Post-COVID Conditions or Long COVID and COVID Long-Haulers

By Jamshed Arslan, Pharm D, PhD

Post-acute infection syndrome (PAIS) is a phenomenon where ill effects of an infection persist even after the infection itself is over. PAIS in the case of COVID is called the long COVID or post-COVID conditions (PCC): sequelae of SARS-CoV-2 infection that persist for months/years after the initial infection and/or symptoms. People facing PCC are sometimes called the COVID long-haulers. It must be noted that no consensus on the definition of long COVID exists at the time of writing because of the heterogeneity of patients and their symptoms.

What are Symptoms of Long COVID?

Long COVID was formally recognized about six months after the start of the 2019 pandemic as the emergence or persistence of neurological and/or respiratory symptoms of SARS-CoV-2 infection that do not vanish when the infection is over. The most common neurological symptom is prolonged fatigue. Respiratory symptoms usually include a cough and breathlessness. More diverse symptoms like muscle ache are also not uncommon. The reality is that the symptoms can affect any part of the body and may even trigger diabetes and kidney problems.

Reasons Behind Long COVID

A longitudinal cohort study by Ballering et al. (2022) involving 76,422 patients concluded that about one in eight patients suffer from symptom(s) that can only be attributed to a previous COVID infection. Since COVID affects multiple organs, several hypotheses exist to explain PCC: perturbance of microbiota-gut-brain axis, autoimmunity, tissue damage, or chronic inflammation. Whether long COVID represents a hidden infection or COVID-induced exacerbation of some pre-existent condition(s) is still up for debate.

However, some patients’ symptoms may be unrelated to COVID since the pre-COVID situation was not as rigorously recorded as the post-COVID scenario. Lack of accurate pre-COVID data limits researchers’ understanding of the disease. As scientists are unlocking the mysteries of COVID, PAIS has garnered renewed attention and the funding for COVID research is likely to rub off on other infections.

What are Risk Factors of Long COVID?

The risk factors for PCC mainly include obesity, age between 35-65 years, female sex, underlying conditions such as asthma, and lower socioeconomic status. All-time COVID cases and deaths have exceeded 640 million and 6.6 million, respectively. Although SARS-CoV-2 infection is in decline, many people report at least one symptom that persists for two or more months after COVID diagnosis or recovery. At least half of the hospitalized patients do not fully recover from COVID. Thankfully, only a minority faces severe symptoms.

Infection Management

Vaccination before infection or infection with omicron as opposed to previous variants have been shown to reduce the likelihood of long COVID. However, anti-COVID vaccines are associated with a reduction in risk of PCC of just 15%. The multidimensional symptoms of long COVID are manageable, but no therapy exists primarily owing to the random nature of who is affected.

Humans will most likely co-exist with the virus for the years to come, but scientists emphasize the continued exploration of biomarkers for diagnosis, prognosis, and treatment options. They also rely heavily on patients’ experiences and feedback to accurately track long COVID and to see what works and what does not.

People must come to terms with the fact that there is no cure available for long COVID. The touted “treatments” like acupuncture, vitamin and other infusions, Botox, certain blood-filtering procedures, or hyperbaric oxygen are all unproven and they will leave your wallets empty and hopes crushed. What is certain is that the best approach against PCC is still the same old prevention strategy: wearing a mask, avoiding large gatherings, and getting vaccinated.