long covid-19

what is long COVID?

WHO definition

• usually within 3 months from the onset of COVID-19, with symptoms and effects that last for at least 2 months

• symptoms cannot be explained by alternative diagnosis

• no minimum symptoms required for diagnosis

• occurs regardless of disease severity

new NASEM definition

• LC is an infection-associated chronic condition (IACC) that occurs after SARS-CoV-2 and is present for at least 3 months as a continuous relapsing and remitting or progressive disease that affects one or more organ systems

  • SOB, cough, persistent fatigue, post-exertional malaise

  • can also manifest as single or multiple diagnosable conditions: interstitial lung disease, cardiovascular disease, POTS, chronic fatigue syndrome, fibromyalgia, etc

• similar to MS in terms of different types

new or worsening preexisting conditions

• ie. triggers preexisting conditions to become symptomatic that were previously asymptomatic

  • cardiovascular disease (covid can cause blood clots)

  • chronic kidney disease

  • POTS

  • diabetes

  • cognitive impairment

  • etc.

clinical presentation

• PCC can be characterized as 3 potential categories

  • multi-dimensional (pre-existing condition exacerbated)

  • fluctuating (high level of disability post infection)

  • episodic (moderate)

• generally has impact on every day functioning → interferes with ability to work, attend school, participate in communities, and engage in ADLs

• present for prolonged time frames and/or relapse over time

INSERT PIC

common symptoms

• post exertional malaise

• cognitive impairment

• depression, anxiety

• persistent fatigue (MOST COMMON)

• difficulty concentrating

• memory changes

• headaches

• sleep disturbance

• SOB, cough

• problems w/ taste and smell

INSERT PIC

symptoms cont.

• no clear established link between medical and demographic characteristics and outcomes

• some causal links noted that may increase risk of PCC:

  • female

  • older, younger

  • minority ethnicity

  • underlying health conditions

  • reinfections

  • pregnant

what is “safe” rehab

• no standard protocol

• 4 concepts

  • avoiding acute events & symptom flare-ups → prevents further decline in functional performance

  • personalization

  • facilitating expectations (what does recovery look like?)

  • psychologically supportive → managing client’s expectations/emotions

• avoid graded exercise therapy → do not want to over exert client

• establish activity mgmt plan

“safe” rehab signs

pause session, reassess/proceed with caution

• autonomic dysfunction

• post exertional malaise

SEE a doctor/terminate session entirely

• exertional oxygen desaturation (below 92%)

• cardiac impairment

managing dysautonomia

• postural orthostatic tachycardia syndrome (POTS) → chronic condition that causes abnormal increase in HR when standing up/sitting up

• common symptoms

  • difficulty standing still, fatigue, lightheadedness, nausea, brain fog, palpitations, SOB

• how to treat:

  • exercise

  • lifestyle changes: hydration, adding salt, limiting alcohol

  • compression

    • stockings

    • abdominal binder

  • sleep

    • raising HOB

    • quality sleep

  • pacing

outcome measures

• post-covid core outcome set (PC-COS)

  • fatigue

  • post-exertion symptoms

  • cognitive functioning

  • mental function

  • pain

  • work/occupational changes