It's not over till it's over: a narrative review of Long COVID

Abstract

Viral persistence following acute COVID infection is increasingly being reported by patients and gradually being recognized as a medical syndrome. Like much about COVID, this so-called Long COVID is perplexing. It is associated with numerous symptoms, foremost among them profound fatigue, and often occurs in a relapsing/remitting pattern. There is one “living” guideline for managing Long COVID and even terminology and definitions of the syndrome are in flux. Long COVID occurs in patients who have recovered from the acute infection and this may be viral persistence, a form of autoimmunity, or the long-term results of organ damage sustained during the acute infection. Symptoms have been reported up to six months after acute infection with no clear association between the severity of the acute infection and the presence or absence of Long COVID. The symptoms of the acute illness do not necessarily align with the symptoms of Long COVID. Disruptions to the autonomic function in Long COVID are particularly puzzling, including orthostatic intolerance syndrome (which may not have occurred during the acute infection). Loss of the sense of smell and taste is one symptom that appears common in both acute and Long COVID; on the other hand, fever is more prevalent in acute than Long COVID. Research is urgently needed to better understand Long COVID, for example: what is the role of elevated biomarkers such as D-dimer and C-reactive protein in Long COVID? Is Long COVID one or more than one syndrome? How can patients with Long COVID be appropriately treated?

Pain Management and COVID-19: A Latin American Perspective

“…Although older age is a risk factor for acute COVID-19 infection, it does not seem to be a risk factor for long COVID-19 [22]. Moreover, the symptoms that occurred in acute COVID-19 are not necessarily the same as the symptoms that emerge in long COVID-19 [19].…”

“…Long-haul COVID-19 or long COVID-19 is a postviral syndrome that was first reported online by people discussing their symptoms after COVID-19 resolution and has since been described in the literature [18]. Symptoms of long COVID-19 are many, but prominent among them are chronic fatigue, diffuse myalgia, and sleep disorders [19]. Postviral syndromes have occurred with other viruses, such as the severe acute respiratory syndrome (SARS) epidemics in 2002 [20].…”

The impact of COVID-19 on chronic pain

“…The first group included those whose chronic pain first prevailed after COVID-19 infection, which may be categorized as a variety of post-viral chronic pain in which the pain is either directly related to organ damage caused by the acute infection or an entity referred to as long COVID-19 ( 8 ). Long COVID-19 is defined in the current literature as a post-viral syndrome, which comprises sleep disorders, chronic fatigue, and diffused myalgia ( 9 , 10 ). This syndrome occurs in those who recover from acute COVID-19 infection with prolongation of the previously described symptoms for over 4 weeks ( 10 ).…”

“…Long COVID-19 is defined in the current literature as a post-viral syndrome, which comprises sleep disorders, chronic fatigue, and diffused myalgia ( 9 , 10 ). This syndrome occurs in those who recover from acute COVID-19 infection with prolongation of the previously described symptoms for over 4 weeks ( 10 ). The pathology for this syndrome is not well defined and comprises primary symptoms related to the cardiovascular, neurological, psychological, and pulmonary systems such as, but not limited to, brain fog and other cognitive deficits, disordered sleep patterns, autonomic disturbances, dyspnea, anosmia, chest and joint pains, cardiac arrhythmias, and neuropathies ( 10 ).…”

Updates on Palliative Medicine in the COVID-19 Era

“…A complete change in healthcare access [17] due to reallocation of resources and redeployment, as well as the impact of the pandemic on the mental health of caregivers and health workers, is further challenging the teams that are already struggling to provide adequate care [18]. Additionally, we are starting to learn about the new needs of the COVID-19 palliative care patients, such as managing long-COVID-19 symptoms and breathlessness [10,19]. Moreover, palliation is a paradigm shift for healthcare professionals who are trained to use sometimes heroic and extreme measures to prolong life.…”