Long COVID

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Updated 9 May 2022

Long COVID is the name used to describe symptoms that continue or develop after someone has COVID-19 (4 weeks from the initial infection). The most common Long COVID symptoms are fatigue, shortness of breath, loss of smell, impairment of functional mobility, changes in mental health (depression, anxiety), sleep disturbances, and concentration difficulties), which can impact daily functioning. Long COVID symptoms in children (<18 years) are typically resolved within 1–5 months, although it is important to contact your child’s GP if your child has an ongoing fever. For more information visit KidsHealth.

Information for Patients

Information for GPs and other health professionals

 

Summary

The most common Long COVID symptoms are fatigue, shortness of breath, loss of smell, impairment of functional mobility, changes in mental health (depression, anxiety), sleep disturbances, and concentration difficulties), which can impact daily functioning.

Long COVID symptoms in children (<18 years) are typically resolved within 1–5 months. Contact your child’s GP if your child has an ongoing fever. To know more, follow KidsHealth. Vaccinated people are mostly asymptomatic or present with mild symptoms while infected, and report less symptoms of long COVID.

The long-term effects of the Omicron variant are still unknown, but many studies suggest that even a mild infection of SARS-CoV-2 can cause Long COVID.

Several studies into the cardiovascular impacts have confirmed the adverse effects of COVID-19 on microcirculation and endothelium. A study involving the national databases of the US Department of Veterans Affairs (n = 12,095,836) showed increased risks of cardiovascular diseases (CVD) in the 12 months after acute COVID-19 infection, irrespective of age, race, sex and other cardiovascular risk factors, previous history of CVD, and severity of acute phase of COVID-19. Another recent publication with the same database showed people with COVID-19 exhibited an increased risk (HR 1·40, 95% CI 1·36–1·44) and excess burden (13·46, 95% CI 12·11–14·84, per 1000 people at 12 months) of incident diabetes. Based on their model it is predicted that if one million New Zealanders caught Omicron, 300-900 additional heart attacks and 400-1200 extra strokes would be expected in the following year.

A recent cohort study with 236,379 patients diagnosed with COVID-19 confirmed the increased risk of neurological or psychiatric disorders with the severity of the infection in the following six months (33·62%, 95% CI 33·17–34·07). Among them, 12.84% were the first to be diagnosed. A Mendelian study supported these findings and showed the association of Alzheimer’s disease with the severity of COVID-19 infection. Further to the health impacts, Long COVID has a severe economic impact: in the USA, 1 million people are currently out of work due to chronic illness following COVID infection. The UK is also facing a surge of longer-term absence from work and economic threats.

Long COVID Management

The University of Zurich has developed a prediction model, the PACS score, to predict the risk of Long COVID and help in early detection and treatment. The patient’s age, history of asthma, number of symptoms during the primary infection, and IgG3 and IgM levels are included in the model.

Kidney function should be monitored in Long COVID care. Multiple studies including a large cohort (n = 1,726,683) from the USA exhibited an increased risk of kidney issues.

Blood results should be regularly monitored, and individuals’ thrombotic risk should be regularly evaluated based on their comorbidities and coagulation profile as some patients have reported late-onset thrombocytopenia related to immune system dysregulation.

Glucocorticoids may be an alternative treatment option for patients who are not responding or who are intolerant to conventional therapy. However, avascular necrosis (AVN) of bone due to steroid treatment should be a concern while prescribing. Orthopaedic departments worldwide are reporting a higher number of cases of AVN among those who received steroid treatment during acute infection.  

Several novel treatment options have been proposed, including stellate ganglion block, non-invasive brain stimulation (NIBS) to treat cognitive and visual impairments, and montelukast in cases with respiratory problems.

Announcements

International:
  • NIH awarded $470 million to support diverse research on the long-term effects of COVID-19 at 30 institutes. The NIH REsearching COVID to Enhance Recovery (RECOVER) Initiative has started recruiting children and young adults who previously tested positive for COVID-19 to track the impact on their physical and mental health over three years. Details of the study are accessed here.
  • President Biden has announced disability protection rights for the COVID long hauliers.
  • Finland’s Minister of Family Affairs and Social Services Krista Kiuru said around 20% of its population are experiencing cognitive impairment due to Long COVID.
  • The US National Institutes of Health (NIH) has launched a $1.15-billion research investigation over four years into long COVID.
  • The FDA approved an experimental antiviral medication (molnupiravir) for emergency use on 30th Nov 2021.
  • The University of Helsinki is conducting an extensive multinational online survey (international COVID sleep study (ICOSS)) on sleep and circadian rhythm pattern with COVID survivors. The study collected data across four continents: Europe, North America, South America, and Asia.
  • The January 2022 UK Government's Office of National Statistics (ONS) report indicated that around 2% of its total population had self-reported Long COVID and had the symptoms for one year. The vaccinated population had lower risks of Long COVID.
Aotearoa New Zealand:
  • Victoria University of Wellington has been granted $1.2 million to establish a longitudinal study in New Zealand to understand the short- and long-term impacts of COVID-19 and highlight equity issues anticipated by the cohort.
  • University of Otago's Emeritus Professor Warren Tate and colleagues have received funding from Brain Research New Zealand to study the relationship between Long COVID and myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS). As a co-investigator, Dr Anna Brooks and her team from the University of Auckland are investigating the immunological aspects of Long COVID.

 

The information on this page was prepared by multi-disciplinary health professionals at the National Institute for Health Innovation and affiliates and was originally created on 9 December 2020.