Health
15 things about diagnosing, managing and treating the long COVID
A series of articles published Tuesday provide guidance on patient diagnosis, evaluation, and treatment. long covid.
Practical article published CMAJ (Canadian Medical Association Journal)About 1.4 million people in Canada are affected by prolonged COVID, a systemic condition that can affect most organ systems in the body.
Long-term COVID is defined by symptoms lasting more than 3 months after confirmed or suspected SARS-CoV-2 infection. More than 100 symptoms have been reported, the most common being fatigue, anxiety, depression, shortness of breath, sleep disturbances and heart palpitations.
Each of the three articles contains five points on diagnosing, evaluating, and treating the condition, focusing on the “potentially correctable” aspects.
“The most important thing we as health care providers can do to support people is to listen and validate their experiences, as well as endless tests and consultations that further strain our limited energy supply. MD, PhD, General Physician and Palliative Care Physician, Sinai Health, and Assistant Professor, University of Toronto and Institute of Health Policy, Management and Evaluation, said in a statement.
The World Health Organization has proposed a definition for this condition, but according to one paper, “the sensitivity, specificity, and positive and negative predictive value of the definitive diagnostic criteria” are still unknown.
In addition to the fact that almost 1.5 million Canadians have long-term COVID-19, the paper notes that women are more likely to be affected than men.
The long COVID systemicity may be due to the expression of angiotensin-converting enzyme 2 (ACE2) receptors in various organ systems that provide SARS-CoV-2 entry.
The lingering symptoms can last for a year or more, the paper said. A study conducted in both China and Canada found that roughly the same proportion of people reported being disengaged from the workforce and daily life due to COVID-19.
The most common symptoms that may be treatable include fatigue (reported by 23% to 63%). anxiety and depression (23%–46%); dyspnea (11%–43%); sleep disturbances (11%–31%); and palpitations (6%–22%). These symptoms may require evaluation to rule out other factors or causes.
If no other cause is found, treatment for each may include:
- For fatigue, a structured symptom-based return-to-activity program tailored to the severity of the fatigue
- Guideline use of psychosocial interventions and medications for mental health
- Dyspnea, breathing exercises, body positioning, pulmonary rehabilitation
- For sleep problems, sleep counseling, relaxation techniques, and stimulation control. This may include cognitive-behavioral counseling and prescription medications.
- For palpitations and tachycardia due to specific causes, behavior modification, oral fluids, salinity, elastic stockings, beta blockers, ivabradine, midodrine.
References
1. Quinn KL, Razak F, Cheung A. Diagnosis of post-COVID-19 condition (long COVID) in adults. CMJMore 17 January 2023;195:E78-9. Doi: 10.1503/cmaj.220818
2. Quinn KL, Razak F, Cheung A. A general and potential assessment. Modifiable symptoms of the post-COVID-19 condition (long COVID) in adults. CMJMore 17 January 2023;195:E76-7. Doi: 10.1503/cmaj.220823
3. Quinn KL, Razak F, Cheung A. Treatment of common and potentially modifiable symptoms of post-COVID-19 condition (long-term COVID) in adults. CMJMore January 17, 2023;195:E80-1. Doi: 10.1503/cmaj.220824
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