Treatment for COVID long-haulers: 7 things providers should know

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As the pandemic continues, there's still a lot unknown about COVID-19, particularly in patients whose symptoms persist, recur or reappear four or more weeks after first being infected.

Though information about post-COVID conditions remains incomplete and guidance for healthcare professionals will likely change over time, the CDC provides interim guidance for clinicians, last updated July 9.

Below is everything providers should know about post-COVID conditions and treatment, per the CDC.

What are post-COVID conditions?

Post-COVID conditions encompass a wide range of new, returning or ongoing health problems people can experience four or more weeks after being infected with SARS-CoV-2. Patients may have different types and combinations of health problems for different lengths of time.

Post-COVID conditions are referred to by a wide range of names, including long COVID, post-acute COVID-19, long-term effects of COVID, chronic COVID and long-haul COVID.

Unlike some of the other types of post-COVID conditions that tend only to occur in people who have had severe illness, these symptoms can happen to anyone who has had COVID-19, even if illness was mild or they reported no initial symptoms. 

Who suffers from post-COVID conditions?

Most people with COVID-19 get better within a few weeks of illness, though some do experience post-COVID conditions. People of any age who have had COVID-19 can later develop a post-COVID condition. Post-COVID conditions appear to be less common in children and adolescents than in adults, though long-term effects after COVID-19 do occur for younger individuals. Studies have found long-term symptoms in children who had both mild and severe COVID-19, including those who previously had multisystem inflammatory syndrome in children.  

What are the most common post-COVID conditions?

People commonly report experiencing different combinations of the following symptoms:

  • Difficulty breathing or shortness of breath
  • Fatigue
  • Symptoms that get worse after physical or mental activities (post-exertional malaise)
  • Difficulty thinking or concentrating (brain fog)
  • Cough
  • Chest or stomach pain
  • Headache
  • Heart palpitations
  • Joint or muscle pain
  • Pins-and-needles feeling
  • Diarrhea
  • Sleep problems
  • Fever
  • Dizziness on standing 
  • Rash
  • Mood changes
  • Change in smell or taste
  • Changes in menstrual cycles

What are the multiorgan effects of COVID-19? 

Some people who had severe COVID-19 illness suffer from multiorgan effects or autoimmune conditions over a longer time, with symptoms lasting weeks or months after COVID-19 illness. Multiorgan effects can affect many, if not all, body systems, while autoimmune conditions cause inflammation or tissue damage in affected parts of the body.

Some people, mostly children, experience multisystem inflammatory syndrome during or immediately after a COVID-19 infection, though it is very rare. MIS can lead to post-COVID conditions if a person continues to experience multiorgan effects or other symptoms.

How can hospitalization and severe COVID-19 affect recovery?

Hospitalizations and severe illnesses for lung-related diseases such as COVID-19 can cause severe weakness and exhaustion during recovery.

Effects of hospitalization can also include post-intensive care syndrome, which begins when a person is in an intensive care unit and can remain even after a person returns home. This can include severe weakness, problems with thinking and judgment, and post-traumatic stress disorder.

Some symptoms that can occur after hospitalization are similar to symptoms that people with initially mild or no symptoms may experience weeks after COVID-19. It can be difficult to know whether they are caused by the effects of hospitalization, long-term effects of COVID-19 or a combination of both. These conditions may also be complicated by other effects related to the pandemic, including mental health effects from isolation, socioeconomic conditions and lack of access to care for managing underlying conditions. These factors can affect both people who have had COVID-19 and those who haven't.

Who should provide care for patients with post-COVID conditions?

Based on current information, many post-COVID conditions can be managed by primary care providers. Patient-centered approaches should be incorporated to optimize patient quality of life.

How should post-COVID conditions be assessed?

Lab or imaging findings shouldn't be used as the only measure or assessment of a patient's well-being, according to the CDC. Lack of lab or imaging abnormalities doesn't invalidate the existence or severity of a patient's symptoms.

Healthcare providers should set achievable goals through shared decision-making and approach treatment by focusing on specific symptoms or conditions.

 

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