Long COVID

Fact Sheet

  • TBA

Synonymous Terms

  • Long COVID

  • Postacute sequelae of SARS-CoV-2 infection (PASC)

  • Postacute COVID-19

  • Chronic COVID-19

  • Post-COVID syndrome

Prevention

  • Firstly don’t get COVID if possible

  • Several studies report lower rates of long COVID in people who are vaccinated

  • A case-control study found decreased intensity of symptoms in the first week of COVID and at 38 days in vaccinated versus unvaccinated people

  • Large observational cohort study of 2500 people with mild COVID showed dose-dependent rates of long COVID

    • 42% in people with 0 x vaccinations

    • 30% in people with 1 x vaccinations

    • 17% in people with 2 x vaccinations

    • 16% in people with 3 x vaccinations

  • Older age, higher BMI and comorbidities such as allergies and obstructive lung disease with associated with increased risk of long COVID

Prevalence

Largest study to date, meta-analysis of 54 studies from 22 countries between March 2022 and Jan 2022

  • 6% of people had one of three long COVID symptoms at 3 months

    • Persistent fatigue with bodily pains or mood swings

    • Cognitive problems

    • Ongoing respiratory problems

  • Females > 20 = 10%

  • Males > 20 = 5%

  • Everyone <20 = 3%

Persistent Symptoms

Physical symptoms

  • Fatigue 10-90%

  • Short of breath 10-70%

  • Chest pain or tightness 10-40%

  • Cough 20-30%

  • Loss of smell 10%

  • Less common = Joint pain, headache, rhinitis, taste changes, poor appetite, dizziness, muscle aches, poor sleep, hair loss, sweating, and diarrhoea

Psychological symptoms

  • PTSD 10-20%

  • Impaired memory 20%

  • Poor concentration 15%

  • Anxiety / Depression 20%

Post Intensive Care Syndrome (PICS)

  • 75% had at least one symptom at 1 year

  • Physical weakness 40%

  • Joint symptoms 25%

  • Cognitive dysfunction 25%

  • Muscle aches 20%

Children

  • 5% still had at least one persistent symptom at 3 months

COVID Variant

  • Vaccinated people + Omicron variant = 5% long COVID

  • Delta variant = 10% long COVID

  • Observation study of non-hospitalised health care workers

    • 48% persistent symptoms with wild-type variants

    • 36% with alpha variant

    • 17% with Delta and Omicron

Recovery

  • Shorter recovery for mild illness generally = 2 weeks

  • Longer for moderate to severe illness = 2 to 3 months

  • Long COVID duration was 9 months in hospitalised individuals and 4 months in non-hospitalised individuals

  • Among those with long COVID - 15% experienced symptoms at 1 year

Evaluation

  • History

  • Illness timeline

  • Duration and severity of symptoms

  • Type and severity of complications

    • Clots

    • Kidney injury

    • Oxygen needs

    • Ventilation

      Heart problems

    • Delerium

  • COVID test results

  • Initial treatments used

  • Medical history

  • Medication

Blood tests

Generally not necessary

For more severe illness consider

  • FBC

  • LFT

  • UEC

  • Troponin if heart failure or myocarditis

  • D-dimer if new shortness of breath

  • TSH if unexplained weakness or fatigue

  • CK if muscle symptoms

Specific symptoms evaluation

  • See Up To Date for in-depth workup

  • Heart

  • Lungs

  • Dysautonomia

  • Brain

  • Clots

  • Smell / Taste

  • Fatigue

  • Kidney

  • Liver

  • Endocrine

  • Gut

  • Psychological

  • Skin

  • Infections

  • Sleep

Fatigue

  • “Flat battery” feeling, unable to do usual activities, trying to do more makes symptoms worse, fatigue does not improve with rest

  • Investigations - Bloods as appropriate, exclude other causes

  • Management - Hollistic, self-management with available energy limits, prioritising, planning, building in breaks and rests, knowing when to stop

Post Exertional Symptom Exacerbation (PESE)

  • “Crash”, “relapse”, worsening of symptoms post-exertion

  • Monitor symptom severity, an activity diary can help

  • Management is pacing in phases

Exertional breathlessness

  • Short of breath with physical activity

  • Investigation guided by symptoms

    • Hb

    • Spirometry

    • BNP or Echo

    • PulseOx and sit-to-stand testing

    • CXR D-dimer + PE workup if suspicious

Chest pain

  • Pain in specific positions, pain on exertion

  • Investigations guided by symptoms

    • Consider microvascular angina, AMI, myo or pericarditis, PE, costochondritis

    • Consider ECG, Trop, D-dimer, PulseOx + sit-to-stand, vitamin D, imaging

Autonomic dysfunction

  • Palpitations, dizziness, orthostatic tachycardia, GIT disturbance, generalised pain

  • NASA 10-min lean test, consider 24hr ECG + BP

  • Treat as per guidelines for autonomic dysfunction / POTS

References:

UK Resources:

Your COVID Recovery Website: https://www.yourcovidrecovery.nhs.uk/