COVID-19 Long-Haulers May Benefit From Specialized Care, Review Notes

Although the medical community is still coming to grips with how to treat COVID-19, even less is known about how to care for those suffering from its long-term adverse effects, also known as long-haulers.

An estimated 10% of COVID-19 survivors continue to experience symptoms for 60 days and some as long as 6 months—a condition now called post-acute sequelae of SARS-CoV-2 infection (PASC), according to a report in the Cleveland Clinic Journal of Medicine. The most commonly reported systems include fatigue, cough, labored breathing, chest tightness, difficulty concentrating, joint pain, loss of smell, and headache. Young, previously healthy individuals are at risk of PASC, not just those who are older with comorbid medical conditions, with 20% of suspected cases in adults aged 18 to 34 years.

Patients with COVID-19 symptoms for at least 4 weeks should be assessed for pulmonary, cardiac, neurocognitive, and psychiatric complications, according to the report. Care for patients with PASC calls for a comprehensive multidisciplinary approach that incorporates detailed management of comorbid medical conditions. If there is a post–COVID-19 clinic available, referral is recommended. Patient evaluation may uncover underlying chronic lung or cardiovascular disease and motivate patients who had not been visiting the doctor to schedule routine visits.

Currently, there are no specific treatments for PASC. Therefore, management should focus on the most bothersome symptoms, such as fatigue or cognitive impairment, although data on efficacy are lacking, the authors said. Because of the condition’s effects on both the physical and psychological level, as well as its complexity and impact on multiple organ symptoms, it is critical to establish a rapport with the patient and involve their support system.

The National Institutes of Health is working to build a consensus definition and terminology for PASC and to launch a unified initiative that would include $1.15 billion in grant funding over the course of 4 years to investigate PASC and its treatment, the authors said.

Possible causes of PASC that are being explored are a persistent hyperinflammatory state, inadequate antibody response, ongoing viral activity, and organ damage stemming from COVID-19’s infectious phase, according to the authors. Despite the chronic symptoms involved in PASC, the CDC reports that most patients are unlikely to be contagious after 10 days, with 20 days being the longest period requiring precautions to prevent spread.

There are some early studies with results, the authors added. A study from Italy found that 60 days after onset of COVID-19 symptoms, only 12.6% of patients were symptom free, 32% had 1 or 2 symptoms, and 55% had 3 or more symptoms. Other studies indicated at least 1 persistent symptom, most commonly fatigue or dypsnea, in more than half of patients at 110 or 180 days, suggesting the longest duration is still unknown.

Another study found continued fatigue in 63% of patients after a COVID-19 diagnosis, sleep difficulties in 24%, and anxiety or depression in 23%. The level of persistent lung diffusion impairment and exercise intolerance at 6 months correlated with the severity of COVID-19 illness.

One study also compared lingering symptoms in patients who were hospitalized to those admitted to an intensive care unit (ICU), finding no statistically significant difference. But a British study found that those admitted to the ICU had nearly twice the rate of psychological distress than those admitted to a general ward.

A single-center study in France found 25% of previously active workers had returned to work after 110 days, while another study, from Michigan, found 40% of previously employed workers had not returned to work after 60 days, and 15% had returned with reduced hours or responsibilities.

Reference

Vehar S, Boushra M, Ntiamoah P, Biehl M. Post-acute sequelae of SARS-CoV-2 infection: Caring for the ‘long-haulers.’ Cleve Clin J Med.2021;88(5):267-272. doi:10.3949/ccjm.88a.21010