Long COVID and its Management

Abstract

The pandemic of COVID-19 is the biggest public health crisis in 21^st Century. Besides the acute symptoms after infection, patients and society are also being challenged by the long-term health complications associated with COVID-19, commonly known as long COVID. While health professionals work hard to find proper treatments, large amount of knowledge has been accumulated in recent years. In order to deal with long COVID efficiently, it is important for people to keep up with current progresses and take proactive actions on long COVID. For this purpose, this review will first introduce the general background of long COVID, and then discuss its risk factors, diagnostic indicators and management strategies. This review will serve as a useful resource for people to understand and prepare for long COVID that will be with us in the foreseeable future.

Keywords: COVID-19; SARS; SARS-CoV-2; drug repurposing; long COVID; management; post-acute COVID syndrome (PACS); post-acute sequelae of SARS-CoV-2 (PASC); risk factor; vaccine.

Figure 1

Disease course of COVID-19. COVID-19 disease course is depicted into multiple stages depending on viral counts and symptoms presented over time. Infected host undergoes acute-COVID-19 which lasts five weeks from symptoms onset, until competent virions become undetectable. Persistent symptoms and long-term complications beyond five weeks from COVID-19 infection is defined as long COVID. COVID-19: Coronavirus Disease 2019; PCR: polymerase chain reaction; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.

Figure 2

Proposed risk factors and relevant pathophysiological consequences of long COVID development. Old age, pre-existing comorbidities, and incomplete COVID-19 vaccination are well-established risk factors of acute-COVID-19 severity, which subsequently increase the risk for long COVID. Altered clinical parameters such as immunoglobins, inflammation cytokines, and microbiome profile could reflect the progression of long COVID. Such predisposition may also have an impact on recovery. COVID-19: Coronavirus Disease 2019; CRP: c-reactive protein; IgG: immunoglobulin G; IgM: immunoglobulin M; IL-6: interleukin 6; RAS: renin-angiotensin system; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.

Figure 3

Proactive measures and treatment strategies invovled in relieving long COVID. Management of long COVID should be prioritized throughout the course of disease. Sufficient nutrients from a well-balanced diet, physical activity, appropriate PPE and COVID-19 vaccination are protective measures against SARS-CoV-2 infection and the progression of long COVID. Early viral clearance by preproperate clinical practice during acute-COVID-19 may alleviate viral infection and prevent poor clinical outcomes. Integrated management plan should be provided to individuals with long COVID, depending on assessments and targeted management. CoQ10: coenzyme Q10; COVID-19: Coronavirus Disease 2019; CRP: c-reactive protein; MCAS: mast cell activation syndrome; SARS-CoV-2: severe acute respiratory syndrome coronavirus 2.