Long COVID/Post-COVID conditions

Most people with COVID-19 recover and return to normal health within weeks of illness. However, some people experience symptoms that last for weeks or even months after recovery from acute illness.

These conditions can have different combination of symptoms for different length of time. To describe these wide range of health consequences that are present four or more weeks after infection with SARS-CoV-2, healthcare professionals may use an umbrella term -post COVID conditions. These post-COVID conditions may also be known as long COVID, post-acute COVID-19, long-term effects of COVID, or chronic COVID.

The WHO International Classification of Diseases (ICD) – ICD-10 U09 has proposed the name post COVID-19 condition.  

A clinical case definition of post COVID-19 condition by Delphi consensus (WHO, 6 October 2021)

Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.

(Definitions: Fluctuate – a change from time to time in quantity or quality. Relapse – return of disease manifestations after period of improvement).

People are not infectious to others during this time. Developing symptomatic Long COVID is not related with the severity of the initial COVID-19 infection or the duration of symptoms associated with it. Even people who have mild symptoms in initial illness can experience late symptoms. 

References-

 

People suffering from Long COVID experience symptoms affecting many body systems which may change overtime. These conditions can have different combinations of health problems for different lengths of time.  

Most common post-COVID-19 symptoms are:

General symptoms

  • Tiredness/Weakness / fatigue
  • Recurrent fever

Respiratory symptoms

  • Difficulty in breathing
  • Persistent cough

Cardiovascular symptoms

  • Chest pain
  • Chest tightness
  • Palpitations

Neurological symptoms

  • Difficulty thinking or concentrating (brain fog)
  • Headache
  • Sleep disturbances
  • Dizziness

Gastrointestinal symptoms- Abdominal pain, diarrhea, nausea,

Musculoskeletal symptoms- Joint and muscle pain

Ear nose and throat symptoms- Loss of smell or taste, earache, sore throat, dizziness, tinnitus (ringing in ears)

Dermatological-Skin rash

Psychological symptoms

  • Symptoms of depression
  • Symptoms of anxiety

Long COVID is different from the well-recognized postintensive care syndrome, which is marked by chronically impaired pulmonary function, neuromuscular weakness, long-term psychological impacts and reduced quality of life.

References

 

There are two major reasons for post-COVID-19 symptoms:

Multiorgan effects of COVID-19: Although COVID-19 primarily affects lungs but can affect all organs including heart, brain, liver, kidney. This organ damage may increase the risk of long-term health problems.   

Immunity-related: Autoimmune conditions occur when our immune system attacks healthy cells in our body by mistake, causing inflammation (painful swelling) or tissue damage in the affected parts of the body.

Reference-

 

There is no simple test for diagnosing Long COVID. A clinical diagnosis can be made based on a history of COVID-19 and a failure to fully recover with development of some of the symptoms.

Assessment of medical condition is done according to the individual’s problems, after excluding any coexisting illness that may be giving rise to the symptoms. For example

  • In Individuals with respiratory symptoms, a chest X-ray can be advised.
  • In persons with symptom of dizziness blood pressure is checked for the postural drop (lying and standing blood pressure and heart rate)
  • Persons with complains of chest pain, palpitations or mental illness can be referred to specialists.

References-

 

There are different ways to help manage post-COVID conditions. If you think you have a post-COVID condition, talk to your healthcare provider about options for managing or treating your symptoms and resources for support.

Self-care

  • Take care of your health, make sure you are eating well. Eat a variety of foods to ensure adequate intake of important nutrients including staple foods (e.g. cereals such as wheat, barley, rye, maize or rice, or starchy tubers or roots such as potato), legumes (e.g. lentils, beans), variety of fruit and vegetables and foods from animal sources (e.g. meat, fish, eggs and milk) with reduced salt intake and total fat intake (replacing both saturated fats and trans-fats with unsaturated fats)
  • Drink enough fluids to keep hydration levels of your body well-maintained during the illness and also post-illness.
  • Make sure you are sleeping well.
  • Take regular breaks in between activities by setting easy goals to begin with.
  • Spend time with your friends and family (if not in person then by phone or video call).
  • Exercise is good for both physical and mental wellbeing, go for a walk or practice yoga and can do breathing exercises. 
  • Confide in trusted friends or family about your own feelings
  • Ask for help from family and friends, you can join a support group in the community or online resources.

Know More National Comprehensive Guidelines for Management of Post-COVID Sequelae [for doctors], Ministry of Health and Family Welfare, Government of India

References-

Post COVID management protocol: https://www.mohfw.gov.in/pdf/PostCOVID13092020.pdf

 

The best way to prevent these long-term complications is to prevent COVID-19 by adopting following measures:  

  • Wear a mask that covers your nose and mouth to help protect yourself and others.
  • Keep your distance: Stay 6 feet apart from others who don’t live with you.
  • Wash your hands frequently with soap and water. Use hand sanitizer if soap and water aren’t available.
  • Cough & sneeze into your elbow.
  • Avoid crowds and poorly ventilated indoor spaces.
  • Keep good Ventilation or open windows.
  • Get a COVID-19 Vaccine on your turn. 

Reference-

https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html

 

  • PUBLISHED DATE : Jul 29, 2021
  • PUBLISHED BY : NHP Admin
  • CREATED / VALIDATED BY : Dr. Aruna Rastogi
  • LAST UPDATED ON : Oct 25, 2021

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