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Post-COVID-19 Syndrome or Long COVID: Pathophysiology, Treatments, and Outcomes

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601).

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 12364

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Special Issue Editor

Prof. Manoj Sivan

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Guest Editor

Department of Rehabilitation Medicine, Leeds General Infirmary, Leeds LS1 3EX, UK
Interests: long-term medical conditions; global health; rehabilitation technology; pain medicine; sleep medicine; outcome measurement
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

IJERPH cordially invites you to contribute to this Special Issue on "Post-COVID-19 Syndrome or Long COVID: Pathophysiology, Treatments, and Outcomes".

Long COVID refers to prolonged symptoms beyond 4 weeks following SARS-CoV-2 infection which are not explained by an alternative diagnosis. The term Long COVID encompasses the National Institute for Health and Clinical Excellence (NICE)'s terms 'Ongoing Symptomatic COVID-19' (symptoms lasting 4–12 weeks) and ‘Post-COVID-19 Syndrome (PCS)' (symptoms beyond 12 weeks), and the World Health Organization's term 'Post-COVID-19 Condition'. It is estimated that more than 50 million individuals worldwide are struggling to cope with this condition and its effect on daily activities and quality of life.

PCS or long COVID is a multisystem condition characterised by a constellation of symptoms which may include fatigue, breathlessness, brain fog, chest pain, muscle and joint pain, depression, anxiety, sleep disturbance, palpitations, dizziness, gastrointestinal problems, skin rashes, and allergy to food or drugs. Phenotyping studies have suggested a few condition severity clusters (mild-moderate-severe), and the possibility of symptom-specific clusters. Some individuals have a constant course, while others experience a relapsing and remitting fluctuating pattern with certain physical and cognitive activities triggering a relapse of symptoms.

This Special Issue is aimed at articles of high academic standard investigating these persistent symptoms or emerging long-term problems in the physical, psychological, and social domains. We would like to focus on the plausible mechanisms, phenotypes or symptom clusters, investigations, treatments, outcome measurement, and long-term sequelae of this novel condition. Authors can submit original research, meta-analyses, systematic reviews, and interesting case series related to PCS or Long COVID.

Prof. Manoj Sivan
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

post-COVID-19 condition
post-acute COVID-19 syndrome (PACS)
fatigue
long haulers
chronic pain
depression
anxiety
post-traumatic stress disorder
vocation
quality of life
outcome measurement

Published Papers (5 papers)

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Research

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14 pages, 2384 KiB

Open AccessArticle

Severe Post-COVID-19 Condition after Mild Infection: Physical and Mental Health Eight Months Post Infection: A Cross-Sectional Study

by Marion Egger, Lena Vogelgesang, Judith Reitelbach, Jeannine Bergmann, Friedemann Müller and Klaus Jahn

Int. J. Environ. Res. Public Health 2024, 21(1), 21; https://doi.org/10.3390/ijerph21010021 - 22 Dec 2023

Cited by 1 | Viewed by 1828

Abstract

Severe acute COVID-19 infections requiring intensive care treatment are reported risk factors for the development of post-COVID-19 conditions. However, there are also individuals suffering from post-COVID-19 symptoms after mild infections. Therefore, we aimed to describe and compare the health status of patients who were initially not hospitalized and patients after critical illness due to COVID-19. The outcome measures included health-related quality of life (EQ-5D-5L, visual analogue scale (VAS)); mental health (hospital anxiety and depression scale (HADS)); general disability (WHODAS-12); and fatigue (Fatigue-Severity-Scale-7). Individuals were recruited at Schoen Clinic Bad Aibling, Germany. A total of 52 non-hospitalized individuals (47 ± 15 years, 64% female, median 214 days post-infection) and 75 hospitalized individuals (61 ± 12 years, 29% female, 235 days post-infection) were analyzed. The non-hospitalized individuals had more fatigue (87%) and anxiety (69%) and a decreased health-related quality of life (VAS 47 ± 20) compared to the hospitalized persons (fatigue 45%, anxiety 43%, VAS 57 ± 21; p < 0.010). Severe disability was observed in one third of each group. A decreased quality of life and disability were more pronounced in the females of both groups. After adjusting for confounding, hospitalization did not predict the burden of symptoms. This indicates that persons with post-COVID-19 conditions require follow-up services and treatments, independent of the severity of the acute infection. Full article

(This article belongs to the Special Issue Post-COVID-19 Syndrome or Long COVID: Pathophysiology, Treatments, and Outcomes)

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16 pages, 1128 KiB

Open AccessArticle

Physical Function and Association with Cognitive Function in Patients in a Post-COVID-19 Clinic—A Cross-Sectional Study

by Durita Viderø Gunnarsson, Kamilla Woznica Miskowiak, Johanna Kølle Pedersen, Henrik Hansen, Daria Podlekareva, Stine Johnsen and Christian Have Dall

Int. J. Environ. Res. Public Health 2023, 20(10), 5866; https://doi.org/10.3390/ijerph20105866 - 18 May 2023

Cited by 7 | Viewed by 1597

Abstract

Patients with long-term health sequelae of COVID-19 (post-COVID-19 condition) experience both physical and cognitive manifestations. However, there is still uncertainty about the prevalence of physical impairment in these patients and whether there is a link between physical and cognitive function. The aim was to assess the prevalence of physical impairment and investigate the association with cognition in patients assessed in a post-COVID-19 clinic. In this cross-sectional study, patients referred to an outpatient clinic ≥ 3 months after acute infection underwent screening of their physical and cognitive function as part of a comprehensive multidisciplinary assessment. Physical function was assessed with the 6-Minute Walk Test, the 30 s Sit-to-Stand Test and by measuring handgrip strength. Cognitive function was assessed with the Screen for Cognitive Impairment in Psychiatry and the Trail Making Test-Part B. Physical impairment was tested by comparing the patients’ performance to normative and expected values. Association with cognition was investigated using correlation analyses and the possible explanatory variables regarding physical function were assessed using regression analyses. In total, we included 292 patients, the mean age was 52 (±15) years, 56% were women and 50% had been hospitalised during an acute COVID-19 infection. The prevalence of physical impairment ranged from 23% in functional exercise capacity to 59% in lower extremity muscle strength and function. There was no greater risk of physical impairment in previously hospitalised compared with the non-hospitalised patients. There was a weak to moderate association between physical and cognitive function. The cognitive test scores had statistically significant prediction value for all three outcomes of physical function. In conclusion, physical impairments were prevalent amongst patients assessed for post-COVID-19 condition regardless of their hospitalisation status and these were associated with more cognitive dysfunction. Full article

(This article belongs to the Special Issue Post-COVID-19 Syndrome or Long COVID: Pathophysiology, Treatments, and Outcomes)

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16 pages, 793 KiB

Open AccessArticle

“It Really Is an Elusive Illness”—Post-COVID-19 Illness Perceptions and Recovery Strategies: A Thematic Analysis

by Gerko Schaap, Marleen Wensink, Carine J. M. Doggen, Job van der Palen, Harald E. Vonkeman and Christina Bode

Int. J. Environ. Res. Public Health 2022, 19(20), 13003; https://doi.org/10.3390/ijerph192013003 - 11 Oct 2022

Cited by 4 | Viewed by 2071

Abstract

A substantial number of patients report persisting symptoms after a COVID-19 infection: so-called post-COVID-19 syndrome. There is limited research on patients’ perspectives on post-COVID-19 symptoms and ways to recover. This qualitative study explored the illness perceptions and recovery strategies of patients who had been hospitalised for COVID-19. Differences between recovered and non-recovered patients were investigated. Semi-structured in-depth interviews were held with 24 participating patients (8 recovered and 16 non-recovered) 7 to 12 months after hospital discharge. Data were interpreted using reflexive thematic analysis. Four overarching themes were identified: (I) symptoms after hospital discharge; (II) impact of COVID-19 on daily life and self-identity; (III) uncertainty about COVID-19; and (IV) dealing with COVID-19. Formerly hospitalised post-COVID-19 patients seem to have difficulties with making sense of their illness and gaining control over their recovery. The majority of non-recovered participants continue to suffer mostly from weakness or fatigue, dyspnoea and cognitive dysfunction. No notable differences in illness beliefs were observed between recovered and non-recovered participants Full article

(This article belongs to the Special Issue Post-COVID-19 Syndrome or Long COVID: Pathophysiology, Treatments, and Outcomes)

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Review

Jump to: Research

18 pages, 414 KiB

Open AccessReview

From Acute Infection to Prolonged Health Consequences: Understanding Health Disparities and Economic Implications in Long COVID Worldwide

by Jaleel Jerry G. Sweis, Fatima Alnaimat, Valeria Esparza, Supritha Prasad, Abeera Azam, Zeel Modi, Mina Al-Awqati, Pim Jetanalin, Nadia J. Sweis, Christian Ascoli, Richard M. Novak, Israel Rubinstein, Ilias C. Papanikolaou and Nadera Sweiss

Int. J. Environ. Res. Public Health 2024, 21(3), 325; https://doi.org/10.3390/ijerph21030325 - 11 Mar 2024

Viewed by 1394

Abstract

The COVID-19 pandemic has resulted in a growing number of patients experiencing persistent symptoms and physiological changes after recovering from acute SARS-CoV-2 infection, known as Long COVID. Long COVID is characterized by recurring symptoms and inflammation across multiple organ systems. Diagnosis can be challenging, influenced by factors like demographics, comorbidities, and immune responses. Long COVID impacts various organ systems and can have neuropsychological effects. Health disparities, particularly related to race, contribute to a higher burden of infection and ongoing symptoms in minority populations. Managing Long COVID entails addressing a spectrum of symptoms that encompass physical, cognitive, and psychological aspects. The recovery period for patients with Long COVID can vary significantly, influenced by factors like the severity of the disease, hospitalization, comorbidities, and age. Currently, there are no universally effective treatments, although certain interventions show promise, necessitating further research. Self-management and rehabilitation programs can provide relief, but more research is needed to establish their effectiveness. Preventive measures such as vaccination and the use of antiviral medications and metformin. It is imperative to conduct further research to develop evidence-based guidelines and gain a better understanding of the long-term implications of COVID-19. Long COVID could have substantial economic impact on the labor market, productivity, healthcare expenditures, and overall economic growth. To address the challenges patients with long-term complications face, there is a focus on strategies like promoting telework and flexible work arrangements to accommodate diverse symptoms, particularly chronic fatigue and other Long COVID effects. In conclusion, this review emphasizes the multifaceted complexity of Long COVID and the ongoing need to address its potential long-term health and economic impacts. Full article

(This article belongs to the Special Issue Post-COVID-19 Syndrome or Long COVID: Pathophysiology, Treatments, and Outcomes)

21 pages, 1149 KiB

Open AccessReview

Non-Pharmacological Therapies for Post-Viral Syndromes, Including Long COVID: A Systematic Review

by Joht Singh Chandan, Kirsty R. Brown, Nikita Simms-Williams, Nasir Z. Bashir, Jenny Camaradou, Dominic Heining, Grace M. Turner, Samantha Cruz Rivera, Richard Hotham, Sonica Minhas, Krishnarajah Nirantharakumar, Manoj Sivan, Kamlesh Khunti, Devan Raindi, Steven Marwaha, Sarah E. Hughes, Christel McMullan, Tom Marshall, Melanie J. Calvert, Shamil Haroon and Olalekan Lee Aiyegbusi Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2023, 20(4), 3477; https://doi.org/10.3390/ijerph20043477 - 16 Feb 2023

Cited by 11 | Viewed by 4637

Abstract

Background: Post-viral syndromes (PVS), including Long COVID, are symptoms sustained from weeks to years following an acute viral infection. Non-pharmacological treatments for these symptoms are poorly understood. This review summarises the evidence for the effectiveness of non-pharmacological treatments for PVS. Methods: We conducted a systematic review to evaluate the effectiveness of non-pharmacological interventions for PVS, as compared to either standard care, alternative non-pharmacological therapy, or placebo. The outcomes of interest were changes in symptoms, exercise capacity, quality of life (including mental health and wellbeing), and work capability. We searched five databases (Embase, MEDLINE, PsycINFO, CINAHL, MedRxiv) for randomised controlled trials (RCTs) published between 1 January 2001 to 29 October 2021. The relevant outcome data were extracted, the study quality was appraised using the Cochrane risk-of-bias tool, and the findings were synthesised narratively. Findings: Overall, five studies of five different interventions (Pilates, music therapy, telerehabilitation, resistance exercise, neuromodulation) met the inclusion criteria. Aside from music-based intervention, all other selected interventions demonstrated some support in the management of PVS in some patients. Interpretation: In this study, we observed a lack of robust evidence evaluating the non-pharmacological treatments for PVS, including Long COVID. Considering the prevalence of prolonged symptoms following acute viral infections, there is an urgent need for clinical trials evaluating the effectiveness and cost-effectiveness of non-pharmacological treatments for patients with PVS. Registration: The study protocol was registered with PROSPERO [CRD42021282074] in October 2021 and published in BMJ Open in 2022. Full article

(This article belongs to the Special Issue Post-COVID-19 Syndrome or Long COVID: Pathophysiology, Treatments, and Outcomes)

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