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Post-acute COVID-19: Classifying long COVID syndrome

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Dr Elizabeth Sunila CX, Consultant – Pulmonology, Aster Medcity talks about long COVID syndrome

As one is aware, long COVID syndrome consists of a myriad of multisystem symptoms which are manifested for a variable period after COVID-19 infection. Ever since COVID-19 emerged as a pandemic, the variable biopsychosocial effects of the disease have fascinated the medical society. Variability as a term was ever more frequently used to describe various aspects. The severity of illness is variable among masses, the rate of recovery is variable, the amount of sequela is variable and so on. This article therefore intends to describe long COVID syndrome, its implications and management.

Like any other viral infection COVID-19 also affects many organ systems including the lungs, heart, brain, kidneys, liver, clotting systems, vascular systems, immune systems etc. In most people, the symptoms subside after a short interval of few days to weeks. Many experience mild to moderate illness varying from systemic symptoms like a running nose, body ache, fatigue, fever to moderate pneumonia without a dip in oxygen levels which is usually treated in an OPD or clinics.

A fraction of people develop severe debilitating pneumonia with ARDS, sepsis, Multiorgan Dysfunction Syndrome (Heart, kidneys, liver, brain) and lung failure, requiring ICU admission, invasive ventilation and perhaps ECMO. Despite treatment some succumb to death after fighting for a variable period of time in ICUs. The time for complete resolution from such an illness is expected to be few weeks to months. The time for complete resolution and going back to normalcy is again variable. A few factors affecting the same are mainly severity of the Covid illness-

  • CT Severity Score
  • Need for ICU admission
  • Ventilatory requirements
  • No damage to organ systems
  • Time required for recovery
  • Amount of residual fibrosis

Critical illness polyneuropathy

This also comprises of the status of the patient prior to illness, which include age, comorbidities, status and reserve of each organ systems, BMI, functional status, and physical activity before the illness.

Classification (Week’s post infection)

An early description of long COVID syndrome portrays a miscellany of symptoms that are distinct from those of patients recovering from severe COVID-19 who required hospitalisations. Long COVID syndrome is a term to describe illness in people who have either recovered from Covid-19 but are still reporting lasting effects of infection or have had the usual symptoms for far longer than would be expected. As our experience increases over the last 2 years, we classify the disease as Long COVID or POST-ACUTE COVID (symptoms beyond 3 weeks) and chronic post‐COVID syndrome (beyond 12 weeks). Studies report quite variable incidences; on an average 1 in 10 people affected with mild to moderate Covid illness are unwell after 3 weeks or more. Two fifth of people reported a worsened quality of life. There are studies reporting that only 13 per cent of people were completely free of any symptoms after 60 days of discharge from hospitals. Even those patients who were asymptomatic during the time of illness develops new nonspecific symptoms after few weeks of illness. Though the symptoms are mostly nonspecific, most common symptoms are fatigue, exertional breathlessness, chest discomfort, joint and muscle pain, palpitation, decreased sleep. Some studies showed that two thirds of patients reported at least one symptom on both 30th and 60th days of symptom onset. Even those who had mild to moderate disease who were managed in an OPD experienced long COVID syndrome, later, with ongoing morbidity and disability following noncritical illness. Rare syndromes like Guillen Barrie Syndrome, Myesthenia Gravis, Positional Orthostatic Tachycardia Syndrome are other rare conditions associated with post COVID illness.

The exact reasons for prolonged symptoms are not clearly understood and it is thought to be an ongoing inflammatory process in recovering patients. Treatment is focused on a multifaceted approach to tackle the physical, cognitive, psychological, social, and vocational domains of this health condition. These patients have complex needs in multiple domains and require a multidisciplinary team that has representation from hospital medical specialists (Respiratory Medicine, Cardiology, Rehabilitation Medicine) and Cognate Disciplines (these include physiotherapy, occupational therapy, psychology, speech and language therapy along with dietetics). Recognising long-term effects early, maintained with thorough regular follow-ups at dedicated multidisciplinary outpatient clinics that are supported with meticulously integrated research agenda are essential for treating COVID-19 survivors holistically.

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