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Long COVID

Last reviewed: 10 Nov 2024
Last updated: 23 Feb 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • previous diagnosis of COVID-19 or history of suspected acute COVID-19 illness
Full details

Other diagnostic factors

  • fatigue/weakness
  • cognitive impairment (brain fog)
  • impaired sleep
  • headache
  • dizziness
  • dyspnoea
  • cough
  • anosmia/dysgeusia
  • pain (including arthralgias and myalgias)
  • chest pain
  • post-exertional malaise
  • anxiety/depression
  • palpitations
  • thirst/dry mouth
  • loss of sexual drive or capacity
  • numbness/tingling
  • hair loss
  • gastrointestinal symptoms
Full details

Risk factors

  • severe COVID-19 illness (requiring hospitalisation or ICU admission)
  • not vaccinated or only partially vaccinated against COVID-19
  • female sex
  • age >40 years
  • BMI >30 kg/m²
  • smoking
  • anxiety/depression
  • asthma
  • chronic kidney disease
  • chronic obstructive pulmonary disease (COPD)
  • diabetes
  • immunosuppression
  • ischaemic heart disease
Full details

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
  • full blood count
  • comprehensive metabolic panel
  • creatine kinase
  • C-reactive protein
  • erythrocyte sedimentation rate
  • serum ferritin level
  • thyroid function tests
  • serum 25-hydroxy vitamin D
  • pulse oximetry
Full details

Investigations to consider

  • orthostatic testing-tilt table testing
  • electrocardiogram
  • pulmonary function testing
  • chest radiograph
  • chest CT
  • B-type natriuretic peptide
  • D-dimer
  • anti-nuclear antibody
  • rheumatoid factor
  • anti-cyclic citrulinated peptide
  • serum vitamin B12
  • blood thiamine
  • serum folate
  • plasma homocysteine
  • high sensitivity troponin
  • transthoracic echocardiogram
  • ambulatory cardiac monitoring
  • cardiac stress test
  • cardiopulmonary exercise test
  • cardiac MRI
  • autonomic function testing
  • overnight sleep study
  • MRI head
  • neuropsychological testing
Full details

Treatment algorithm

ONGOING

all patients

Contributors

Authors

Benjamin Abramoff, MD, MS

Assistant Professor of Physical Medicine and Rehabilitation

Perelman School of Medicine

University of Pennsylvania

Philadelphia

PA

Disclosures

BA has served on medical advisory boards regarding long COVID for Axcella Pharmaceutical, AstraZeneca, Intrivo Diagnostics, and UnitedHealthcare. BA is an author of references cited in this topic.

Shawn Joshi, MD, PhD

Clinical Resident of Physical Medicine & Rehabilitation

Spaulding Rehabilitation Hospital

Clinical Fellow in Medicine

Harvard Medical School

Boston

MA

Disclosures

SJ declares that he has no competing interests.

Eric Herman, MD

Assistant Professor of Family Medicine

School of Medicine

Oregon Health and Science University

Portland

OR

Disclosures

EH serves as co-chair in the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Multidisciplinary PASC Collaborative. EH has been invited to serve as an expert witness in a case involving long COVID. EH is an author of references cited in this topic.

Julie Silver, MD

Associate Professor of Physical Medicine and Rehabilitation

Harvard Medical School

Associate Chair, Department of Physical Medicine and Rehabilitation

Spaulding Rehabilitation Network

Massachusetts General Hospital

Brigham and Women's Hospital

Boston

MA

Disclosures

JS has participated in research funded by NIH and foundations on topics not related to COVID-19 including culinary medicine, prehabilitation, and chronic pain. JS is author of references cited in this topic.

Peer reviewers

Sarah Jolley, MD, MSc

Associate Professor

Division of Pulmonary Sciences and Critical Care Medicine

University of Colorado

Denver

CO

Disclosures

SJ receives NIH funding for work related to long COVID via the RECOVER consortium and AHRQ related to long COVID care delivery.

Trisha Greenhalgh, MA, MD, FRCP, FRCGP, FFPH, PhD

Professor of Primary Care Health Sciences

University of Oxford

Oxford

UK

Disclosures

TG is an author of references cited in this topic.

  • Long COVID images
  • Differentials

    • Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
    • Post-intensive care syndrome
    • Postural orthostatic tachycardia syndrome (POTS)
    More Differentials
  • Guidelines

    • COVID-19 rapid guideline: managing the long-term effects of COVID-19
    • Post-COVID conditions: information for healthcare providers
    More Guidelines
  • Patient information

    COVID-19 (coronavirus)

    Coronavirus (COVID-19): vaccines

    More Patient information
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