15 Things About the Diagnosis, Management, and Treatment of Long COVID

A set of articles published Tuesday offer guidance about the diagnosis, assessment, and treatment of people with long COVID.

The practice articles were published in the CMAJ (Canadian Medical Association Journal). About 1.4 million people in Canada have been affected by long COVID, a systemic condition that can affect most organ systems in the body.

Long COVID is defined by symptoms lasting longer than 3 months after a confirmed or suspected SARS-CoV-2 infection. More than 100 symptoms have been reported, with the most common including fatigue, anxiety and depression, shortness of breath, sleep disturbances and heart palpitations.

Each of the 3 articles contain 5 points about the diagnosis, assessment, and treatment of the condition, with a focus on the “potentially modifiable” aspects.

"I believe that the most important thing that we as health care providers can do to support people is to listen and validate their experiences, and to avoid a diagnostic cascade of endless tests and consultations that further tax their limited energy supply," Kieran Quinn, MD,PhD, a general internist and palliative care physician, Sinai Health, and an assistant professor, University of Toronto and Institute of Health Policy, Management and Evaluation, said in a statement.

Although the World Health Organization has proposed a definition of the condition, “the sensitivity, specificity, and positive and negative predictive value of definitive diagnostic criteria” are not yet known, according to one paper.

Besides the fact that nearly 1.5 million Canadians have long COVID, the paper noted that women are more likely to be affected than men.

The systemic nature of long COVID may be due to the expression of angiotensin-converting-enzyme 2 (ACE2) receptors in different organ systems, which provide entry to SARS-CoV-2.

Lingering symptoms may continue for a year or more, the paper said. In studies conducted in both China and Canada, about the same proportion of people reported that long COVID kept them out of the workforce or away from their daily activities.

The most common potentially treatable symptoms include fatigue (reported by 23%–63%); anxiety and depression (23%–46%); dyspnea (11%–43%); sleep disturbances (11%–31%); and palpitations (6%–22%). These symptoms may warrant assessment to rule out other factors and causes.

If other causes are not found, treatment for each one could include the following:

• For fatigue, a structured and symptom-guided return to activity program, tailored to their severity of fatigue
• For mental health, guideline-directed use of psychosocial interventions and medications
• For dyspnea, breathing exercises, body positioning, and pulmonary rehabilitation
• For sleep problems, sleep counseling, relaxation techniques, and stimulus control, which may include cognitive behavioral counseling and prescription medications.
• For palpitations and tachycardia with certain causes, behavioral modifications, oral fluids, salt, compression stockings, beta-blockers, ivabradine and midodrine.

References

1. Quinn KL, Razak F, Cheung A. Diagnosing post-COVID-19 condition (long COVID) in adults. CMAJ 2023 January 17;195:E78-9. doi: 10.1503/cmaj.220818

2. Quinn KL, Razak F, Cheung A. Assessing common and potentially . modifiable symptoms of post-COVID-19 condition (long COVID) in adults. CMAJ 2023 January 17;195:E76-7. doi: 10.1503/cmaj.220823

3. Quinn KL, Razak F, Cheung A. Treating common and potentially modifiable symptoms of post-COVID-19 condition (long COVID) in adults. CMAJ 2023 January 17;195:E80-1. doi: 10.1503/cmaj.220824