«Long COVID»: the current state of the problem. A review of foreign scientific and medical publications

Abstract

Not all the patients diagnosed with COVID-19 can completely recover; some of them experience various persistent symptoms which wax and wane. As the COVID-19 pandemic continues, the number of people with long-term symptoms is rapidly increasing, adding to the burden on the healthcare and society.

The prevalence of the COVID-19 consequences varies between studies, with some researchers reporting that more than half of hospitalized patients suffer from long-lasting symptoms for at least 6 months after the acute SARS-CoV-2 infection, and others observing such symptoms for more than 12 months. The overall prevalence of residual symptoms in patients infected with SARS-CoV-2 is currently estimated as 10–30%. This clinical syndrome is commonly referred to as post-acute COVID syndrome (PACS) or long COVID.

This multifactorial syndrome is characterised by a variety of debilitating symptoms, including fatigue, brain fog, postural hypotension with tachycardia, and post-exertional malaise. Many of the post COVID-19 condition observations, including changes in the immune, cardiovascular, gastrointestinal, nervous and autonomic systems, are shared with those for myalgic encephalitis/chronic fatigue syndrome (ME/CFS) patients. A comprehensive longitudinal symptom monitoring is required to confirm the diagnosis, uncover the mechanisms of post-COVID-19-associated ME/CFS, and develop the prevention and treatment measures. The current absence of an effective treatment reflects the unclear causes of the post COVID-19 conditions which cannot be targeted properly until the mechanism is established and confirmed.

The multisystem aspects of long COVID remain poorly understood. The COVID-19 pandemic has exposed a significant gap in the knowledge about the post-acute consequences of infectious diseases and the need for a unified nomenclature and classification, diagnostic criteria, and a reliable assessment of post-COVID conditions. Unraveling the complex biology of PACS relies on the identification of biomarkers in the plasma and tissue samples harvested from individuals infected with SARS-CoV-2 that will allow classification of the phenotypes of patients who develop PACS.

For a comprehensive treatment of patients with post-COVID syndrome, multidisciplinary therapy and rehabilitation are required. Understanding the physiological mechanisms underlying the long-term clinical manifestations of COVID-19 and the post-COVID-19 state is vital for the development of appropriate effective therapies.

Keywords

COVID-19 pandemic / consequences of COVID-19 / post-acute COVID syndrome / long COVID / post-COVID-associated myalgic encephalitis/chronic fatigue syndrome / post-infection syndrome / long-term post-COVID symptoms / biomarker / multidisciplinary therapy

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