15 things about the diagnosis, management and treatment of long COVID

A series of articles published on Tuesday offer advice on the diagnosis, evaluation and treatment of people with long COVID.

The practice articles were published in the CMAJ (Journal of the Canadian Medical Association). About 1.4 million people in Canada have been affected by long-term COVID, a systemic disease that can affect most organ systems in the body.

Long COVID is defined by symptoms lasting longer than 3 months after confirmed or suspected SARS-CoV-2 infection. Over 100 symptoms have been reported, the most common being fatigue, anxiety and depression, shortness of breath, trouble sleeping and heart palpitations.

Each of the 3 articles contains 5 points on the diagnosis, evaluation and treatment of the disease, emphasizing the “potentially modifiable” aspects.

“I believe the most important thing we as health care providers can do to support people is to listen to and validate their experiences, and avoid a cascade of diagnostic tests and consultations. who further tax their limited energy supply,” Kieran Quinn, MD, PhD, General Internist and Palliative Care Physician, Sinai Health, and Assistant Professor, University of Toronto and Institute of Health Policy, Management and Evaluation, said in a press release.

Although the World Health Organization has proposed a definition of the disease, “the sensitivity, specificity and positive and negative predictive value of the definitive diagnostic criteria” are not yet known, according to an article.

Besides the fact that nearly 1.5 million Canadians have long COVID, the paper notes that women are more likely to be affected than men.

The systemic nature of long COVID may be due to the expression of angiotensin-converting enzyme 2 (ACE2) receptors in different organ systems, which allow entry to SARS-CoV-2.

Persistent symptoms can linger for a year or more, according to the journal. In studies from both China and Canada, roughly the same proportion of people said COVID-19 kept them out of the labor market or daily activities for a long time.

The most common potentially treatable symptoms include fatigue (reported by 23% to 63%); anxiety and depression (23% to 46%); dyspnea (11% to 43%); sleep disturbances (11% to 31%); and palpitations (6% to 22%). These symptoms may warrant evaluation to rule out other factors and causes.

If other causes are not found, treatment for each could include the following:

• For fatigue, a structured, symptom-guided return to activity program tailored to the severity of fatigue
• For mental health, guideline-guided use of psychosocial interventions and medications

• For dyspnea, breathing exercises, body positioning and pulmonary rehabilitation
• For sleep problems, sleep counseling, relaxation techniques, and stimulus control, which may include cognitive behavioral counseling and prescription medications.
• For palpitations and tachycardia with certain causes, behavioral changes, oral fluids, salt, compression stockings, beta-blockers, ivabradine, and midodrine.

References

1. Quinn KL, Razak F, Cheung A. Diagnosis of post-COVID-19 (long COVID) status in adults. CMY 2023 Jan 17;195:E78-9. doi: 10.1503/cmaj.220818

2. Quinn KL, Razak F, Cheung A. Common and potentially assessment. modifiable symptoms of post-COVID-19 (long COVID) condition in adults. CMY 2023 Jan 17;195:E76-7. doi: 10.1503/cmaj.220823

3. Quinn KL, Razak F, Cheung A. Treating common and potentially modifiable symptoms of post-COVID-19 (long COVID) status in adults. CMY 2023 Jan 17;195:E80-1. doi: 10.1503/cmaj.220824