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==Epidemiology and Demographics==
==Epidemiology and Demographics==
* The reported incidence/prevalence of long COVID-19 varies in different studies mainly due to the absence of single terminology and definition.
* The reported [[incidence]]/[[prevalence]] of long COVID-19 varies in different studies mainly due to the absence of single terminology and definition.
* One study found that up to 70% of individuals at low risk of mortality from COVID-19 experience impairment in one or more organs (including heart, lungs, kidneys, liver, pancreas, or spleen) 4 months after acute COVID-19 episode.
* One study found that up to 70% of individuals at low risk of [[mortality]] from [[COVID-19]] experience impairment in one or more organs (including heart, lungs, kidneys, liver, pancreas, or spleen) 4 months after acute [[COVID-19]] episode.
* A meta-analysis, including 47,910 patients (age 17-87 years), estimated that 80% of the patients with SARS-CoV-2 infections developed one or more long-term (ranging from 14 to 110 days) symptoms.  
* A [[meta-analysis]], including 47,910 patients (age 17-87 years), estimated that 80% of the patients with [[SARS-CoV-2]] infections developed one or more long-term (ranging from 14 to 110 days) [[symptoms]].  
* Women seem to be more commonly affected by long COVID than men.
* Women seem to be more commonly affected by long COVID than men.



Revision as of 18:15, 6 March 2022

WikiDoc Resources for Long COVID

Articles

Most recent articles on Long COVID

Most cited articles on Long COVID

Review articles on Long COVID

Articles on Long COVID in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Long COVID

Images of Long COVID

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Podcasts & MP3s on Long COVID

Videos on Long COVID

Evidence Based Medicine

Cochrane Collaboration on Long COVID

Bandolier on Long COVID

TRIP on Long COVID

Clinical Trials

Ongoing Trials on Long COVID at Clinical Trials.gov

Trial results on Long COVID

Clinical Trials on Long COVID at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Long COVID

NICE Guidance on Long COVID

NHS PRODIGY Guidance

FDA on Long COVID

CDC on Long COVID

Books

Books on Long COVID

News

Long COVID in the news

Be alerted to news on Long COVID

News trends on Long COVID

Commentary

Blogs on Long COVID

Definitions

Definitions of Long COVID

Patient Resources / Community

Patient resources on Long COVID

Discussion groups on Long COVID

Patient Handouts on Long COVID

Directions to Hospitals Treating Long COVID

Risk calculators and risk factors for Long COVID

Healthcare Provider Resources

Symptoms of Long COVID

Causes & Risk Factors for Long COVID

Diagnostic studies for Long COVID

Treatment of Long COVID

Continuing Medical Education (CME)

CME Programs on Long COVID

International

Long COVID en Espanol

Long COVID en Francais

Business

Long COVID in the Marketplace

Patents on Long COVID

Experimental / Informatics

List of terms related to Long COVID

For COVID-19 main page, click here

For COVID-19 frequently asked inpatient questions, click here

For COVID-19 frequently asked outpatient questions, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];

Synonyms and keywords: Long COVID Syndrome, long COVID, long-haul COVID, post-COVID-19 condition, post-COVID-19 syndrome, post-acute sequelae of COVID-19 (PASC), chronic COVID syndrome (CCS).

Overview

  • Shortly after the COVID-19 pandemic onset, emerging studies showed that a considerable proportion of patients with COVID-19 might exhibit sustained postinfection sequelae.

Historical Perspective

Classification

There is no established system for the classification of long COVID.

Pathophysiology

The exact pathogenesis of long COVID is not fully understood.

Epidemiology and Demographics

  • The reported incidence/prevalence of long COVID-19 varies in different studies mainly due to the absence of single terminology and definition.
  • One study found that up to 70% of individuals at low risk of mortality from COVID-19 experience impairment in one or more organs (including heart, lungs, kidneys, liver, pancreas, or spleen) 4 months after acute COVID-19 episode.
  • A meta-analysis, including 47,910 patients (age 17-87 years), estimated that 80% of the patients with SARS-CoV-2 infections developed one or more long-term (ranging from 14 to 110 days) symptoms.
  • Women seem to be more commonly affected by long COVID than men.

Risk Factors

Screening

There is insufficient evidence to recommend routine screening for long COVID.

Natural History, Complications, and Prognosis

  • The natural history, clinical course, long-term complications, and prognosis of long COVID-19 are still not completely understood.
  • Manifestations of the post-COVID-19 condition vary considerably in terms of organ involvement and severity of symptoms; however, they generally impact the everyday functioning of affected patients.
  • Symptoms might newly develop following initial recovery from an acute COVID-19 illness or occur as a persist from the initial episode.
  • Symptoms might also fluctuate or relapse over time.

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Long COVID can involve almost every organ. The most common symptoms of Long COVID include:

Physical Examination

Laboratory Findings

There are no diagnostic laboratory findings associated with long COVID. Symptoms do not correlate with the serology of SARS-CoV-2.

Electrocardiography

In patients with cardiopulmonary symptoms, an ECG may be needed.

X-ray

A chest x-ray may be helpful in the diagnosis of pulmonary complications of COVID such as lung damage (ie, ground glass opacities, consolidation, interlobular septal thickening), pleural effusion.

Echocardiography or Ultrasound

In selected patients with cardiopulmonary symptoms, echocardiography may be necessary.

CT scan

In patients with cardiopulmonary symptoms, a chest CT scan may be needed.

MRI

There are no MRI findings associated with long COVID. However, a cardiac MRI may be helpful in the diagnosis of myocarditis in COVID-19 patients.

Other Imaging Findings

There are no other imaging findings associated with long COVID.

Other Diagnostic Studies

In selected patients with cardiopulmonary symptoms, Holter monitoring, cardiopulmonary exercise testing (CPET), and pulmonary function tests may be necessary.

Treatment

Due to the diversity of symptoms and their severity, the mainstay of long COVID treatment is multidisciplinary and supportive. The management should focus on supporting self-management and individualized rehabilitation.

Medical Therapy

  • Dyspnea
    • Dyspnea in long COVID patients should be treated similar to non-COVID-19 patients. General measures in the management of dyspnea in long covid patients may include:
      • Oxygen therapy
      • Breathing exercises
        • Pursed lip breathing exercises
        • Deep breathing exercises:
      • Pulmonary rehabilitation
    • In the presence of any identified underlying cardiac or pulmonary disease, referral to a cardiologist or pulmonologist and appropriate pharmacotherapy may be required.
  • Cough
    • Cough should be managed in a similar to cough in patients with post-viral cough syndrome.
    • Attention should be paid to diagnose and treat other exacerbating or contributing factors such as gastrointestinal reflux disease and asthma.
    • Over-the-counter cough suppressants, including benzonatate, guaifenesin, and dextromethorphan are the mainstay of treatment.
  • Cardiac injury
    • Long COVID patients with evidence of cardiac injury should be referred to cardiology services.
  • Orthostasis
    • Orthostasis and dysautonomia, such as unexplained sinus tachycardia, dizziness on standing, is initially managed conservatively with compression stockings, abdominal binder, increased intake of fluid and salts, physical therapy/rehabilitation, and behavioral modifications.
    • In patients with postural orthostatic tachycardia syndrome (PoTS) and *inadequate response to non-pharmacological therapy, beta-blockers, ivabradine, or fludrocortisone (with blood pressure and response monitoring) might be considered.
  • Olfactory/gustatory symptoms
    • In most patients with a loss or decrease in sense of smell or taste, symptoms improve slowly over several weeks and do not require medical intervention. Patients may need education on food and home safety.
    • In patients with persistent symptoms, olfactory training may be appropriate. If conservative management fails, referral to an otolaryngologist and specialized taste and smell clinic may also be considered.
  • Weight loss
    • In patients with long COVID, weight loss is multifactorial and may occur due to a combination of malnutrition, loss of appetite, catabolic state, swallowing difficulty, and alterations in taste and smell.
    • Patients should be encouraged to eat small, frequent meals with protein and calorie supplementation. Nutrition consultation and referral to a dietician may be required in selected patients with severe weight loss.
  • Psychological and emotional issues
    • In patients experiencing emotional distress, mood disturbances, anxiety, or symptoms of post-traumatic stress disorder, mental health assessment and possible referral to a psychiatrist may be required.
  • Alopecia
    • There is no specific therapy for alopecia in COVID-19 patients, and it should be managed similarly to non-COVID-19 patients.
    • In patients with concomitant malnutrition, nutritional deficiencies should be corrected.
  • Insomnia
    • All patients with insomnia should be educated on sleep hygiene guidelines, stimulus control instructions, and relaxation techniques. Short-term pharmacologic treatment with benzodiazepines or non-benzodiazepine hypnotics may be needed in selected patients.

Primary Prevention

The most effective measure to prevent the post-COVID-19 condition is to prevent COVID-19. These primary prevention strategies include:

Secondary Prevention

There are no established measures for the secondary prevention of [long COVID].

See also

References