Defining Post-COVID Symptoms (Post-Acute COVID, Long COVID, Persistent Post-COVID): An Integrative Classification

Abstract

The pandemic of the coronavirus disease 2019 (COVID-19) has provoked a second pandemic, the "long-haulers", i.e., individuals presenting with post-COVID symptoms. We propose that to determine the presence of post-COVID symptoms, symptoms should appear after the diagnosis of SARS-CoV-2 infection; however, this situation has some problems due to the fact that not all people infected by SARS-CoV-2 receive such diagnosis. Based on relapsing/remitting nature of post-COVID symptoms, the following integrative classification is proposed: potentially infection related-symptoms (up to 4-5 weeks), acute post-COVID symptoms (from week 5 to week 12), long post-COVID symptoms (from week 12 to week 24), and persistent post-COVID symptoms (lasting more than 24 weeks). The most important topic is to establish the time reference points. The classification also integrates predisposing intrinsic and extrinsic factors and hospitalization data which could promote post-COVID symptoms. The plethora of symptoms affecting multiple systems exhibited by "long-haulers" suggests the presence of different underlying mechanisms.

Keywords: COVID-19; classification; definition; long COVID; persistent; symptoms.

Figure 1

Integrative post-COVID symptoms model in non-hospitalized patients showing transition phase (blue), and phases 1 (green), 2 (yellow), and 3 (red) of post-COVID symptoms. PTSD: post-traumatic stress disorder.

Figure 2

Integrative post-COVID symptoms model in hospitalized patients showing transition phase (blue), and phases 1 (green), 2 (yellow), and 3 (red) of post-COVID symptoms. PTSD: post-traumatic stress disorder.

Figure 3

Integrative post-COVID symptoms model in asymptomatic individuals showing transition phase (blue), and phases 1 (green), 2 (yellow), and 3 (red) of post-COVID symptoms. PTSD: post-traumatic stress disorder.