What is Postacute Coronavirus (COVID-19) Syndrome?
COVID-19 is a viral illness caused by a new type of coronavirus called SARS-CoV-2. This disease was first discovered in Wuhan, China, in December 2019, and since then, it has affected many people and caused numerous deaths globally. Thanks to scientists’ hard work, we now have a better understanding of this virus, and it has led to the creation of new treatments and vaccines to help manage the ongoing pandemic.
Many patients who have recovered from COVID-19 often experience a range of physical, mental, and cognitive symptoms. These symptoms can persist even after medical tests show that the virus has stopped replicating, or making copies of itself, about four weeks after the initial infection. These persistent symptoms have been referred to by several names, but across various countries, “long COVID” is the term that is now widely accepted to describe this condition.
Long COVID has been seen in at least 10% of people who have had COVID-19 and possibly in as many as 50% to 70% of people who have had to stay in the hospital due to the virus. It can occur in anyone who has had the disease, regardless of how severe their symptoms were. However, those who had more severe disease seem to be at higher risk of developing long COVID. There are more than 200 known symptoms of long COVID, with the most common ones including tiredness, shortness of breath, brain fog, changes in heart function, headaches, persistent loss of smell or taste, cough, depression, low-grade fevers, heart palpitations, dizziness, muscle pain, and joint pain.
This article talks about how common long COVID is, the varying symptoms it can cause in different parts of the body, the useful medical tests, treatments available, and why a team approach from different health professionals is important in managing long COVID-19.
What Causes Postacute Coronavirus (COVID-19) Syndrome?
Long COVID refers to a situation where symptoms of COVID-19 persist for a long period after the initial diagnosis. Different health organizations have varied definitions of how long these symptoms must last. The U.S. Centers for Disease Control and Prevention believe symptoms lasting over four weeks signify long COVID. In contrast, the U.K. National Institute for Health and Care Excellence and the World Health Organization think symptoms must last for at least three months after diagnosis. People with long COVID may continue to experience symptoms for weeks, months, or potentially even years.
Previous outbreaks of similar viruses have shown that those who recover can still experience persistent symptoms like severe fatigue, breathlessness, and mental health issues. Such lasting symptoms put a significant strain on healthcare systems where these outbreaks occur. Similarly, in the case of COVID-19, many patients continue to have a variety of symptoms even after they are no longer actively infected with the virus.
Upon suffering a severe infection or injury, the human body reacts by triggering a protective immune response, which can be followed by a prolonged period of anti-inflammatory activity to balance out the initial response. The balance between these two responses determines not just the immediate recovery but also the long-term health outcome post-infection. Acute COVID-19 infection may lead to an excessive release of cytokines, one of the immune system’s chemical messengers, causing potentially severe consequences, including respiratory distress, blood clotting abnormalities, organ failure, and even death in some cases.
Multiple theories exist concerning what causes long COVID. The cause likely involves several factors, including ongoing viral infection, disruption of the immune system, formation of tiny blood clots, development of fibrosis (a process where healthy tissue is replaced with scar tissue), autoimmune responses, the persistence of the virus within the central nervous system, and dysfunction of the body’s automatic processes that regulate essential functions like heart rate and digestion.
For example, there might still be reservoirs of the COVID-19 virus remaining in the body after the initial infection. This residual virus could contribute to continued inflammation and immune response. There are documented cases where the genetic material of the virus can still be detected many months after the initial infection.
Other theories suggest that our immune systems might be knocked off balance following a COVID-19 infection. This imbalance can involve immune suppression, which might set patients up for other infections, or a low-grade chronic inflammation state. Both imbalanced states are linked to the long-lasting symptoms of COVID-19.
An increased level of blood clotting has been observed in some patients, and this abnormal clotting could contribute to long-term symptoms. Changes to the gut’s microbiome (the community of bacteria that live in our digestive tract) have also been reported following COVID-19 infection and could play a role in causing persistent COVID-19 symptoms.
The symptoms of two other conditions–chronic fatigue syndrome and postural orthostatic tachycardia syndrome (a condition where standing causes a rapid increase in heart rate)–bear notable similarities to long COVID symptoms. With each of these conditions, the bodily processes and symptoms involved overlap significantly with those seen in long COVID, leading to speculation that some long COVID symptoms might be alleviated by approaches used to treat these conditions.
Risk Factors and Frequency for Postacute Coronavirus (COVID-19) Syndrome
An estimated 65 million people around the world have been living with long-lasting symptoms of COVID-19, also referred to as “long COVID”, since the pandemic began. People who have been hospitalized for COVID-19 are at a greater risk of developing long COVID compared to those who were treated as outpatients. Getting the COVID-19 vaccine can reduce the chances of experiencing symptoms long after the acute illness has passed. Certain conditions such as asthma, obesity, diabetes, hypothyroidism and depression can increase a person’s risk of having long COVID.
- Long COVID affects all age groups, with varying symptoms but there isn’t a specific age group that is affected more.
- Women are seen to have a higher incidence of long COVID than men.
- Studies from the United States and United Kingdom indicate that long COVID is more prevalent in Black, Asian, and Hispanic populations compared to White individuals.
Signs and Symptoms of Postacute Coronavirus (COVID-19) Syndrome
Long COVID has over 200 symptoms associated with it, according to the Centers for Disease Control and Prevention. The most common symptoms vary depending on the bodily system they affect:
- General symptoms:
- Tiredness or fatigue that interferes with daily life
- Symptoms that worsen after physical or mental effort
- Fever
- Respiratory and heart symptoms:
- Difficulty breathing or shortness of breath
- Cough
- Chest pain
- Fast-beating or pounding heart (heart palpitations)
- Neurological symptoms
- Difficulty thinking or concentrating (sometimes referred to as “brain fog”)
- Headache
- Sleep problems
- Dizziness when standing up
- Pins-and-needles feelings
- Change in smell or taste
- Depression or anxiety
- Digestive symptoms:
- Diarrhea
- Stomach pain
- Other symptoms:
- Joint or muscle pain
- Rash
- Changes in menstrual cycles
Some symptoms like hair loss, menstrual irregularities, and certain skin changes such as toe swelling and discoloration, are not usually seen in other post-viral infections but have been noted in long COVID. The most commonly reported symptoms across various studies include fatigue, muscle pain, stress, memory loss, difficulty concentrating, coughing, and sleep problems.
The physical signs of long COVID can vary from person to person, and many symptoms are subjective, meaning they do not show up in a physical exam. Some observable signs may include low oxygen levels, especially when exercising, low blood pressure when standing up, a fast heartbeat, abnormal lung sounds, hyperactive bowel sounds, decreased muscle strength or numbness in certain areas, and abnormal skin rash or discoloration.
Testing for Postacute Coronavirus (COVID-19) Syndrome
When assessing what is known as ‘long COVID’, there are several steps that doctors are currently suggested to take:
Firstly, during a follow-up visit, doctors need to have a detailed chat about your current symptoms, their onset and duration, any existing health conditions you may have as well as the severity of the COVID-19 you had and any medication you’ve been taking.
Secondly, if you’ve been hospitalized due to COVID-19, your doctor will review all the related records, which include the duration of your hospital stay and any relevant tests you had during that time.
As ‘long COVID’ is a fairly new condition, there isn’t yet a specific set of guidelines to follow when managing it. In these cases, doctors consider ‘long COVID’ as an exclusion diagnosis. This means that all other possible conditions linked with COVID-19 and other potential diagnoses first have to be ruled out with appropriate lab tests and imaging.
Some previously infected patients have reported a reoccurrence or coming back of the SARS-CoV-2 virus. Thus, one of the things to be eliminated is SARS-CoV-2 reinfection. Others are bacterial or fungal infections caused by a previous viral illness. To do so, doctors start with routine lab tests, which usually include a complete blood count, a broad metabolic panel for checking kidney and liver function, and a coagulation panel. Depending on each case, further tests may be needed. These could be C-reactive protein, fibrinogen, D-dimer, troponin, and ferritin.
If the patients show mostly respiratory symptoms, another scan of the lungs, most likely a high-resolution CT scan or CT angiogram, would be necessary. Additionally, heart functioning tests like an echocardiograph can eliminate any underlying heart or lung diseases. There have been cases of changes in a part of an electrocardiogram (QRS complex) with long COVID. Cardiac MRI and echocardiograph can spot acute and chronic coronary pathologies like myopericarditis, ventricular dysfunction or wall motion abnormalities.
If you’re showing neuropsychiatric manifestations, a CT/MRI brain scan is often ordered, along with neuropsychological testing. And if doctors think you might have postural orthostatic tachycardia syndrome – a condition where your heart rate increases significantly upon standing – tilt table testing might also be carried out. Some of the tests used for ME/CFS, an illness resembling long COVID, can be applied as well, such as saliva tests, erythrocyte deformation, and electrical impedance blood tests.
Treatment Options for Postacute Coronavirus (COVID-19) Syndrome
Research shows that people who are vaccinated against COVID-19 have a lower chance of developing long-term symptoms from the virus, often referred to as “long COVID.” Recent data also suggests that using certain antiviral drugs during the early phase of the infection might reduce the chance of long COVID. These findings underscore the importance of preventive measures in managing these extended symptoms.
It is believed that long COVID may be tied to an overactive or poorly regulated immune system. This is why different immunomodulatory strategies (methods that help control or adjust the immune system) are being considered. Some potential treatments being researched include classes of drugs known as transforming growth factor-B inhibitors, checkpoint inhibitors, and antivirals, including remdesivir, favipiravir, and nirmatrelvir-ritonavir. Other anti-inflammatory drugs are also being looked at for their potential benefits.
An approach called therapeutic apheresis is sometimes used to lessen the symptoms associated with long COVID. This procedure helps to reduce potential disease-causing elements, like harmful antibodies or tiny blood clots, from the bloodstream. Another related condition called postural orthostatic tachycardia syndrome is sometimes treated with similar strategies as long COVID, including certain classes of drugs and possibly anti-clotting treatments. Doctors also often recommend that patients with long COVID supplement with Vitamin D for overall bone health.
Long COVID is a complex condition that can affect multiple body systems and cause a variety of symptoms, which may occur singly or in combination. Recognizing this, doctors aim to develop individualized treatment plans that consider the whole person and their specific set of symptoms. This may involve a range of medical specialists to manage the various symptoms and aspects of the condition.
It’s also important for people with long COVID to manage any existent health conditions like diabetes, kidney disease, or high blood pressure. Self-monitoring at home using devices to measure things like oxygen levels, blood pressure, and blood glucose can be helpful. It’s also helpful for patients to maintain a healthy lifestyle by eating a balanced diet, ensuring good sleep habits, limiting alcohol, and quitting smoking. Over-the-counter pain relievers like acetaminophen can be used for pain as needed.
For those with lingering lung or heart symptoms after a COVID-19 infection, it’s recommended to have regular appointments with specialists like pulmonologists and cardiologists. These doctors might suggest different tests or treatments depending on specific symptoms and patient health history.
Some patients with long COVID might need further support for mental health concerns, such as anxiety, depression, or insomnia. Referral to behavioral health specialists may be recommended. Neurology specialists might also be needed to evaluate frequent neurological symptoms related to long COVID.
What else can Postacute Coronavirus (COVID-19) Syndrome be?
At present, our understanding of ‘Long COVID’, a condition where COVID-19 symptoms continue for weeks or even months after the illness, is still limited. This condition can affect any body system. Therefore, when ‘Long COVID’ is suspected, healthcare providers must first rule out all other known complications related to COVID-19 and other potential health conditions. To do this, they usually employ the right laboratory tests and imaging techniques.
‘Long COVID’ can manifest itself through various symptoms involving the respiratory, cardiovascular, blood, mental health, and infectious disease systems. Here are some conditions that may show overlapping symptoms and could be considered when diagnosing ‘Long COVID’:
- Respiratory Problems:
- Blood clot in lung (Pulmonary embolism)
- Collapsed or scarred lung tissues (Lung atelectasis/fibrosis)
- Post-viral bacterial pneumonia
- Heart and Blood Vessel Issues:
- Heart muscle disease (Ischemic heart disease)
- Inflammation of heart muscle after a viral infection (Post-viral myocarditis)
- Scarring or hardening in heart muscles (Myocardial fibrosis/scarring)
- Heart failure
- Irregular heart rhythms (Arrhythmias)
- Blood clot in a deep vein (Deep vein thrombosis)
- Mental Health Challenges:
- Stroke
- Blood clot in brain (Cerebral vein thrombosis)
- Seizures
- Anxiety
- Depression
- Difficulty sleeping (Insomnia)
- Post-traumatic stress disorder
- Infections:
- Bacterial and fungal infections
- Other viral infections, including re-infection with SARS-CoV-2
Identifying these conditions and treating them can help in managing ‘Long COVID’ more effectively.
What to expect with Postacute Coronavirus (COVID-19) Syndrome
The future health outcomes of this new health condition are still uncertain and probably depend on how severe the symptoms are, any existing health conditions, and how well the patient responds to treatment. We need more studies evaluating patients after they’ve had COVID-19 to understand how long the condition lasts and what the long-term impacts might be.
Possible Complications When Diagnosed with Postacute Coronavirus (COVID-19) Syndrome
Long COVID, which is a complication from having COVID-19 that lasts for a long time, is becoming more acknowledged. However, we don’t have a good understanding right now of the problems that come along with this syndrome. We need more data from clinical studies to fully comprehend the long-term effects of this syndrome.
Preventing Postacute Coronavirus (COVID-19) Syndrome
Here are some suggestions that can help individuals with this specific health condition learn more about how to manage it:
* If achievable, people who have this syndrome should understand the need to carefully check their own health at home. This can be done with the assistance of a home health aide; a healthcare professional who provides essential personal care in the comfort of an individual’s home.
* Individuals should not be hesitant to ask for immediate medical help when required.
* Individuals ought to get professional mental health support and have access to emergency mental health contact numbers. This is especially relevant if the syndrome has associated neuropsychiatric manifestations, which are changes in sensation, thinking, perception, or voluntary movement caused by the disease.
* People with this syndrome need to be aware of the usefulness and positive impact of existing vaccines, and how these can enhance their health.
