Clinical Overview of Long COVID

Table of Contents

Introduction to Long COVID

Long COVID, also known as “Post-COVID Conditions (PCC)”, is an infection-associated chronic condition that can occur after SARS-CoV-2 infection, the virus that causes COVID-19, and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems. The definition for Long COVID

Development of new or recurrent symptoms and conditions after the symptoms of initial acute COVID-19 illness have resolved.
Symptoms that can emerge, persist, resolve, and reemerge over varying lengths of time.
A spectrum of physical, social, and psychological consequences.
Functional limitations that can affect patient wellness and quality of life.

Causes

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It can be difficult to distinguish symptoms caused by Long COVID from symptoms that occur for alternative reasons.

Long COVID is heterogeneous and may be attributed to different underlying pathophysiologic processes. Possible etiologies include:

Organ damage resulting from acute phase infection
Complications from a dysregulated inflammatory state
Microvascular dysfunction
Ongoing viral activity associated with an intra-host viral reservoir
Autoimmunity
Inadequate antibody response
Other potential causes

Risk factors

Researchers are actively studying the prevalence, mechanism, duration, and severity of symptoms following acute SARS-CoV-2 infection, as well as risk factors associated with developing Long COVID. Research shows certain groups of people are more likely to develop Long COVID, including:

Women
Hispanic people
People who experienced more severe outcomes of COVID-19, including hospitalization or being admitted to the intensive care
People with underlying health conditions
People who did not get a COVID-19 vaccine

Clinical features

Signs and symptoms

A wide range of symptoms and clinical findings can occur in people with varying degrees of illness from acute SARS-CoV-2 infection. These effects can overlap with multiorgan complications, or with effects of treatment or hospitalization and can persist after the acute COVID-19 illness has resolved. While more than 200 Long COVID symptoms have been identified, commonly reported symptoms include:

Bloating/constipation/diarrhea
Difficulty concentrating
Light headedness/fast heart rate
Memory change
Persistent fatigue
Post-exertional malaise
Problems with smell
Problems with taste
Recurring headaches
Shortness of breath/cough
Sleep disturbance

Some patients may feel embarrassed about their symptoms, have experienced stigma or experienced difficulty in being believed. It is important for healthcare providers to:

Not dismiss symptoms that are difficult to explain.
Practice empathy in conversations with patients.
Encourage patients to report any new or changing symptoms or any changes in activities or routines.

Presentation

Different onset patterns for Long COVID have been identified, including symptoms and conditions that can:

Emerge, evolve, persist, resolve, and reemerge over time following initial acute COVID-19 illness.
Develop following asymptomatic disease or a period of acute symptom relief or remission.
Worsen pre-existing symptoms or conditions

Documentation

Documenting SARS-CoV-2 infection and Long COVID, also referred to as “Post-COVID Conditions,” is critical for accurate public health surveillance.

U09.9 Post COVID-19 Condition, unspecified– to establish a link with COVID-19; not to be used in cases that still are presenting with acute COVID-19. The code should be used for patients with a history of probable or confirmed SARS-CoV-2 infection and who are identified with a Post-COVID Condition.

Keep reading: Additional assign codes for specific conditions and symptoms can be found at 2022 ICD-10-CM Guidelines

Prevention

Preventing severe outcomes of COVID-19 illness reduces people’s risk of developing Long COVID. These severe outcomes include hospitalization, admission to the intensive care unit, or intubation.

Healthcare providers can advise their patients on protecting themselves against severe COVID-19 by:

Testing and diagnosis

Male mature doctor working in hospital laboratory

Clinicians may clinically evaluate and diagnose Long COVID based on patient history and findings from a physical examination, while others might require directed diagnostic testing. Currently, no laboratory test can be used to definitively diagnose Long COVID or to distinguish Long COVID from conditions with different etiologies.

Treatment and symptom management

For most patients, the goal of medical management of Long COVID is to optimize function and quality of life through established symptom management approaches, which may include:

Focusing on the most bothersome symptoms identified by the patient.
Creating a comprehensive rehabilitation plan.
Optimizing management of underlying medical conditions.
Creating patient diaries and calendars to document changes in health conditions and symptom severity.

Patients with Long COVID may experience some of the symptoms that occur in other disorders. These patients may benefit from symptom management approaches used to manage symptoms of:

Treatment of Long COVID should be tailored to a patient’s specific symptoms or conditions, including FDA-approved or over-the-counter medications. Holistic support for the patient throughout their illness can also be beneficial. Healthcare providers play a significant role in supporting their patients and can further help patients with Long COVID by:

Validating their symptoms
Recognizing and validating the impact of illness on quality of life.
Completing a full clinical evaluation based on signs and symptoms reported by the patient
Connecting them to additional care, services and supports, as appropriate.

Resources

link

Clinical Overview of Long COVID

Introduction to Long COVID

Causes

Risk factors