<strong>Long COVID, A Comprehensive Systematic Scoping Review</strong>

Abstract

Introduction: Despite more than one year passed since the first cases of SARS-CoV-2 were reported, there is still no consensus on the definition and clinical management of post-acute-COVID-19. The condition has heterogeneously been named as Chronic COVID syndrome, Post COVID-19 Syndrome, post-acute sequela of SARS-CoV-2 (PASC), and the more familiar long COVID. Method: In order to capture all relevant published studies, we undertook a multi-step search with no language restriction. The following four-step search strategy was utilized: First, a preliminary (limited) search was conducted on January 20, 2021, in Google Scholar and PubMed to identify the appropriate keywords. Then, on January 30, 2021, we adopted a search strategy of electronic databases from Cochrane Library, PsycINFO, PubMed, Embase, Scopus, and Web of sciences, using those keywords. Then, after duplicate removal, we screened all titles, abstracts, and full texts. This resulted in 66 eligible studies. Subsequently, after a forward and backward search of their references and citations an additional 54 publications were found, resulting in a total of 120 publications that formed the basis of the present analysis. The titles, abstracts, and full-texts of non-English articles were translated using Google Translate for further evaluation. We conducted our scoping review based on the PRISMA-ScR Checklist.Results: We found only one randomized clinical trial in our search. Of the 67 original studies, 22 were cohort and 28 were cross-sectional studies totaling 74.6% of the original studies. Of the total of 120 publications, 59 (49.1%) focused on signs and symptoms, 28 (23.3%) were focused on management, and 13 (10.8%) focused on pathophysiology. Ten (9%) publications focused on imaging studies. Ninety-one percent of the original investigations came from high and upper-middle-income countries, highlighting the scarcity of reports originating from low-income and lower-middle-income countries.Conclusion: The predominant symptoms among those with the so-called &amp;ldquo;Long COVID&amp;rdquo; were: fatigue, breathlessness, arthralgia, sleep difficulties, and chest pain. Recent reports also point to the risk of long-term sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness. The ambiguity and controversies in its definition have impaired proper recognition and management of those requiring additional support following the resolution of the acute phase of this infection. This has resulted in long-standing distress for the patients and their families. Our findings highlight the need for a multidisciplinary approach, support, and rehabilitation for these patients in terms of long-term mental and physical health.

Post-Covid-19 Syndrome, Inflammatory Markers and Sex Differences

“…The second most frequent symptom of PCS was anosmia (41.7% of women and 36.4% of men) .. As previously published, COVID-19 anosmia is more common in women [48], young patients [3], and mild forms of the disease [49]. Regarding biomarkers, we found that women with anosmia had a significantly higher neutrophil count.…”

“…Fatigue, myalgia, dyspnea, anosmia, ageusia, autonomic dysregulation (manifested as orthostatic hypotension, tachycardia, thermoregulatory or gastrointestinal alterations), anxiety, depression, and cognitive problems were the main symptoms reported [1,2]. These clinical manifestations fluctuate over time [3], and can significantly affect the quality of life [4].…”

“…Most of the PCS reports have been carried out on post-discharged patients [3], with overrepresented comorbidity and after a moderate or severe COVID-19. In this sense, it has been recommended [16] to study PCS in mild COVID-19, in a community setting, since this approach makes it possible to analyze PCS, reasonably ruling out persistent symptoms due to comorbidities or to organ sequelae.…”

Orthostatic intolerance in adults with long COVID was not associated with postural orthostatic tachycardia syndrome

“…While SARS CoV 2 might be able to affect neurovascular integrity via direct cytotoxic or indirect pro-inflammatory mechanisms (Khosravani, 2021), our results are in the context of a high burden of psychological symptoms, which is in keeping with other reports (Bucciarelli et al, 2021;Qi et al, 2021). Given our recruitment focus, the proportion of fatigue in our cohort was higher than elsewhere (Akbarialiabad et al, 2021;Lopez-Leon et al, 2021;Sanchez-Ramirez et al, 2021;Sandler et al, 2021). For contextualization to our cohort, previous research showed that a CFQ score of 29 discriminated between chronic fatigue sufferers and controls in 96% of cases [36]; CES-D scores of 16 or greater can signal risk for clinical depression (Lewinsohn et al, 1997); and an IES-R score of 33 and above is suggestive of PTSD (Creamer et al, 2003).…”

Musculoskeletal Components of Post-Acute Sequelae of SARS-CoV-2 Infections

“…Typically, PASC had been defined as persistent symptoms and/or delayed or long-term complications of SARS-CoV-2 infection beyond 4 weeks from acute COVID-19 onset 3 . Symptoms of PASC have been reported in systematic reviews as including general fatigue, muscle weakness, diaphoresis, myalgia, arthralgia, chills, limb edema, dizziness, respiratory symptoms (polypnea, chest pain, cough, sputum, sore throat), cardiovascular abnormalities, alopecia, olfactory abnormalities, psychosocial symptoms such as sleep difficulties, depression, anxiety, dysphoria, feelings of inferiority, and generally a worse quality of life 2-17 . There is evidence that an increased severity of COVID-19 during the acute period 2,3,18 and being older as well as having more comorbidities increase the risk of post-COVID symptoms 6,19,20 .…”