Post-COVID Conditions

 

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Post-COVID Conditions

Although most people with COVID-19 get better within weeks of illness, some people experience post-COVID conditions. Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience more than four weeks after first being infected with the virus that causes COVID-19. Even people who did not have symptoms when they were infected can have post-COVID conditions. These conditions can have different types and combinations of health problems for different lengths of time.

Types of Post-COVID Conditions

Long COVID

Long COVID is a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if the illness was mild, or they had no symptoms. People with long COVID report experiencing different combinations of the following symptoms:

·       Tiredness or fatigue

·       Difficulty thinking or concentrating (sometimes referred to as “brain fog”)

·       Headache

·       Loss of smell or taste

·       Dizziness on standing

·       Fast-beating or pounding heart (also known as heart palpitations)

·       Chest pain

·       Difficulty breathing or shortness of breath

·       Cough

·       Joint or muscle pain

·       Depression or anxiety

·       Fever

·       Symptoms that get worse after physical or mental activities

Multiorgan Effects of COVID-19

Multiorgan effects can affect most, if not all, body systems including heart, lung, kidney, skin, and brain functions. Multiorgan effects can also include conditions that occur after COVID-19, like multisystem inflammatory syndrome (MIS) and autoimmune conditions. MIS is a condition where different body parts can become swollen. Autoimmune conditions happen when your immune system attacks healthy cells in your body by mistake, causing painful swelling in the affected parts of the body.

It is unknown how long multiorgan system effects might last and whether the effects could lead to chronic health conditions.

Post-acute COVID-19 syndrome

 

Fig. 1: Timeline of post-acute COVID-19.

Acute COVID-19 usually lasts until 4 weeks from the onset of symptoms, beyond which replication-competent SARS-CoV-2 has not been isolated. Post-acute COVID-19 is defined as persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. The common symptoms observed in post-acute COVID-19 are summarized.

 

Fig. 2: Interdisciplinary management in COVID-19 clinics.

Multidisciplinary collaboration is essential to provide integrated outpatient care to survivors of acute COVID-19 in COVID-19 clinics. Depending on resources, prioritization may be considered for those at high risk for post-acute COVID-19, defined as those with severe illness during acute COVID-19 and/or requirement for care in an ICU, advanced age and the presence of organ comorbidities (pre-existing respiratory disease, obesity, diabetes, hypertension, chronic cardiovascular disease, chronic kidney disease, post-organ transplant or active cancer). The pulmonary/cardiovascular management plan was adapted from a guidance document for patients hospitalized with COVID-19 pneumonia76. HRCT, high-resolution computed tomography; PE, pulmonary embolism.

 

Box 1 Summary of post-acute COVID-19 by organ system

Pulmonary

• Dyspnea, decreased exercise capacity and hypoxia are commonly persistent symptoms and signs
• Reduced diffusion capacity, restrictive pulmonary physiology, and ground-glass opacities and fibrotic changes on imaging have been noted at follow-up of COVID-19 survivors
• Assessment of progression or recovery of pulmonary disease and function may include home pulse oximetry, 6MWTs, PFTs, high-resolution computed tomography of the chest and computed tomography pulmonary angiogram as clinically appropriate

Hematologic

• Thromboembolic events have been noted to be <5% in post-acute COVID-19 in retrospective studies
• The duration of the hyperinflammatory state induced by infection with SARS-CoV-2 is unknown
• Direct oral anticoagulants and low-molecular-weight heparin may be considered for extended thromboprophylaxis after risk–benefit discussion in patients with predisposing risk factors for immobility, persistently elevated D-dimer levels (greater than twice the upper limit of normal) and other high-risk comorbidities such as cancer

Cardiovascular

• Persistent symptoms may include palpitations, dyspnea and chest pain
• Long-term sequelae may include increased cardiometabolic demand, myocardial fibrosis or scarring (detectable via cardiac MRI), arrhythmias, tachycardia and autonomic dysfunction
• Patients with cardiovascular complications during acute infection or those experiencing persistent cardiac symptoms may be monitored with serial clinical, echocardiogram and electrocardiogram follow-up

Neuropsychiatric

• Persistent abnormalities may include fatigue, myalgia, headache, dysautonomia and cognitive impairment (brain fog)
• Anxiety, depression, sleep disturbances and PTSD have been reported in 30–40% of COVID-19 survivors, similar to survivors of other pathogenic coronaviruses
• The pathophysiology of neuropsychiatric complications is mechanistically diverse and entails immune dysregulation, inflammation, microvascular thrombosis, iatrogenic effects of medications and psychosocial impacts of infection

Renal

• Resolution of AKI during acute COVID-19 occurs in the majority of patients; however, reduced eGFR has been reported at 6 months follow-up
• COVAN may be the predominant pattern of renal injury in individuals of African descent
• COVID-19 survivors with persistent impaired renal function may benefit from early and close follow-up in AKI survivor clinics

Endocrine

• Endocrine sequelae may include new or worsening control of existing diabetes mellitus, subacute thyroiditis and bone demineralization
• Patients with newly diagnosed diabetes in the absence of traditional risk factors for type 2 diabetes, suspected hypothalamic–pituitary–adrenal axis suppression or hyperthyroidism should undergo the appropriate laboratory testing and should be referred to endocrinology

Gastrointestinal and hepatobiliary

• Prolonged viral fecal shedding can occur in COVID-19 even after negative nasopharyngeal swab testing
• COVID-19 has the potential to alter the gut microbiome, including enrichment of opportunistic organisms and depletion of beneficial commensals

Dermatologic

• Hair loss is the predominant symptom and has been reported in approximately 20% of COVID-19 survivors

Ayurvedic treatment may be helpful to reduce post covid complications:-

1-    Dashmool Kwath

2-    Dashmoolarishta

3-    Sansamni vati

4-    Arjun kwath

5-    Breathing exercise

6-    Chandraprabha vati

7-    Arogyavardhini vati

8-    Chawanprash awleh

9-    Kaishor Guggulu

10- Shnehan

11- Prawal pisti

12- Drakhcha awleha

13- Golden milk

14- Tulsi

15- Adrak

16- Swarn malti basant rash

17- Lukewarm water

18- Vitamin -A

19- Laghu aahar

20- Mild exercise