Long COVID
Top Contributors - Darren Brown, Jess Bell, Olajumoke Ogunleye, Kim Jackson, Shwe Shwe U Marma, Robin Tacchetti, Tarina van der Stockt, Lucinda hampton, Candace Goh and Chelsea Mclene
Introduction[edit | edit source]
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease (COVID-19) [1]. The effects of COVID-19 have been characterised across different time points [2]:
- Acute COVID-19 infection with signs and symptoms of COVID-19 for up to 4 weeks.
- Ongoing symptomatic COVID-19 with signs and symptoms of COVID-19 from 4 weeks up to 12 weeks.
- Long term consequences of COVID-19 which usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body for more than 12 weeks.
The long term sequelae of COVID-19 awaits consensus definition, and a variety of nomenclature has been used to describe the long term signs and symptoms of COVID-19. This includes the patient directed terms "Long Covid" [3][4][5][6][7][8], "Long-Haul Covid" [4][9] and "Long Haulers" [10][11], plus other terms including "Post-COVID-19 syndrome" [2][12], "Post-COVID Syndrome" [13], "Post-Acute COVID-19" [14], and "Post-Acute COVID-19 syndrome"[15]. For the purposes of consistency, this page will refer to the long term consequences of COVID-19 as "Long Covid" and to "People Living with COVID-19". We will refer to "Long Covid" because this term acknowledges that disease cause and course are as yet unknown, makes clear that “mild” COVID-19 is not necessarily mild, avoids “chronic,” “post” and “syndrome” that may delegitimise peoples experiences, draws attention to morbidity, and centres people with disability [3]. We will refer to "People Living with COVID-19" to align with existing person first language [16] and applying knowledge from other health care conditions with experiences of stigma [17].
What is Long Covid?[edit | edit source]
Long Covid has been preliminarily defined by The National Institute for Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network, and the Royal College of General Practitioners, as the presence of signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for 12-weeks or more and are not explained by an alternative diagnosis. This includes both ongoing symptomatic COVID-19 (from 4 to 12 weeks) and "Post-COVID Syndrome" (12-weeks or more) [18]. Consensus has not yet been reached for a Long Covid definition [6][19][20].
Long Covid Symptoms[edit | edit source]
Long Covid usually presents as clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body [18][19][21][22][23]. Long Covid can include a range of 205 different signs and symptoms across body systems including but not limited to: pulmonary, cardiovascular, gastrointestinal, reproductive, genitourinary, endocrine, renal, dermatologic, musculoskeletal, neurological, neuropsychiatric, immunological, ophthalmic, and audiological [19].
The most common Long Covid symptom is fatigue [19][24][25][26][27][28]. The most frequently reported Long Covid symptoms after 6 months include fatigue, post-exertion malaise, and cognitive dysfunction [19]. The multidimensional, episodic and often unpredictable nature of Long Covid has been described as "relapsing and remitting" [22], whereby 86% of people with Long Covid report relapses over 7 months, with physical activity, stress, exercise and mental activity being the most common triggers of relapses [19]. The trajectory of Long Covid is heterogenous with some improving over time, some worsening and others unchanging, with many experiencing ongoing symptoms after 6 months [19].
Prevalence[edit | edit source]
Estimating the prevalence of Long Covid symptoms poses several challenges due to current lack of consensus definition and limited data collection in national surveys. The COVID-19 Infection Survey [29] is a nationally representative sample of the UK community population, from which it is has been estimated that around 1 in 5 people exhibit Long Covid symptoms for 5 weeks or longer, and around 1 in 10 exhibit Long Covid symptoms for 12 weeks or longer [7].
Mechanism of Injury / Pathological Process[edit | edit source]
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Clinical Presentation[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Management / Interventions[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Resources[edit | edit source]
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References[edit | edit source]
- ↑ https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it
- ↑ 2.0 2.1 https://www.nice.org.uk/guidance/gid-ng10179/documents/final-scope
- ↑ 3.0 3.1 https://blogs.bmj.com/bmj/2020/10/01/why-we-need-to-keep-using-the-patient-made-term-long-covid/
- ↑ 4.0 4.1 https://www.sciencedirect.com/science/article/pii/S0277953620306456
- ↑ https://www.nature.com/articles/d41586-020-02796-2
- ↑ 6.0 6.1 https://www.bmj.com/content/371/bmj.m4938
- ↑ 7.0 7.1 https://www.ons.gov.uk/news/statementsandletters/theprevalenceoflongcovidsymptomsandcovid19complications
- ↑ https://www.nature.com/articles/d41586-020-02796-2
- ↑ https://n.neurology.org/content/95/13/559.long
- ↑ https://www.nature.com/articles/d41586-020-02598-6
- ↑ https://onlinelibrary.wiley.com/doi/10.1002/jmv.26624
- ↑ https://openres.ersjournals.com/content/6/4/00542-2020
- ↑ https://www.england.nhs.uk/coronavirus/publication/national-guidance-for-post-covid-syndrome-assessment-clinics/
- ↑ https://www.bmj.com/content/370/bmj.m3026
- ↑ https://www.england.nhs.uk/coronavirus/publication/national-guidance-for-post-covid-syndrome-assessment-clinics/
- ↑ https://evidence.nihr.ac.uk/themedreview/living-with-covid19/
- ↑ https://www.nhivna.org/file/5dcbdcb83254e/BP-19-2.pdf
- ↑ 18.0 18.1 https://www.nice.org.uk/guidance/ng188
- ↑ 19.0 19.1 19.2 19.3 19.4 19.5 19.6 https://www.medrxiv.org/content/10.1101/2020.12.24.20248802v2.full.pdf
- ↑ https://www.medrxiv.org/content/10.1101/2020.12.08.20246025v1
- ↑ https://jamanetwork.com/journals/jama/fullarticle/2768351
- ↑ 22.0 22.1 https://patientresearchcovid19.com/research/report-1/
- ↑ https://www.journalofinfection.com/article/S0163-4453(20)30762-3/fulltext
- ↑ https://www.medrxiv.org/content/10.1101/2020.11.04.20226126v1
- ↑ https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/late-sequelae.html
- ↑ https://www.medrxiv.org/content/10.1101/2020.10.14.20212555v1
- ↑ https://www.cdc.gov/mmwr/volumes/69/wr/mm6930e1.htm
- ↑ https://www.acpjournals.org/doi/10.7326/M20-5926
- ↑ https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/previousReleases
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