The frequency of long-term symptoms and conditions following SARS-CoV-2 infection varies widely in the literature, ranging from 5% to 80%.

Patients with certain comorbidities could be at higher risk for post-COVID conditions, although prevalence by clinical characteristics is limited.

Although older patients might have an increased risk for severe acute disease and related ongoing symptoms, younger patients, including those in good health before SARS-CoV-2 infection, have also reported debilitating post-COVID conditions months after acute illness.

People with post-COVID conditions report experiencing different combinations of the following symptoms:

• Dyspnea or increased respiratory effort
• Fatigue
• *Post-exertional malaise and/or poor endurance
• “Brain fog,” or cognitive impairment
• Cough
• Chest pain
• Headache
• Palpitations and/or tachycardia
• Arthralgia
• Myalgia
• Paresthesia
• Abdominal pain
• Diarrhea
• Insomnia and other sleep difficulties
• Fever
• Lightheadedness
• Impaired daily function and mobility
• Pain
• Rash (e.g., urticaria)
• Mood changes
• Anosmia or dysgeusia
• Menstrual cycle irregularities

* Post-exertional malaise (PEM) is the worsening of symptoms following even minor physical or mental exertion, with symptoms typically worsening 12 to 48 hours after activity and lasting for days or even weeks.

Cardiovascular

Myocarditis, heart failure, pericarditis, orthostatic intolerance (e.g., postural orthostatic tachycardia syndrome (POTS))

Pulmonary

Interstitial lung disease, reactive airway disease

Renal

Chronic kidney disease

Dermatologic

Alopecia

Rheumatologic

Reactive arthritis, fibromyalgia, connective tissue disease

Endocrine

Diabetes mellitus, hypothyroidism

Neurologic

Transient ischemic attack/stroke, olfactory and gustatory dysfunction, sleep dysregulation, altered cognition, memory impairment, headache, weakness, and neuropathy

Psychiatric

Depression, anxiety, and post-traumatic stress disorder (PTSD), psychosis

Hematologic

Pulmonary embolism, arterial thrombosis, venous thromboembolism, or other hypercoagulability

Urologic

Incontinence, sexual dysfunction

Other

Weight loss, dysautonomia, vitamin D deficiency, allergies and mast cell activation syndrome, reactivation of other viruses, pain syndromes, and progression of comorbid conditions

Patient History and Physical Exam

Assessment and Testing

Laboratory Testing

Healthcare professionals should also consider the possibility of SARS-CoV-2 reinfection, especially in persons with new or worsening post-COVID conditions.

Basic diagnostic laboratory testing to consider for patients with post-COVID conditions

More specialized diagnostic laboratory testing to consider for patients with post-COVID conditions

* The specialized diagnostic tests should be ordered in the context of suggestive findings on history and physical examination (e.g., testing for rheumatological conditions in patients experiencing arthralgias).

Additional diagnostic testing for persistent or new respiratory or cardiac concerns should be guided by findings from the patient history and physical examination and results of previous diagnostic testing, and may include:

chest x-ray,

pulmonary function tests,

electrocardiogram, or echocardiogram, 

computed tomography (CT) imaging of the chest, 

For most patients, the goal of medical management of post-COVID conditions is to optimize function and quality of life.

• Breathing exercises to improve symptoms of dyspnea.

• Physical and occupational therapy, speech and language therapy, vocational therapy, as well as neurologic rehabilitation for cognitive symptoms.

• Cautious initiation of exercise and recommendations about pacing may be useful. Gradual return to exercise as tolerated could be helpful for most patients.

• Optimizing management of underlying medical conditions might include counselling on lifestyle components such as nutrition, sleep, and stress reduction (e.g., meditation).

Follow-up visits with a healthcare professional might be considered every 2–3 months, with frequency adjusted up or down depending on the patient’s condition and illness progression.