Post-acute sequalae of COVID-19

Background

• Also called post-acute sequalae of COVID-19 (PASC), post-acute COVID-19 syndrome (PACS), long, long-haul, or chronic COVID

Epidemiology

• Unfortunately, studies use a variety of definitions
• Affects somewhere around 40% of patients, depending on the definition
• More common in patients with risk factors for severe COVID-19 disease
• Less common in patients who have been vaccinated1

Pathophysiology

• Unclear
• Hypothesized to involve some combination of delayed resolution of inflammation, triggered autoimmunity, and persistent viral reservoir

Clinical Manifestations

• Fatigue, dyspnea, chest pain, brain fog
• More common after severe disease
• At 2 months, about 2/3 had symptoms, with 33 to 37% having cough or dyspnea and 13 to 23% has dysgeusia or anosmia23
  • Those with persistent symptoms were more likely to be aged 40 to 60 years and have been hospitalized
• At 6 months, 75% had at least one symptom4
  • Fatigue or weakness (63%)
  • Difficulty sleeping (26%)
  • Hair loss (22%)
  • Dysgeusia or anosmia (10%)
• A minority have changes to pulmonary function tests (8%) or chest x-ray (18%)5
• May have persistent lymphopenia, elevated ferritin, or elevated D-dimer5

Diagnosis

• Definitions vary widely

WHO Clinical Case Definition

• History of probable or confirmed SARS-CoV-2 infection
• Onset usually within 3 months of infection
• Symptoms last for at least 2 months, without another explanation
• Fatigue, dyspnea, cognitive dysfunction, or others
• Symptoms may be new, following initial recovery, or persistent from initial illness
• Symptoms may fluctuate

Investigations

• Consider CBC/liver/renal, TSH, CRP, ferritin, ±BNP, ±cortisol
• Consider exercise tolerance tests
• If ongoing respiratory symptoms, consider CXR at 12 weeks
• If postural symptoms, get orthostatic vitals