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Some people experiencing long COVID have formed community care networks and support groups on [[social media]] websites.<ref name=cdc/><ref name=nice/><ref name=Wolf/><ref>{{Cite web |vauthors=Witvliet MG |date=27 November 2020 |title=Here's how it feels when COVID-19 symptoms last for months |url=https://www.pbs.org/newshour/health/im-a-covid-19-long-hauler-and-an-epidemiologist-heres-how-it-feels-when-symptoms-last-for-months |access-date=29 November 2020 |website=PBS NewsHour |archive-date=29 November 2020 |archive-url=https://web.archive.org/web/20201129015550/https://www.pbs.org/newshour/health/im-a-covid-19-long-hauler-and-an-epidemiologist-heres-how-it-feels-when-symptoms-last-for-months |url-status=live}}</ref> Internationally, there are several long COVID advocacy groups.<ref name=jrsm/><ref>{{cite web |title=The Covid 'longhaulers' behind a global patient movement |vauthors=Macnamara K |publisher=AFP |url=https://uk.news.yahoo.com/covid-longhaulers-behind-global-patient-040355384.html |access-date=30 January 2021 |archive-date=4 February 2021 |archive-url=https://web.archive.org/web/20210204090110/https://uk.news.yahoo.com/covid-longhaulers-behind-global-patient-040355384.html |url-status=live}}</ref><ref>{{Cite web |url=https://patientresearchcovid19.com/ |title=Patient-Led Research Collaborative for Long COVID |work=Patient Led Research Collaborative |access-date=8 January 2022 |archive-date=10 January 2022 |archive-url=https://web.archive.org/web/20220110164939/https://patientresearchcovid19.com/ |url-status=live}}</ref><ref>{{cite journal | vauthors = Callard F, Perego E | title = How and why patients made Long Covid | journal = Social Science & Medicine | volume = 268 | pages = 113426 | date = January 2021 | pmid = 33199035 | pmc = 7539940 | doi = 10.1016/j.socscimed.2020.113426 | doi-access = free }}</ref> Clinical advice on self-management and online healthcare programs are used to support people with long COVID.<ref name=Wolf/>
Some people experiencing long COVID have formed community care networks and support groups on [[social media]] websites.<ref name=cdc/><ref name=nice/><ref name=Wolf/><ref>{{Cite web |vauthors=Witvliet MG |date=27 November 2020 |title=Here's how it feels when COVID-19 symptoms last for months |url=https://www.pbs.org/newshour/health/im-a-covid-19-long-hauler-and-an-epidemiologist-heres-how-it-feels-when-symptoms-last-for-months |access-date=29 November 2020 |website=PBS NewsHour |archive-date=29 November 2020 |archive-url=https://web.archive.org/web/20201129015550/https://www.pbs.org/newshour/health/im-a-covid-19-long-hauler-and-an-epidemiologist-heres-how-it-feels-when-symptoms-last-for-months |url-status=live}}</ref> Internationally, there are several long COVID advocacy groups.<ref name=jrsm/><ref>{{cite web |title=The Covid 'longhaulers' behind a global patient movement |vauthors=Macnamara K |publisher=AFP |url=https://uk.news.yahoo.com/covid-longhaulers-behind-global-patient-040355384.html |access-date=30 January 2021 |archive-date=4 February 2021 |archive-url=https://web.archive.org/web/20210204090110/https://uk.news.yahoo.com/covid-longhaulers-behind-global-patient-040355384.html |url-status=live}}</ref><ref>{{Cite web |url=https://patientresearchcovid19.com/ |title=Patient-Led Research Collaborative for Long COVID |work=Patient Led Research Collaborative |access-date=8 January 2022 |archive-date=10 January 2022 |archive-url=https://web.archive.org/web/20220110164939/https://patientresearchcovid19.com/ |url-status=live}}</ref><ref>{{cite journal | vauthors = Callard F, Perego E | title = How and why patients made Long Covid | journal = Social Science & Medicine | volume = 268 | pages = 113426 | date = January 2021 | pmid = 33199035 | pmc = 7539940 | doi = 10.1016/j.socscimed.2020.113426 | doi-access = free }}</ref> Clinical advice on self-management and online healthcare programs are used to support people with long COVID.<ref name=Wolf/>

=== Work-related impacts ===
The impact of long COVID on people's ability to [[Employment|work]] is large. Estimates vary on how many people are out of work, or work reduced hours because of long COVID. For those with mild or moderate disease, between 12% and 23% had had long periods of absence or remained absent from work at 3 to 7 months. The share of people working adjusted hours or tasks after mild or moderate COVID, was around 8% to 45% after three to eight months.<ref name=":1">{{Cite journal |last=Nittas |first=Vasileios |last2=Gao |first2=Manqi |last3=West |first3=Erin A. |last4=Ballouz |first4=Tala |last5=Menges |first5=Dominik |last6=Wulf Hanson |first6=Sarah |last7=Puhan |first7=Milo Alan |date=2022 |title=Long COVID Through a Public Health Lens: An Umbrella Review |url=https://www.ssph-journal.org/articles/10.3389/phrs.2022.1604501/full#B55 |journal=Public Health Reviews |language=English |volume=43 |pages=1604501 |doi=10.3389/phrs.2022.1604501 |issn=2107-6952}}</ref> The percentage of people returning to work after hospitalisation was lower.<ref name=":1" /> Return to work after hospitalisation differed by country. In China and the US a higher percentage went back to work. In the US, this could be partially explained by a lack of [[paid sick leave]] for some workers.<ref>{{Cite journal |last=Gualano |first=Maria Rosaria |last2=Rossi |first2=Maria Francesca |last3=Borrelli |first3=Ivan |last4=Santoro |first4=Paolo Emilio |last5=Amantea |first5=Carlotta |last6=Daniele |first6=Alessandra |last7=Tumminello |first7=Antonio |last8=Moscato |first8=Umberto |date=2022-01-01 |title=Returning to work and the impact of post COVID-19 condition: A systematic review |url=https://content.iospress.com/articles/work/wor220103 |journal=Work |language=en |volume=73 |issue=2 |pages=405–413 |doi=10.3233/WOR-220103 |issn=1051-9815}}</ref> The [[Institute for Fiscal Studies]] studied labour impacts of long COVID in the UK in 2021. They concluded that one of ten people with long COVID who worked before contracting the condition, had stopped working. Most of them were on sick leave, rather than losing their job.<ref>{{Cite book |last=Waters |first=Tom |url=https://ifs.org.uk/sites/default/files/output_url_files/BN346-Long-COVID-and-the-labour-market.pdf |title=Long COVID and the labour market |last2=Wernham |first2=Thomas |publisher=The Institute for Fiscal Studies |year=2022 |isbn=978-1-80103-079-3 |pages=10–11}}</ref>


== Research ==
== Research ==

Revision as of 08:03, 5 August 2023

"Post COVID" redirects here. For the South Park special, see South Park: Post Covid.

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Long COVID or long-haul COVID is a series of health problems persisting or developing after an initial COVID-19 infection. Symptoms can last months to years and are often debilitating. The causes of long COVID are not yet fully understood.[1]

Long COVID may affect multiple organ systems, including disorders of the respiratory, cardiovascular, gastrointestinal and nervous systems. It also effects mental health, metabolism, and can cause pain in muscles and joints, anemia and exercise intolerance / post-exertional malaise.[2][3] The most commonly reported symptoms of long COVID are fatigue and memory problems.[2][4] Many other symptoms have also been reported, including headaches, shortness of breath, loss of smell, distorted smell, distortion or loss of taste, muscle weakness, fever, and cognitive dysfunction.[5][6]

Estimates of the prevalence of long COVID vary based on definition, population studied, time period studied, and methodology, generally ranging between 5% and 50%.[7] Health systems in some countries and jurisdictions have been mobilized to deal with this group of patients by creating specialized clinics and providing advice.[2][8] As of 2023, there are no tests to diagnose long COVID and no established treatments.[1][5] Overall, it is considered to be a diagnosis of exclusion.[9]

Terminology and definitions

Long COVID is a patient-created term which was reportedly first used in May 2020 as a hashtag on Twitter by Elisa Perego, an archaeologist at University College London.[10][11] While long COVID is the most prevalent name, the terms long-haul COVID, post-COVID-19 syndrome, post-COVID-19 condition,[12][13] post-acute sequelae of COVID-19 (PASC), and chronic COVID syndrome (CCS)[14] are also in use.[15][2][16]

There are multiple definitions of long COVID, depending on country and on institution. The most accepted is the WHO definition, which defines long COVID to start three months after initial infection.[17] It is normal and expected that people who experience severe symptoms or complications such as post-intensive care syndrome or secondary infections will take longer to recover than people who did not require hospitalization (called mild COVID-19[18]) and had no such complications. It can be difficult to determine whether an individual's set of ongoing symptoms represents a normal, prolonged convalescence, or extended 'long COVID'.[19]

World Health Organization clinical case definition

The World Health Organization (WHO) established a clinical case definition in October 2021,[12] published in the journal The Lancet Infectious Diseases:[13]

post-COVID-19 condition occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually three months from the onset, with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include, but are not limited to, fatigue, shortness of breath, and cognitive dysfunction, and generally have an impact on everyday functioning. Symptoms might be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms might also fluctuate or relapse over time.

British definition

The British National Institute for Health and Care Excellence (NICE) divides COVID-19 into three clinical case definitions:

  • acute COVID-19 for signs and symptoms during the first four weeks after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the first, and
  • long Covid for new or ongoing symptoms four weeks or more after the start of acute COVID-19, which is divided into the other two:
    • ongoing symptomatic COVID-19 for effects from four to twelve weeks after onset, and
    • post-COVID-19 syndrome for effects that persist 12 or more weeks after onset.

NICE describes the term long COVID, which it uses "in addition to the clinical case definitions", as "commonly used to describe signs and symptoms that continue or develop after acute COVID-19. It includes both ongoing symptomatic COVID-19 (from four to twelve weeks) and post-COVID-19 syndrome (12 weeks or more)".[16]

NICE defines post-COVID-19 syndrome as "Signs and symptoms that develop during or after an infection consistent with COVID‑19, continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body. Post‑COVID‑19 syndrome may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed".[16]

American definition

In February 2021, the U.S. National Institutes of Health (NIH) director Francis Collins indicated long COVID symptoms for individuals who "don't recover fully over a period of a few weeks" be collectively referred to as "Post-Acute Sequelae of SARS-CoV-2 Infection" (PASC). The NIH listed long COVID symptoms of fatigue, shortness of breath, brain fog, sleep disorders, intermittent fevers, gastrointestinal symptoms, anxiety, and depression. Symptoms can persist for months and can range from mild to incapacitating, with new symptoms arising well after the time of infection.[20] The Centers for Disease Control and Prevention (CDC) term Post-Covid Conditions qualifies long COVID as symptoms four or more weeks after first infection.[2]

Symptoms

A scientific review identified over 50 apparent long-term effects – including those of 'long COVID' – along with their estimated prevalence and estimated that 80% of included patients had at least one overall effect beyond two weeks.[21][22]
External videos
video icon “Long Covid: A parallel pandemic”, Akiko Iwasaki and others, Knowable Magazine, 8 August 2022.

There is a large set of symptoms associated with long COVID, impacting many different organs and body systems. Long COVID symptoms can differ significantly from person to person.[23] Common symptoms reported in studies are post-exertional malaise (symptoms worsen with activity), fatigue, muscle pain, shortness of breath, chest pain and cognitive disfunction ("brain fog").[23] The neurological symptoms of long COVID can limit people's ability to day-to-day activities.[1]

Symptom relapse occurred in 86% of adult participants triggered by physical or mental effort or by stress. Three groups of symptoms were identified: initial symptoms that peak in the first two to three weeks and then subside; stable symptoms; and symptoms that increase markedly in the first two months and then stabilize.[24]

Neurological symptoms

Common neurological symptoms in long COVID are difficulty concentrating, cognitive impairment and headaches.[6][1] People also frequently experience loss of taste and loss of smell.[6]

In terms of mental health, people with long COVID often experience sleep difficulties.[6] A large study showed that depression and anxiety levels are raised in the first two months after infection, but return to normal values afterwards. This was in contrast to other neurological symptoms, such as brain fog and seizures, which lasted at least two years.[1]

Lungs, heart and digestive system

A 2022 review found difficulty breathing as the second-most common symptoms of long COVID.[25] People can also experience an enduring cough. In the cardiovascular system, effort intolerance and chest pain occur often in people in long COVID.[6]

Less frequenty, people with long COVID experience diarrhea and nausea.[6]

Other symptoms

Joint pain and muscle pain are frequently reported as symptoms of long COVID.[6]

People are at increased risk of stroke, pulmonary embolism, myocardial infraction and type I and II diabetes after recovering from acute COVID. There is disagreement whether this should be seen as an aspect of long COVID, or whether this should be considered separately.[23]

Subgroups

Because the symptom combinations of long COVID vary significantly from person to person, one approach to researching the condition is to define subgroups or clusters of long-haulers. This would allow for a more targeted management.[23] One study of 35,000 patients with long COVID symptoms found cases clustered into four major symptom patterns:[26][27]

  • Subphenotype 1 (cardiac and renal), representing about 34% of people was dominated by cardiac-related, kidney-related and circulation-related issues, including cardiac and circulatory conditions, renal failure, anemia and fluid and electrolyte disorders.
  • Subphenotype 2 (respiratory, sleep and anxiety) representing 33% people was dominated by respiratory conditions, sleep disorders, anxiety and symptoms such as headache and chest pain.
  • Subphenotype 3 (musculoskeletal and nervous) consisted of 23% people who had musculoskeletal and nervous system sequelae, such as musculoskeletal pain, headaches and sleep-wake disorders.
  • Subphenotype 4 (digestive and respiratory) included 10% people who mainly had digestive system and respiratory conditions, including abdominal pain, breathing abnormalities and throat or chest pain, anemia and nausea or vomiting.

Epidemiology

Chart called "Who is Most Likely to Get Long Covid?" showing that the prevalence of long Covid is somewhat higher in women and middle-aged adults
Long COVID's prevalence varies by age and gender

Estimates of the prevalence of long COVID vary widely. The estimates depend on the definition of long COVID and the population studied. An April 2022 meta-analysis estimated that the pooled prevalence of post-COVID conditions was 43%, with estimates ranging between 9% and 81%. People who had been hospitalised with COVID saw a higher prevalence of 54%, while this number dropped to 34% for nonhospitalised people. Prevalence generally decreased with a longer follow-up time.[28] In people age 0–18 years the prevalence of long COVID conditions – like mood symptoms, fatigue and sleep disorders – appears to be at ~25% overall.[29][30]

In a large population cohort study in Scotland, 42% of respondents said they had not fully recovered after 6 to 18 months after catching COVID, and 6% indicated they had not recovered at all. The risk of long COVID was associated with disease severity; people with asymptomatic infection did not have increased risk of long COVID symptoms compared to people who had never been infected. Those that had been hospitalised had 4.6 times higher odds of no recovery compared to nonhopitalised people.[31]

In June 2022, a CDC study based on electronic health records showed that "one in five COVID-19 survivors aged 18–64 years and one in four survivors aged ≥65 years experienced at least one incident condition that might be attributable to previous COVID-19" or long COVID.[32][33] An analysis of private healthcare claims showed that of 78,252 patients diagnosed with 'long COVID', 75.8% had not been hospitalized for COVID-19.[34][35]

Children

Long COVID is uncommon in children and their features differ from adults: In a retrospective cohort study from October 2022 of almost 660,000 US children tested for SARS-CoV-2 by antigen or polymerase chain reaction, the incidence of at least 1 systemic, syndromic, or medication feature of long COVID (1–6 months afterwards) was 42% among viral test–positive children versus 38% among viral test–negative children, that is there was an incidence proportion difference of only 3.7%. Long COVID was identified more in those cared for intensive care unit during the acute illness phase, children younger than five years, and those with complex chronic conditions. Neurological symptoms, such as headache, vertigo, and paresthesiae were not significant findings in this study, as opposed to in adults.[36]

A 2021 study from the UK Office for National Statistics with 20,000 participants, including children and adults, found that, in children who tested positive, at least one symptom persisted after five weeks in 9.8% of children aged two to eleven years and in 13% of children aged 12 to 16 years.[37] A 2022 University College London study in the UK found that children ages 11–17 who had a positive PCR test were more likely to have three or more symptoms three months after their diagnosis compared to those with a negative test.[38]

Causes and mechanisms

Diagram of the body showing autoimmune response, persistent virus, organ damage, and microclots
Possible causes of long COVID

The causes of long COVID are not yet fully understood. It is likely that there is no single cause, but instead multiple, and possibly overlapping, mechanisms that all contribute to the development of long COVID.[1] Organ damage from the acute infection can explain a part of the symptoms, but long COVID is also observed in people where organ damage seems to be absent.[39] Several hypotheses have been put forward explaining long COVID. A 2023 review article included:[1]

Further hypothesis include a dysfunction of the mitochondria and the cellular energy system,[40] persistent systemic inflammation, and the persistance of SARS-COV-19 antigens.[41]

Similarities to other syndromes

Many symptoms have similar severity in long COVID and ME/CFS

Long COVID has many symptoms in common with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and thus some people with long COVID meet ME/CFS diagnostic criteria.[1] Like long COVID, ME/CFS is often triggered by infections, and some biological changes overlap.[42] There are also similarities with post-Ebola syndrome and aftereffects of the chikungunya virus. These conditions may have similar pathophysiology to long COVID.[19] Dysautonomia and POTS are also potential aspects of long COVID.[1]

Risk factors

In terms of demographic risks, women are more at risk then men.[28] Age forms another risk factor, with older people more at risk.[28] This is also true for children, with older children at a higher risk than younger children.[17] Risks of developing long COVID were further higher for those from an ethnic minority, people with lower incomes and people with fewer years of education.[17] People that smoke also have a higher risk of developing long COVID.[17]

Various health issues raise the risk of long COVID. For instance, people with obesity more often report long COVID.[28] Asthma and chronic obstructive pulmonary disease also form risk factors.[17][28] In terms of mental health, depression and anxiety raise risks.[17]

Finally, characteristics of the acute infection play a role in developing long COVID. People that experience more unique symptoms during the acute infection are more likely to develop long COVID, as well as people that require hospitalisation.[28] Finally, long COVID risks may have been higher with the SARS-CoV2 Delta variant compared to the Omicron variant. The higher infection rate from the Omicron variant means that it is still responsible for a large group of long-haulers.[17]

Diagnosis

There are no standardized tests to determine if symptoms persisting after COVID-19 infection are due to long COVID. Post-COVID conditions are not one illness, but rather may involve numerous organ systems and disorders.[2] There are diagnostic tools available for some elements of long COVID, such as the tilt table test for POTS and MRI scans to test for cardiovascular impairment. Diagnostic test for other symptoms are in development. Tests offered in standard care often come back normal.[1]

Prevention

Preventing COVID-19 is the most effective way to prevent long COVID. COVID-19 vaccination reduces the risk of long COVID, but by how much is unclear, as the available studies differ widely and are of limited quality.[43][44] One complication is that healthy people more often opt to get vaccinated, which makes it more difficult to draw conclusions on the effect of vaccination.[45] One study has found no effect of vaccination, whereas others have found vaccines prevent between 15% and 41% of long COVID cases.[1]

Treatment and management

As of 2023, there are no established effective treatments for long COVID.[1]

Management of long COVID depends on symptoms, with current guidelines recommending multidisciplinary rehabilitation to improve symptoms and quality of life.[2] Rest, planning and prioritising are advised for people with fatigue. People who get post-exertional malaise may benefit from activity management with pacing.[46] People with allergic-type symptoms such as rashes on the skin may benefit from antihistamines.[47]

Olfactory dysfunction symptoms from a COVID infection can be persistent and be impactful on a person's life.[48] Approaches for treating persistent olfactory dysfunction include medications such as systematic corticosteroids and intranasal corticosteroids, palmitoylethanolamide and Luteolin, however the effectiveness of these approaches is not clear.[48] It is also not clear if medications or olfactory training techniques are effective at preventing a person from developing longer term or persistent olfactory dysfunction after a COVID infection.[49]

Health system responses

Australia

In October 2020, a guide published by the Royal Australian College of General Practitioners (RACGP) says that ongoing post-COVID-19 infection symptoms such as fatigue, shortness of breath and chest pain will require management by GPs, in addition to the more severe conditions already documented.[50]

In December 2021, research by a health economics expert at Deakin University suggests that even without fully understanding the Omicron variant's effects yet, a further 10,000 to 133,000 long COVID cases are likely to emerge on top of the current approximately 9450 in New South Wales and 19,800 in Victoria, after border and other restrictions had been recently lifted. The RACGP released new guidelines for general practitioners to manage a large number of new long COVID patients.[51]

South Africa

In October 2020, the DATCOV Hospital Surveillance Department of the National Institute for Communicable Diseases (NICD) looked into a partnership with the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) (an open-access research and data resource)[52] in order to conduct clinical research into the impact PASC may have within the South African context. As of 30 January 2021, the project has yet to receive ethical approval for the commencement of data collection. Ethics approval was granted on 3 February 2021 and formal data collection began on 8 February 2021.[citation needed]

United Kingdom

In Britain, the National Health Service set up specialist clinics for the treatment of long COVID.[53][46] The four Chief Medical Officers of the UK were warned of academic concern over long COVID on 21 September 2020 in a letter written by Trisha Greenhalgh published in The BMJ[54] signed by academics including David Hunter, Martin McKee, Susan Michie, Melinda Mills, Christina Pagel, Stephen Reicher, Gabriel Scally, Devi Sridhar, Charles Tannock, Yee Whye Teh, and Harry Burns, former CMO for Scotland.[54]

In October 2020, NHS England's head Simon Stevens announced the NHS had committed £10 million to be spent that year on setting up long COVID clinics to assess patients' physical, cognitive, and psychological conditions and to provide specialist treatment. Future clinical guidelines were announced, with further research on 10,000 patients planned and a designated task-force to be set up, along with an online rehabilitation service[55] – "Your Covid Recovery".[56] The clinics include a variety of medical professionals and therapists, with the aim of providing "joined-up care for physical and mental health".[57] NHS Long COVID clinics have been found to positively impact quality of life and support the management of symptoms, although further research is required to improve these services.[46]

The National Institute for Health Research has allocated funding for research into the mechanisms behind symptoms of long COVID.[57][8]

In December 2020, University College London Hospitals (UCLH) opened a second long COVID clinic at the National Hospital for Neurology and Neurosurgery for patients with post-COVID neurological issues. The first clinic had opened in May, primarily focused on respiratory problems, but both clinics refer patients to other specialists where needed, including cardiologists, physiotherapists and psychiatrists.[58] By March 2021 there were 69 long COVID clinics in the English NHS, mostly focussing on assessing patients, with more planned to open. There were fears that community rehabilitation services did not have capacity to manage large numbers of referrals.[59]

On 18 December 2020, the National Institute for Health and Care Excellence (NICE), the Royal College of General Practitioners (RCGP) and the Scottish Intercollegiate Guidelines Network (SIGN) published a guide to the management of long COVID.[60] The guideline was reviewed by representatives of the UK doctors #longcovid group, an online support group for COVID long-haulers, who said that it could be improved by introducing a more comprehensive description of the clinical features and physical nature of long COVID, among other changes.[61]

In November 2021 complaints were reported from NHS staff that neither their employers nor their trades unions were supportive, though the British Medical Association was pushing for long COVID to be classed as an occupational disease.[62]

In May 2022 demand for occupational therapy led rehabilitation services in Britain was reported to have increased by 82% over the previous six months as occupational therapists were supporting people whose needs have become more complex because of delays in treatment brought about by the pandemic. Half of occupational therapists surveyed were supporting people affected by lasting Covid symptoms.[63]

United States

On 23 February 2021, the National Institutes of Health director, Francis Collins, announced a major initiative, backed by $1.15 billion in funding over four years,[64] to identify the causes and ultimately the means of prevention and treatment of people who have long COVID.[20] The initiative took on the name the "Researching COVID to Enhance Recovery," or RECOVER. The initiative intends to fund studies at more than 200 research sites across the United States.[65] Part of this initiative includes the creation of the COVID-19 Project,[66] which will gather data on neurological symptoms. On July 31, 2023, the US Department of Health and Human Services announced the creation of the Office of Long COVID Research and Practice to coordinate research across government agencies.[67] In February 2022, at least sixty-six hospitals and health systems had launched COVID recovery programs to aid patients who experience long term or lingering symptoms.[68]

Societal impact and support communities

As of 2022, several countries and medical organizations have produced guidelines on long COVID for clinicians and the public.[2][16][69] People with long COVID may need care within several clinical disciplines for long-term monitoring or intervention of ongoing symptoms, and to implement social services, physical therapy, or mental health care.[69] In some countries, such as the UK and Germany, specialized long COVID outpatient clinics have been established to assess individual cases for the extent of surveillance and treatment needed.[70] Two reviews indicated that primary physicians should provide the first assessment of people with long COVID symptoms, leading to specialist referrals for more complex long COVID symptoms.[69][70] Long-term follow-up of people with long COVID involves outcome reports from the people themselves to assess the impact on their quality of life, especially for those who were not hospitalized and receiving regular clinical follow-up.[69][70] Digital technologies, such as videoconferencing, are being implemented between primary care physicians and people with long COVID as part of long-term monitoring.[69]

Some people experiencing long COVID have formed community care networks and support groups on social media websites.[2][16][70][71] Internationally, there are several long COVID advocacy groups.[69][72][73][74] Clinical advice on self-management and online healthcare programs are used to support people with long COVID.[70]

Work-related impacts

The impact of long COVID on people's ability to work is large. Estimates vary on how many people are out of work, or work reduced hours because of long COVID. For those with mild or moderate disease, between 12% and 23% had had long periods of absence or remained absent from work at 3 to 7 months. The share of people working adjusted hours or tasks after mild or moderate COVID, was around 8% to 45% after three to eight months.[75] The percentage of people returning to work after hospitalisation was lower.[75] Return to work after hospitalisation differed by country. In China and the US a higher percentage went back to work. In the US, this could be partially explained by a lack of paid sick leave for some workers.[76] The Institute for Fiscal Studies studied labour impacts of long COVID in the UK in 2021. They concluded that one of ten people with long COVID who worked before contracting the condition, had stopped working. Most of them were on sick leave, rather than losing their job.[77]

Research

As long COVID is a novel condition, open questions abound. Research is ongoing in many areas, including developing more accurate diagnostic criteria, refining estimates of its likelihood, unearthing risk factors, gathering data on its impact on daily life, discovering which populations face barriers to adequate care, and learning how much protection vaccination provides.[78]

Many experimental and repurposed drugs are being researched as treatments for different aspects of long Covid. As viral persistence is one hypothesis, the antivirals favipiravir, nirmatrelvir/ritonavir (Paxlovid), and remdesivir are being studied. Ivabradine and metoprolol succinate are being investigated for POTS and cardiovascular issues, and there are many trials of known or purported anti-inflammatories, such as ibudilast, imatinib, infliximab, pentoxifylline, low dose naltrexone, and cannabinoids. Fluvoxamine is being studied for parosmia. Vitamin D is also being investigated. Montelukast, LYT-100 (deupirfenidone) and S-1226 are in testing for respiratory symptoms; AXA1125 for muscle function; lithium, vortioxetine, and temelimab for cognitive function, and pimozide for tinnitus.[79] The experimental drug BC-007 is also being researched.[80]

See also

References

  1. ^ a b c d e f g h i j k l Davis HE, McCorkell L, Vogel JM, Topol EJ (March 2023). "Long COVID: major findings, mechanisms and recommendations". Nature Reviews. Microbiology. 21 (3): 133–146. doi:10.1038/s41579-022-00846-2. PMC 9839201. PMID 36639608.
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Further reading

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External links

Look up long COVID in Wiktionary, the free dictionary.
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