Patients will need your help managing long COVID...when symptoms linger more than 4 weeks after initial infection.
COVID-19 can leave lasting effects anywhere in the body...causing brain fog, diarrhea, shortness of breath, etc.
Symptoms seem to be more common in patients who’ve had severe COVID-19 (hospitalized, etc), a repeat infection, or are unvaccinated.
But even those who had mild or no symptoms can be affected.
Acknowledge that symptoms can be vague...can come and go or worsen with activity...and may take months to improve.
Tell patients that there’s still a lot to learn about long COVID...and there’s no proven treatment yet.
Advise treating symptoms as you would otherwise. For example, suggest prn acetaminophen or an NSAID for headache...honey for cough...or loperamide for diarrhea.
Emphasize nondrug measures (meditation, limiting alcohol and caffeine, etc) for sleep problems. Or advise patients with fatigue to schedule time for rest and pace themselves with exercise.
Help connect patients to support groups, physical therapy, or specialists (cardiology, ENT, pulmonology, etc) if needed.
There’s no good evidence that COVID-19 vaccines improve symptoms if given to patients WITH long COVID.
But point out that staying current with COVID-19 vaccination is the best bet at prevention...and reducing long COVID risk.
Advise high-risk patients (diabetes, etc) who get COVID-19 to seek treatment, such as Paxlovid (nirmatrelvir/ritonavir), ASAP.
Preliminary data suggest that starting Paxlovid within 5 days of infection may also reduce risk of long COVID.
You may hear that metformin started within 3 days of infection lowers the potential for developing long COVID. But this is also based on preliminary data...and it’s too soon for widespread use.
Encourage any patient who wants to contribute to research about long COVID to explore RecoverCOVID.org.
- https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html (3-23-23)
- https://www.covid.gov/assets/files/Services-and-Supports-for-Longer-Term-Impacts-of-COVID-19-08012022.pdf (3-23-23)
- https://www.idsociety.org/covid-19-real-time-learning-network/disease-manifestations--complications/post-covid-syndrome/ (3-23-23)
- https://www.publichealth.va.gov/n-coronavirus/docs/Whole-Health-System-Approach-to-Long-COVID_080122_FINAL.pdf (3-23-23)
- https://www.who.int/europe/publications/i/item/WHO-EURO-2021-855-40590-59892 (3-23-23)