POST COVID 19 SYMPTOMS

The Coronavirus disease 2019 (COVID-19) pandemic has affected a large number of population in the world. It has resulted in mild to severe infection to the patients and recovery rate has been reported to be around 98 percent.

Individuals recovering from acute SARS-CoV-2 may experience a wide range of symptoms after recovery from acute illness. These symptoms are referred by several terms including “long COVID” and Post-Acute Sequelae of SARS-CoV-2 infection (PASC).

Stages of COVID-19 recovery can be broadly divided into the following categories which reflect symptomatic recovery, and are not related to active viral infection and infectivity.

• Acute COVID-19 : symptoms of COVID-19 illness for up to 4 weeks following the onset of symptoms.

• Ongoing symptomatic COVID-19 : symptoms of COVID-19 illness from 4 to 12 weeks following the onset of symptoms.

• Post-COVID-19 : symptoms that develop during or after COVID-19 illness and continue for ≥ 12 weeks, not explained by an alternative diagnosis.

What are POST COVID 19 SYMPTOMS?

It has been reported that around one-third or more patients recovering from COVID 19 illness experiencing more than one persistent symptom. Prolonged symptoms can follow mild or severe illness and include:

Common physical symptoms

• Tiredness and weakness

• Breathlessness

• Chest uneasiness

• Cough

• Lack of smell

Less common physical symptoms

• Joint pain, headache, dryness, rhinitis, distortion of the sense of taste, poor appetite, dizziness, muscle pain, poor sleep, hair fall, sweating, and loose motions.

Psychological and Neurocognitive Symptoms

• Stress disorder

• Poor memory

• Poor concentration

• Anxiety

• Depression

Psychological and cognitive complaints are also common during recovery from acute COVID-19, most common among them is stress and anxiety.

How long these symptoms can last?

There is wide variability in time to symptoms resolution with mild disease recovering in 2-4 weeks and it may take 2-3 months for those with more severe disease.

Earlier it was thought that there is a longer recovery course in patients who were hospitalized, older patients with preexisting comorbidities, patients who experienced medical complications (eg, secondary bacterial pneumonia, venous thromboembolism), and patients who had a prolonged stay in the hospital or ICU. But it is now seen that even patient will mild illness and who were never hospitalized, can also experience prolonged and persistent symptoms

Some symptoms resolve more quickly than others. Fevers, chills, and symptoms related to taste and smell usually resolve within two to four weeks, while fatigue, dyspnea, chest tightness, memory and concentration problems, and psychological effects may last for months (eg, two to six months)

When to consult a doctor for Post COVID 19 Illness?

For all patients with persistent symptoms, particularly those with multisystem complaints or symptoms lasting beyond 12 weeks, an evaluation requiring physical examination and investigations are suggested, after consulting specialist based on patient’s specific symptoms.

In a healthy young patient who has recovered from COVID 19 illness and who is improving, there is no need to follow up review with doctor, unless there are persistent, progressive, or new symptoms.

In an older patient or a patient with comorbidities (eg, hypertension, diabetes), with mild to moderate acute disease but not requiring hospitalization, follow up with doctor is suggested after 3 weeks of the onset of illness.

For patients with more severe acute COVID-19 disease requiring hospitalization (with or without the need for subsequent post-acute care such as inpatient rehabilitation), weekly follow up is suggested.

When can you return to work or exercise?

Most patients recovering from their acute illness can restart exercise as tolerated, starting at a low-intensity level and slowly increasing activity over the next several weeks.

The ability of patients to return to work or exercise also based on individual health, and will be different for each individual depending upon their baseline pre-COVID-19 functional status and the severity of illness as well as the type and severity of complications experienced by the patient.

Patients who have new or progressive symptoms on starting physical activity or difficulty in advancing to pre-COVID-19 activity levels should consult a doctor for proper clinical evaluation and testing.

For patients who remain asymptomatic, slow escalation of higher-intensity exercise towards their pre-COVD-19 baseline with close monitoring for symptoms can be started.

In general, patients planning to return to high-level sport or a physically demanding occupation following confirmed myocarditis should be first evaluated by a cardiologist.

Dr Rahul Gupta, MD (Medicine)

Senior Consultant Physician

Swastik Medical Centre