Long Covid— Risk factors & Symptoms

Covid-19 has spread and had a profound effect on the lives and health of people around the globe.

Recent evidence shows that a range of symptoms can remain after the clearance of the acute infection in many people who have had covid-19, and this condition is known as long covid.

The National Institute for Health and Care Excellence (NICE) defines long covid as the symptoms that continue or develop after acute covid-19 infection and which cannot be explained by an alternative diagnosis. This term includes ongoing symptomatic covid-19, from four to 12 weeks post-infection and post-covid-19 syndrome, beyond 12 weeks post-infection.

Symptoms

The symptoms of long covid include fatigue, dyspnea, cardiac abnormalities, cognitive impairment, sleep disturbances, symptoms of post-traumatic stress disorder, muscle pain, concentration problems, and headache.

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Fatigue and Dyspnea

Fatigue

Fatigue is more profound than being overtired; it is unrelenting exhaustion and a constant state of weariness that reduces a person’s energy, motivation, and concentration. Following the SARS outbreak, up to 60% of patients reported ongoing fatigue at 12 months following recovery from the acute illness. These findings show that fatigue is a major manifestation of long covid.

Dyspnea

Breathlessness is common in people with long covid. The ONS estimates that shortness of breath has a prevalence of 4.6% at five weeks post-covid-19 infection, regardless of presence of acute respiratory symptoms or disease severity. Several studies have found that dyspnea is a common manifestation following covid-19 infection.

Cardiovascular abnormalities

· Cardiac injury and elevated cardiac troponin levels are associated with a significantly increased risk of mortality in patients admitted to hospital with acute covid-19 infection.

· A cohort study showed cardiac involvement, ongoing myocardial inflammation, and elevated serum troponin levels in many people with covid-19 at 71 days following diagnosis, while a large case series showed that chest pain, possibly owing to myocarditis, was a common manifestation in patients 60.3 days following onset of covid-19 symptoms.

· In addition to cardiac complaints, studies have highlighted an emerging trend in the development of new onset postural orthostatic tachycardia syndrome (POTS) in individual’s post-covid-19 infection, because of autonomic dysfunction.

Cognition and mental health

· Studies have explored cognitive function and deficits in patients with covid-19 and suggest that the virus can cause septic encephalopathy, non-immunological effects such as hypotension, hypoxia, and vascular thrombosis, and immunological effects such as adaptive autoimmunity, microglial activation, and a maladaptive cytokine profile.

· Additionally, patients admitted to hospital with covid-19 have presented with a range of complaints including encephalopathy, cognitive impairment, cerebrovascular events/disease, seizures, hypoxic brain injuries, corticospinal tract signs, dysexecutive syndrome, an altered mental status, and psychiatric conditions.

· The pandemic has had a negative effect on mental health, with people who have had covid-19 exhibiting long term psychiatric symptoms including post-traumatic stress disorder (PTSD), depression, anxiety, and obsessive-compulsive symptoms following recovery from the acute infection.

· Quarantine, isolation, and social distancing also have damaging effects on mental health and cognition.

· Sleeplessness is also commonly reported following recovery from covid-19, with many studies finding poor sleep quality and sleep disturbances to be frequent following recovery from acute illness.

Other commonly reported manifestations

Covid-19 infection can result in multi-organ impairment in individuals with low or high risk for severe acute disease.

· Studies show the presence of acute kidney injury in discharged patients who have recovered from covid-19.

· Acutely, pancreatitis triggered by SARS-CoV-2 has been seen in people with covid-19, while serum amylase and lipase levels have been observed to be higher in people with severe illness compared with mild cases, and computed tomography images have shown pancreatic injury.

· Other organs and tissues, such as the liver, gastrointestinal tract, muscle, and blood vessels express the ACE2 receptor and are susceptible to direct damage from SARS-CoV-2 and indirect damage through elevated systemic inflammation.

· Alterations in gut microbiota and subacute thyroiditis have been observed following covid-19 infection.

· Abnormalities of smell and taste have been reported to persist following recovery from covid-19. The ONS estimated the 5 week prevalence of loss of smell and loss of taste as 7.9% and 8.2% of all people who have had covid-19, respectively.