagnosis is based on clinical presentation
LC can result in significant disability and decreased quality of life and treatment is mainly supportive and symptom based at this time