Long-term health effects from COVID-19 can be hard to understand and even harder to treat. Experts from the departments of neurology and physical medicine and rehabilitation discuss how long-term symptoms develop and what patients can expect.
Symptoms can last months or even years, and may be mild or severe. Some people have difficulty recovering their normal lung function, while others are frustrated by chronic fatigue or shortness of breath that can get worse when doing certain activities. Others have lingering neurological effects such as confusion, memory problems or persistent headaches that won’t go away. Many of these symptoms can be difficult for patients and their families to manage and sometimes are misinterpreted or misattributed to psychiatric causes.
Many of these symptoms can be linked to the coronavirus infection, but they can also be caused by other factors such as hospitalization for the post Covid-19 disorders illness, medications and treatment, and underlying medical conditions like heart disease or diabetes. Those who were most severely affected by the virus have higher rates of long-term consequences such as PTSD, depression and anxiety. Some of the long-term effects can be permanent, including tracheal stenosis from intubation or permanent weakness from prolonged bed rest and prolonged hospitalization.
The multisystem disorder of post-acute COVID-19 syndrome, also known as long COVID-19, is characterized by symptoms of both the respiratory and non-respiratory systems and can involve other organs such as the cardiovascular and hematologic systems. It is a complex clinical entity that can be challenging to identify and diagnose because of its unique presentation, overlapping features with other conditions and the lack of specific diagnostic criteria. In order to assess for this condition, a comprehensive history and complete evaluation with pertinent laboratory and radiologic assessment must be performed. Neuropsychological testing should be done in all patients presenting with neuropsychiatric manifestations.
Other complications of COVID-19 that can be seen as signs and symptoms of this condition include pulmonary fibrosis, hepatic involvement, renal dysfunction and coagulopathy. A full hematologic panel including a CBC, comprehensive metabolic panel and clotting screen should be done in all patients to rule out other alternative diagnoses. Cardiopulmonary examination should be obtained in all patients and a cardiovascular workup with echocardiogram is indicated in those with symptomatic cardiac involvement.
A multidisciplinary approach is needed in the management of these patients. This includes providing patient-centered care to optimize functional outcomes, facilitating standardized, trauma-informed assessments with an emphasis on reducing stigma, and ensuring access to a broad range of resources and support for patients who have persistent and recurrent symptoms.