Long-Covid Diagnosis and Treatment
Long COVID-19 is estimated to affect approximately 1.4 million Canadians. In clinic, I happened to see a suspected case. Here I will discuss the diagnosis and treatment of Long COVID syndrome.
Diagnosis:
The current case definition put forth by the world health organization describes long-COVID as: symptoms that linger beyond 3 months of a probable or confirmed SARS-CoV-2 infection, which last at least 2 months and cannot be explained by an alternative diagnosis.
However, there are not yet specific diagnostic tests that have a high enough negative or positive predictive value that can rule in or rule out disease. ie, this is currently a clinical diagnosis.
Interestingly, confirmed SARS-CoV-2 infection need not be presented via PCR or RAT. Instead a likely case ie. high-risk exposure with symptoms qualifies in this case definition.
Perhaps the most important part of this case definition is that alternative diagnoses must be ruled out. Ie, if the one of the patient's symptoms include a headache, a primary headache disorder such as migraines or a secondary headache disorder such as GCA must be ruled out.
Treatment:
While there is not specific or definitive treatment for Long-COVID, features of the syndrome are treated symptomatically.
Fatigue and Post-Exertional malaise
This is a common symptom of long-covid and recommended treatment includes:
a structured and symptom-guided return to activity program, tailored to their severity of fatigue. The 4 Ps (pacing; prioritizing which activities need to get done on specific days and which activities can be postponed; positioning to modify activities to make them easier to perform [e.g., while sitting]; and planning)
Mental health complications of long COVID
Common mental health complications of long COVID include anxiety depression and and post-traumatic stress disorder. The recommended treatment of these conditions is guideline based medical therapy. Referral to a psychiatrist can also be considered.
Dyspnea
In people with mild dyspnea, pursed lip or deep breathing exercises may improve symptoms. While persistent hypoxemia is rare, it should prompt Respirology referral to rule out lung pathologies such as an organizing pneumonia
Sleep disturbances
Patients should receive counselling on sleep hygiene, relaxation techniques and stimulus control. Cognitive behavioural therapy is an option for treating sleep disturbances. Alternatively, medical therapy may also include management with: eszopiclone, zolpidem or doxepin
Palpitations/Tachycardia
Options for treating inappropriate sinus tachycardia include: behavioural modifications, oral fluids, salt, compression stockings, β-blockers, ivabradine and midodrine
References:
-AM-
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