Long COVID symptoms are believed to affect about 10 per cent of those infected and can last from weeks to months. What symptoms persist in people with long COVID, and how can these be treated? Dr. Tejal Patel, a pharmacy professor at the University of Waterloo, provides answers to these and other questions.

What is long COVID?
There was a review recently published in the journal Clinical Review and a feature by the Science Table highlighting the broad range of research in this new and evolving diagnosis. Long COVID and “post-COVID-19 condition” are being used to describe the range of symptoms that can persist for weeks or months after a COVID-19 infection. We’re learning about long COVID, and different organizations define it in different ways. Here in Canada, the Public Health Agency of Canada (PHAC) has defined long COVID as symptoms that persist or recur for weeks after an acute COVID-19 infection. 

PHAC further breaks long COVID into “short term,” lasting from four to 12 weeks and “long-term,” lasting longer than 12 weeks. PHAC says long COVID symptoms limit a person’s ability to return to baseline levels of functioning and increase the use of healthcare. Emerging research suggests long COVID can develop in those who had severe or mild COVID-19 infection and even those who were asymptomatic or did not experience any symptoms of a COVID-19 infection.

What symptoms persist in people with long COVID?
Long COVID has a wide range of symptoms that can affect different body systems. Effects on the brain can include cognitive impairment or brain fog. Heart symptoms can include chest pain and palpitations. Lung symptoms can include breathlessness, shortness of breath and cough.

Other symptoms include muscle weakness and joint pain; stomach and intestinal symptoms such as diarrhea; psychological effects like mood swings; and sensory symptoms such as changes to smell or taste.  Although over 200 symptoms have been reported, the most common symptoms are fatigue or extreme tiredness.  The symptoms can wax and wane, improving or worsening with time. Long COVID can have real impacts, with some people struggling to return to normal daily activities such as dressing or bathing and may not be able to take care of other family members. Others may find it difficult to work.

How common is Long COVID?
There are many different estimates for how many people have been affected with long COVID. The World Health Organization estimates that one in four people who had COVID will have symptoms for at least one-month post-infection, and one in 10 people will have symptoms for 12 weeks or more.  In Ontario, 57,000 to 78,000 people are estimated to have or have had long COVID. 

People who are overweight or obese, female, older, or who have a more severe COVID-19 infection appear to be at higher risk of long COVID.  Vaccinations against COVID-19 reduce the risk of long COVID by reducing the likelihood of infection.  Some studies indicate that people with a higher number of underlying medical conditions have greater odds of not returning to their pre-COVID-19 level of functioning. 

How can long COVID be treated?
Treatment for long COVID is usually symptom-based.  For example, if a person presents with symptoms related to the heart, then investigations for the specific heart-related cause will be implemented, and an appropriate treatment strategy is initiated for the specific heart-related cause.  In some cases, people with long COVID will be advised to stop smoking or avoid extremes in temperature if they present with symptoms related to the lungs.  People with long COVID may be asked to rest for certain symptoms, while medications may be initiated for other symptoms.  Research for understanding long COVID and why so many systems are affected is ongoing.  Until we have a deeper understanding that allows us to design specific treatments, treatment will be based on symptoms. 

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