Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.
Prolonged recovery from COVID-19, also known as COVID “long-term” syndrome, continues to challenge both clinicians and patients, with evidence on how to best manage the most common symptoms, based primarily on cross-sectional studies and anecdotal reports.
Until a clearer picture emerges from larger, prospective and multi-center studies, experts shared what is known and what evidence remains elusive in a February 12 media conference sponsored by the Infectious Diseases Society of America.
To be considered post-COVID-19 syndrome, symptoms must persist for at least 4 weeks after acute SARS-CoV-2 infection. However, many patients experience symptoms that last 2 to 6 months or longer.
Fatigue appears to be the most common, followed by shortness of breath and other pulmonary complications, said Allison Navis, MD in the Department of Neuroseptic Diseases at the Icahn School of Medicine at Mount Sinai in New York City, during the briefing.
Dr Allison Navis
She said neurological symptoms, especially ‘brain fog’ and numbness or tingling in the body, as well as mental health problems, including post-traumatic stress disorder (PTSD), have been reported anecdotally.
Symptoms of post-COVID-19 syndrome may be similar to those of acute infection.
Symptomatic infection precedes most cases
People experiencing asymptomatic SARS-CoV-2 infection rarely appear to progress to persistent post-COVID syndrome, says Kathleen Bell, MD, Kimberly Clark Distinguished Chair in Mobility Research at UT Southwestern Medical Center in Dallas.
Dr Kathleen Bell
“However, we definitely see people not being admitted to the hospital who were acutely ill and getting it right at home” with post-COVID syndrome, Bell said. He is also Professor and Chair of the Department of Physical Medicine and Rehabilitation at UT Southwestern.
Navis agreed that in her experience, most people with long-term consequences have acute infection at home or are hospitalized. “There were maybe one or two people who probably had asymptomatic infection and came up with a mild long-covid syndrome,” she said.
Dangers associated with hospitalization
For some patients, this in itself can lead to long-term recovery problems for COVID-19 in the hospital. For example, Bell may be more likely to experience peripheral neuropathy in inpatients who spend a large amount of time in a supine position. The associated arm and leg weakness may be particularly important in people with diabetes.
Furthermore, a prolonged hospital stay can cause adverse effects on mental health. “We have had people in the hospital for 3 months, and in a large percentage we see symptoms of mental health, including PTSD, anxiety and depression,” Bell said. These adverse effects are not unique to COVID-19, but are also reported in other people who spend weeks or months in critical care, she added.
Some people with mild mental health problems may have compensated well before their experience with COVID-19, but the stress of acute infection and hospitalization exacerbates their condition, Bell explained.
A local outbreak can also increase the risk for mental health issues. The increase in business in March and April 2020, for example, was a very narrow time here in New York, ‘Navis said.
“Some people were isolated in their apartments and heard the sounds of ambulances and sirens and were worried about their own health and survival,” she said, adding that it also causes anxiety, depression or PTSS for some.
Consensus and guidelines in the works
The World Health Organization released updated treatment guidelines for COVID-19 on January 26, also for people with persistent symptoms.
The Centers for Disease Control and Prevention is working on guidelines for the diagnosis and management of people with post-COVID syndrome, “which is very exciting,” Bell said. The recommendations are expected to emerge from an event about 3 or 4 weeks ago in which the agency brought together experts to share their care models.
The National Institutes of Health is also interested in developing protocols, Navis said.
Many specialized teams and clinics have stepped forward to address the growing population of COVID-19 “long-distance guards”.
Interestingly, although many centers initially set up their own protocols for treating this patient population, “we are starting to look alike,” Bell said.
The COVID-19 recovery clinics at Bell’s and Navis’ institutions focus on multidisciplinary collaboration, including general medical care and specialists such as pulmonologists, cardiologists and psychiatrists, as well as rehabilitation specialists to address specific symptoms.
Remaining questions
It is unknown what percentage of people with COVID-19 will go on to have post-COVID syndrome. “The expectation would be that most people are likely to get better in weeks to months, and that about 10% to 15% will have longer problems,” Bell said. Larger studies should help clarify the figures.
Although it is generally accepted that more men than women develop and die from COVID-19, it remains to be seen whether the risk for long-term effects differs between men and women. In her experience, Navis has reported a fairly equal distribution of affairs by gender.
How vaccination can prevent or alleviate post-COVID syndrome also remains an open question. The vaccines “are so new, it’s going to be a crystal ball question,” Bell said.
Bell predicted that it would take about 6 months before responses to this and other unknowns about post-COVID syndrome would emerge from larger, prospective studies.
Damian McNamara is a staff journalist in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology and critical care. Follow Damian on Twitter: @MedReporter.
Follow Medscape on Facebook for more news, Twitter, Instagram and YouTube.