Long COVID

Introduction

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that causes coronavirus disease (COVID-19) [1]. The impact of COVID-19 has been shown at various times:

• Severe COVID-19 illness with signs and symptoms of COVID-19 for up to 4 weeks.
• Persistent symptoms of COVID-19 with signs and symptoms from 4 to 12 weeks.
• COVID-19 usually causes a cluster of symptoms that often overlap that can fluctuate and fluctuate over time and can affect any system in the body for more than 12 weeks.

The long-term effects of COVID-19 are awaiting definition approval and different names have been used to describe the long-term signs and symptoms of COVID-1 This includes the patient guide terms Long Covid [3][4][5][6][7][8][9] Long-Haul Covid [4][10] and Long Haulers [11][12] among others terms include Post-COVID-19 Condition [13] Post-COVID-19 syndrome [2][14] Post-COVID-19 syndrome [15] Post-Acute COVID-19 [16] and Post-Acute COVID-19 syndrome[ . . . . The policy brief (no. 39) from the World Health Organization regional office for Europe used the term Long COVID [17].

For consistency, this page refers to the long-term consequences of COVID-19 as Long COVID and people with Long COVID. We will refer to Long COVID as this term acknowledges that the etiology and course of the disease are unknown, which clearly indicates “mild” COVID-19 Not necessarily benign Avoiding “chronic”, “late” and “syndromic” that can delegitimize people’s experiences Draws attention to morbidity and places disability at the center [3]. We will mention people with long term COVID first to be consistent with existing Language [18] applies knowledge from other healthcare conditions often associated with stigma. [19]

What is Long COVID?

Long Covid has been initially defined by the National Institute for Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network and the Royal College of General Practitioners as signs and symptoms occurring during or after infection associated with COVID-19 persists for 12 weeks or more and cannot be explained by another diagnosis. This includes ongoing symptomatic COVID-19 (4 to 12 weeks) and post-COVID syndrome (12 weeks or more). [20]

A rapid and dynamic review of the Long Covid evidence by the National Institutes of Health (NIHR) suggests that Long Covid may consist of 4 phenotypes [18]:

• post-intensive care
• post-viral fatigue
• permanent organ damage
• long-term COVID

Prolonged COVID affects people who have been hospitalized with severe COVID-19 and those who have handled it in the community. There is growing evidence that all individuals infected with mild or severe COVID-19 may have prolonged symptoms or develop Long COVID-19 [21] [22] [23] [24] [25] [26] [27] There is still no consensus on an internationally agreed definition of Long COVID[6][17][30][31] but there is increasing evidence that Long COVID is both prevalent and debilitating. They have tried to show Long Covid as the longer the intervention of multiple systems and the greater the disability.[30][32]

As of October 2021, the World Health Organization (WHO) has a case definition for post-COVID-19 conditions.

Post-COVID-19 illness occurs in individuals with a history of suspected or confirmed SARS-CoV-2 infection, usually 3 months after the onset of COVID-19, symptoms persist for at least 2 months, and cannot be explained by another diagnosis. Common symptoms include fatigue short Respiratory cognitive impairment, among other symptoms, often affects daily functioning. Symptoms may be new after initial recovery from an acute episode of COVID-19 or may persist from initial illness. Symptoms may also fluctuate or recur over time. [33]

Separate definitions may apply to children.

This definition is expected to change as new evidence emerges and our understanding of the consequences of COVID-19 evolves.

Long COVID Symptoms

Long-term COVID usually presents as clusters of often overlapping symptoms that fluctuate and change over time and can affect any system of the body. [17][20][30][34][35][36][37] Prolonged COVID may include a range of different signs and symptoms across body systems, including but not limited to: Pulmonary Cardiovascular Gastrointestinal Genitourinary Genitourinary Endocrine Renal Skin Musculoskeletal Neuropsychoimmune Ophthalmology and Audiology [30] The National Institute for Health and Care Excellence provides a list of common Long COVID symptoms (Nice) [20].

The most common symptom of Long Covid is fatigue. [30][34][38][39][29][40][41][42][25][43][44][45][46][47][48][27][49 ][50] The most frequently reported Long COVID symptoms after 6 months included fatigue, post-exercise malaise, and cognitive impairment [30]. Multidimensional plots and often The unpredictability of Long COVID has been described as relapse and remission [35], where 86% of Long COVID patients reported relapse within 7 months, with physical exercise, stress exercise, and mental activity being the most common relapse triggers. [30] The trajectory of Long COVID is The heterogeneity was that some improved some worsened and others stabilized over time, many with persistent fluctuating symptoms after 6 months [30]. In a sample of 47,780 people hospitalized for COVID-19 in the UK, 29.4% were readmitted within months, with increased risk of hospitalization Readmissions and organ damage compared with matched controls. [51] In a sample of 2649 adults hospitalized in Russia with confirmed COVID-19 6–8 months after discharge, about half (47.1%) reported at least one long-term symptom associated with fatigue since discharge (21.2%) shortness of breath (14.5%) and forgetfulness (9.1%) were the most common long-term symptoms reported. [48] In a sample of 325 people with confirmed COVID-19 admitted to hospitals across the UK, half of the participants reported not feeling fully recovered from COVID-19 (median follow-up 7 months) Three-quarters felt fatigued, half were more out of breath than before, and about one-quarter developed new impairments in vision walking memory self-care and/or communication. [52] Furthermore, women of working age had worse outcomes than men, and women under 50 had more than five times the outcomes of men Compared with men under the age of 50, they were more than five times more likely to report an incomplete recovery. 50 times more likely to report a new disability. [52] An estimated 30% of people who are not hospitalized have mild acute symptoms Symptoms continued up to 9 months after infection. [27] Preliminary evidence suggests that children also experience Long COVID symptoms similar to adults. [53]

[54]

Long COVID Prevalence

Estimating the prevalence of long-term COVID symptoms presents some challenges due to the current lack of consensus definitions and limited data collection in national surveys. The COVID-19 Infection Survey [55] is a nationally representative sample of the UK community population It is estimated that about one in five people exhibits long-term COVID symptoms for 5 weeks or more, and about one in ten people shows long-term COVID symptoms for 12 weeks or more [7][56]. The Zurich Coronavirus Cohort Study [49] recruited 437 SARS-CoV-2 positive individuals. 90% reported symptoms at diagnosis 16%, 40%, 30%, and 13% of the participants reported mild, moderate, severe, and very severe symptoms, respectively. Within two weeks of infection, 20% were hospitalized. At 6 months, 26% reported not returning to normal health; 31% of men and 21% of women. In addition, 23% of people Not hospitalized, 39% of hospitalized patients reported incomplete recovery. The WHO European Regional Office for Long-term COVID Policy Brief presents a summary of selected evidence on long-term COVID prevalence in non-hospitalized and hospitalized populations. [17]

Pathological Process

The etiology and pathophysiology of Long COVID symptoms remain unknown. Initial hypotheses include: viral persistence [57][58][59][60] persistent overactive immune response[61][62][63] cellular metabolic dysfunction[64] autoantibodies[65][66] Dysfunction[67][68][69][70] Neuroimmunology[71] Neuroinflammation[72] and organ damage[29], including cardiac damage[29][73][74][75][76][77]. The musculoskeletal short- and long-term consequences of COVID-19 are also discussed. [78] More research is needed to understand the mechanism of Long COVID [17]

Long COVID Management

The National Institute for Health and Care Excellence (NICE) has published a rapid guideline on the management of prolonged COVID[20] covering adults, children and adults with persistent symptoms after 4 weeks or more in all healthcare settings. Young people determined to assess and manage long-term COVID-19 Onset of acute COVID-19. The novelty of Long COVID has led to an urgent need for more research to fill existing knowledge gaps [79]. Co-design quality criteria for Long COVID services proposed, underlying patient care pathway model emphasizing equity and minimal convenience of access Patient care bears clinical responsibility with a multidisciplinary and evidence-based approach and patient engagement. [80] A multidisciplinary approach to Long COVID assessment and management is critical. [17] Inclusion of a disability model improves clinician responses to Long Coronary pneumonia [81]

Outcome Measures

Due to insufficient evidence currently provided, the National Institutes of Health (NIHR) encourages the use of the International Classification of Disability and Health (ICF) to provide a framework and standard language for describing health and health-related states Guidance[18] The ICF has been implemented in the ICF Browser ICF Checklist and the World Health Organization Disability Assessment Scale (WHODAS) 2.0.

Some studies performed some level of functional assessment, including:

• Assessment of Post-COVID-19 Functional Status (PCFS) [82][83][84][85]
• COVID-19 Yorkshire Recovery Scale (C19-YRS) [17][86][46][87]
• The core outcome measure of recovery is a measure that defines return to daily activities without symptoms and return to pre-illness state of health using a 5-point Likert scale [88][89]
• Sit-to-stand tests [84][90][91]
• Gait speed tests[37][84][92][93][94][95]
• Modified Rankin Score [96]
• EuroQOL EQ-5D-5L [37]
• SF-36 questionnaire [90]
• WHODAS 2.0 [48]
• Washington Group on Disability Statistics [48] [52].

Measurement tools such as the DePaul Symptom Questionnaire [98] may be appropriate to assess post-exercise discomfort [97]. Post-exercise discomfort has been reported in Long COVID patients [30], and the presence of this symptom suggests that exercise is not a safe rehabilitation intervention. [99]

The World Health Organization (WHO) invites clinicians and patients to systematically collect information on COVID-19 and contribute clinical data to the WHO clinical platform to expand knowledge on Long COVID (herein referred to as post-WHO post-COVID-19 disease), and to support patient care and the public health intervention. WHO’s post-COVID case report form (CRF) is designed to report standardized clinical data after an individual’s discharge from hospital or after an acute illness to examine the medium and long-term consequences of COVID-19. These forms will be available in a variety of forms language. The CRF included questions on functioning and disability adopted from the WHODAS 2.0 12-item self-report questionnaire (section 2.5).

Management / Interventions

There is currently insufficient evidence of safe and effective interventions for the management of Long COVID symptoms and impairment or disability. The World Health Organization has called on countries to provide more rehabilitation services for Long COVID patients. [100]

The National Institute for Health and Care Excellence (NICE) warns against the use of graded exercise therapy (GET) to manage post-viral fatigue [79] in response to updated draft guidelines on the management of myalgic encephalomyelitis/chronic fatigue syndrome (ME) /CFS).[99][101] There are substantial concerns about the potential harm of GET as an intervention for ME/CFS. [102] Post-exertional malaise is a symptom experienced by patients with ME/CFS [103] and is characterized by exacerbation of symptoms after exertion, including physical cognition and Emotional activity [104][105][106] inhibits motor interventions. Of the 3762 individuals with Long COVID, 72.2% reported post-exercise discomfort and exercise was a common trigger for symptom recurrence[30][32] Exercise as a form of rehabilitation needs to be treated with caution Interventions for Long COVID and COVID-19 patients.

Groups representing Long COVID patients advocate a risk-stratified approach to exercise as a rehabilitation intervention. Due to 32% of Cardiac injury in a young and low-risk population with prolonged COVID and persistent symptoms. [29]

The National Health Service (NHS) offers a free online self-managed recovery service called Your COVID Recovery for people who have recovered from COVID-19.

The Mount Sinai Long COVID Recovery Program is offering free online breathing training for Long COVID known as STASIS.

The National Institutes of Health (NIHR) recently funded a research award for the Rehabilitation Exercise and Psychological Support after covid-19 infection (REGAIN) study. [108]

Activity management or pacing may be a safe and effective intervention for managing fatigue and post-exercise discomfort. Heart rate monitoring may be a safe and effective intervention for managing fatigue and post-exercise discomfort. Helpful resources on pacing and heart rate monitoring Provided as follows:

• World Physiotherapy Response to COVID-19: Safe Rehabilitation Approaches for Long-Term Covid Patients: Physical Activity and Exercise. June 2021
• Royal College of Occupational Therapy (RCOT): Post-viral fatigue and energy conservation
• Royal College of Occupational Therapy (RCOT): How to cope with post-viral fatigue after COVID-19 – practical advice for those in hospital
• Royal College of Occupational Therapy (RCOT): How to cope with post-viral fatigue after COVID-19 – practical advice for home recoverers
• Royal College of Occupational Therapy (RCOT): How to conserve energy
• Workwell Foundation & Dialogues ME/CFS: Activity and Energy Management – Cadence
• PhysioForME: “Pacing”
• Sheffield Hallam University Advanced Health Research Center (AWRC): Fatigue Video 1 Video 2 Video 3 Video 4
• ME Actions: Guidelines for Pacing and Management of ME/CFS
• Actions for ME: Pacing for People with M.E. A detailed guide to managing energy rest and activity for adults with mild/moderate M.E.
• Emerge Australia: “Pacing”
• PhysioForME: “Heart Rate Monitoring”
• PhysioForME: Heart Rate Monitoring Podcast
• ME Society: Assessing Post-Exercise Malaise (PEM) Page 6

Peer Support

Peer support involves people sharing knowledge, experiences or practical help with each other on a regular basis with the same or similar health conditions. A number of online Long COVID peer support groups have been established for Long COVID patients. These are safe spaces to live with Long COVID for peer support. Therefore, mutual respect and confidentiality are required within these groups. Many of these groups have an output of sharing valuable information with allies. Long COVID Physio blogs with JOSPT, emphasizing the value of peer support. Long COVID groups include:

• Long COVID Physio – Twitter
• Body Politic – Twitter
• Long COVID Support – Twitter
• Long COVID SOS – Twitter
• Long COVID Kids – Twitter
• Long COVID Italia
• Apres J20 (France) – Twitter
• Long COVID Wales
• Long COVID Scotland – Twitter
• Long COVID Netherlands
• Long COVID Spain
• Covid Persistente Espana
• Covid Persistent Andalusia
• Long COVID Aragon
• Long term COVID Germany – Twitter
• Long COVID Valencia
• Long COVID Switzerland
• COVID-19 Longhauler Awareness Project (USA)
• Long COVID Minnesota
• Utah COVID-19 Long Haulers
• CanCOVID (Canada) – Twitter
• Long COVID Canada
• Long COVID Indonesia
• Ongoing COVID Mexico Solidarity Communities
• COVID Persistente Mexico
• COVID Persistente Chile
• COVID-19 Persistent Uruguay
• COVID-19 Persistente Argentina
• Long COVID New Zealand
• COVID-19 Patient Stories/Recovery Collective – Twitter
• Patient-Led Long COVID Research – Twitter
• Long COVID OT (Occupational Therapy) – Facebook
• Long COVID in Academia