Long Covid (post-Covid syndrome)

COVID-19 is a multi-organ disease that can cause a wide range of symptoms. Certain symptoms can persist for a long time after an acute COVID infection. Long COVID and post-COVID syndrome (PCS) were first described during the COVID-19 pandemic. These are therefore recent clinical pictures. If those affected still have symptoms after a period of four weeks following a COVID-19 infection, this condition is referred to as long COVID or post-acute sequelae of COVID-19. If symptoms persist for more than twelve weeks, doctors speak of post-COVID syndrome.

The underlying mechanisms of post-COVID syndrome are not yet precisely known. Virus persistence after acute infection, autoimmune mechanisms, prolonged inflammation after the end of the acute illness or endothelial dysfunction are often suspected to be behind the symptoms. In general, somatic or psychosomatic complaints in the medical history favor the occurrence of long/post COVID syndrome. A high level of psychosocial stress can also contribute to the persistence of COVID symptoms.

Risk factors for the occurrence of PCS are

• Biographical factors (e.g. female gender, middle age)

• Pre-existing conditions (e.g. asthma, mental illness)

• COVID-19-specific factors (e.g. acute symptoms, high viral load)

The risk of PCS is significantly increased in patients who have a severe acute course of the disease, in contrast to patients with mild symptoms in the acute stage of the disease. COVID-19 patients who require intensive medical treatment (e.g. invasive ventilation) in the course of their illness may suffer pathological organ changes (e.g. pulmonary fibrosis, kidney failure) as a result of COVID-19. These organ changes can in themselves - without a PCS - lead to persistent health problems.

Children

Children can also be affected by Long COVID or PCS. Overall, however, the clinical pictures appear to occur primarily in adults. Children over the age of 10 and adolescents are more frequently affected by long COVID symptoms than younger children.

Risk factors for the occurrence of Long COVID in children:

• Female gender

• Previous illnesses

• Severe course of COVID

Most patients with COVID-19 recover completely after an acute illness. A third of acutely COVID-infected people even remain asymptomatic. However, patients who suffer from PCS after an acute illness can have very different courses of the disease. The clinical picture is therefore not uniform. PCS symptoms often lead to a reduction in quality of life and have a negative impact on social and professional life.

The most common symptoms of post-COVID syndrome are

The majority of PCS complaints are non-specific symptoms. Often no organic correlate for the symptoms can be found in the course of diagnosis.

In general, post-COVID symptoms should be diagnosed by a multidisciplinary approach, i.e. by the relevant specialists (e.g. neurologist). The cornerstone for the diagnosis of PCS is a detailed medical history and a physical examination by the attending physician. The physical examination should include a neurological, functional and psychological status.

Further diagnostic options for PCS:

• Testing for organ damage in the event of complaints

• Screening for depression and somatization disorders

• Objectification of functional limitations

• Testing for critical illness polyneuropathy (CIP)

Laboratory diagnostics for PCS are primarily used to rule out other diseases (differential diagnostics). In patients with persistent symptoms, a PCR for SARS-CoV-2 can be performed to differentiate whether the symptoms are due to a prolonged active COVID infection or whether a PCS is responsible for the symptoms.

There are currently no proven drug treatment options for long COVID or post-COVID syndrome. However, a number of different treatment approaches (e.g. immunoadsorption, lipid apheresis or hyperbaric oxygen therapy) are currently being tested in clinical trials. Some studies also report a possible positive influence of a therapeutic vaccination - i.e. a COVID vaccination for existing PCS symptoms - on the symptoms. However, the data on this is currently still sparse, which is why no general recommendations can be made.

In general, PCS sufferers should receive psychosocial support and basic psychosomatic care if necessary. At present, there are already a number of Long COVID outpatient clinics that specialize in the treatment of Long COVID and PCS.

Pacing

The word pacing refers to an energy management method that is suitable for treating the fatigue that often occurs with PCS, for example. Those affected learn to manage their available energy correctly and not to push themselves beyond their individual limits. With the help of activity logs or heart rate and activity monitors, PCS patients can learn not to overload themselves.

Coping

The term coping refers to a person's efforts to deal with a stressful situation. Long COVID and PCS sufferers should be supported in the course of their medical treatment to develop appropriate coping behavior and integrate it into their daily lives. Different strategies can be used depending on the prevailing symptoms.

After a severe COVID-19 disease, organ damage (e.g. lungs, heart or kidneys) occurs more frequently than with a mild course of the disease. This damage can be associated with certain long-term health consequences.

There are currently no known preventive measures to protect against long COVID or post-COVID syndrome. The COVID vaccination can reduce the risk of both clinical pictures, but it only offers partial protection against longer-lasting COVID symptoms in the event of a breakthrough infection. The best way to protect yourself from PCS is to avoid infection or reinfection with SARS-CoV-2 by adhering to infection control measures (e.g. thorough hand hygiene).