Long COVID, an ever-evolving new clinical entity

Recent Journal of Microbiology, Immunology, and Infection This study describes the epidemiology, diagnosis, etiology, and treatment of 2019 long coronavirus disease (COVID-19).

study: Long COVID: inevitable sequelae of SARS-CoV-2 infection. Image credit: fizkes / Shutterstock.com

What is long COVID?

COVID-19 presents as mild or asymptomatic disease in most patients. However, some patients develop severe illness or acute respiratory distress syndrome (ARDS) even after receiving antiviral treatment and/or vaccines. Even after recovering from severe COVID-19, some patients report persistent symptoms collectively referred to as prolonged COVID, post-COVID-19, or acute sequelae of COVID-19 (PASC).

Long COVID can be defined in multiple ways, including the presence of symptoms lasting more than 3 weeks after the onset of the first symptom, or the occurrence of symptoms unexplained by another diagnosis lasting more than 4 weeks. The current study provides an overview of our current understanding of long COVID.

Long COVID epidemiology and risk factors

A meta-analysis of 50 studies estimated the global prevalence of COVID longer than 28 days at 43%. Asia has the highest prevalence at 51%, followed by Europe and America.

Another meta-analysis reported that 63% and 71% of patients had at least one post-COVID-19 symptom 30 and 60 days after onset/admission, respectively. One study observed that the prevalence of long-term COVID in children and adolescents was 25.24%, while the rate of long-term COVID in hospitalized patients was 29.19%.

Furthermore, an Italian study found that long-term COVID prevalence among healthcare workers varied between waves of the COVID-19 pandemic. A US study of veterans showed that vaccine breakthrough infections were associated with an increased risk of acute sequelae, including gastrointestinal, cardiovascular, mental health, neurological, and hematologic disorders. Another retrospective study identified age and severe disease as factors associated with an increased risk that he would experience at least three symptoms at 1-year follow-up.

Clinical manifestations and mechanisms of long COVID

Prolonged COVID can affect multiple organs, and one study concluded that respiratory, cardiovascular, and neuropsychological symptoms were the most frequently reported in COVID-19 survivors. increase. Many studies confirm that fatigue is the most common systemic symptom. Mood swings are most frequently reported in children and young adults.

Shortness of breath, tachypnea after activity, dyspnea, chest discomfort, pain while breathing, cough, and tachypnea have long been common respiratory symptoms of COVID. Common neurological symptoms include brain fog, memory impairment, paresthesia, syncope, dizziness, headache, reduced attention span, bradykinesia, anhedonia, and distress.

Psychosocial symptoms such as depression, anxiety, psychosis, post-traumatic stress disorder (PTSD), and behavioral disorders have also been reported. A meta-analysis observed anxiety and depression in 22% and 23% of long-term COVID patients, respectively. Memory loss/complaints, forgetfulness, and difficulty concentrating and sleeping were also prevalent in the study.

In one study, elevated levels of interleukin-2 (IL-2) and IL-17 and decreased levels of IL-4, IL-6, and IL-10 were associated with COVID patients without sequelae. seen in comparison. angiotensin converting enzyme 2 (ACE2), IL-17, transmembrane protease serine 2 (TMPRSS2), zonulin, and interferon (IFN)-γ.

The longstanding explicit mechanism of COVID remains poorly defined given its novelty. However, several mechanisms have been theorized, including damage to his ACE2-expressing organs by SARS-CoV-2, inflammation due to dissipation of persistent viral reservoirs after infection, host responses such as overproduction of cytokines, and autoimmunity. It has been. Among other things, the delayed resolution of inflammation that affects the homeostatic environment of the organ.

Vaccines, diagnostics, and potential therapeutics

A prospective case-control study reported that people were less likely to report persistent symptoms after receiving a second dose of the COVID-19 vaccine than unvaccinated people. An Italian observational cohort study observed that BNT162b2 vaccination was associated with a lower prevalence of long-term COVID that decreased with the number of doses of vaccine administered.

Adequate diagnostic criteria for long-term COVID are unknown, as the condition presents with non-specific symptoms and can involve multiple organ systems. Nevertheless, diagnosis should be guided by patient history, physical examination, and clinical manifestations. Functional status and quality of life can be assessed using the Post-COVID-19 Functional Status Scale and the Patient-Reported Outcomes Measurement Information System.

The Montreal Cognitive Assessment, Compass 31, Mini-Mental Status Examination, and Neurobehavioral Systems Inventory can be used to assess neurological status. An electrocardiogram, echocardiogram, pulmonary function test, or chest x-ray may be helpful for new heart or respiratory problems.

Long-term COVID management assurance prompts multidisciplinary evaluations focused on managing specific conditions and supporting rehabilitation. Hyperbaric oxygen therapy (HBOT) is also a potential treatment.

There are currently several trials investigating the effects of physical therapy, physical rehabilitation, neurorehabilitation, and cognitive interventions. These studies may provide more conclusive evidence in the future.

in conclusion

As the number of COVID-19 cases continues to rise around the world, the number of long-term COVID cases is likely to rise. Based on currently available information, all his COVID-19 patients can develop long-term her COVID, but critically ill patients are at higher risk.

Moreover, prolonged COVID may present with heterogeneous clinical manifestations, and vaccination may be the only way to avoid prolonged COVID. Future research is needed to gain more insight into COVID over time using established diagnostic and defining criteria.