A hand with a pulse oximeter and IV line

More than a year after COVID-19 first started becoming a pandemic, it is becoming clear that the disease is more dangerous than first thought. If you survive COVID-19, your health may not return to normal right away, or even at all. COVID-19 can cause long-term changes in the way your body works. It is now considered a systemic illness. It affects not just the lungs but multiple organs and organ systems, including

the heart
the brain
the kidneys
the liver
the digestive system

Prolonged symptoms have been recorded even in patients who had mild cases of COVID-19 and did not need hospitalisation. This phenomenon is known by various names, including

long COVID
chronic COVID
post-acute COVID syndrome/PACS
post-acute COVID-19
long-term effects of COVID
long-haul COVID

PACS or is characterized by symptoms that persist for 4 to 12 weeks after the initial infection. One train of thought is that your immune system’s response to COVID-19 triggers these symptoms through a continuing inflammatory process.

Who is at risk?

Risk factors for PACS include

being a woman
being admitted to the ICU for COVID-19
needing ventilator support during COVID-19
pre-existing heart or lung conditions
old age
obesity
diabetes
chronic kidney, liver or heart disease
lung disease
being an organ transplant recipient
current or recent pregnancy within the last 2 weeks
lung disease
disorders of the brain or nervous system

What are the symptoms?

PACS can show itself as a combination of symptoms that affect different systems of the body. These symptoms may be constant or come and go:

Fatigue, even from daily activities
Shortness of breath
Lung fibrosis or scarring
Muscle pain
Joint pain
Trouble sleeping
Coughing
Swelling in the leg
Chest pain
Dysautonomia, or an inability to regulate autonomic nervous functions such as blood pressure, breathing rate, and temperature control
Anemia
Blood clots in the lungs
Heart problems
Brain fog or difficulty concentrating
Headache
Loss of smell
Loss of taste
Depression
Anxiety
Low fever
Heart palpitations
Dizziness or lightheadedness
Hair loss
Hormone imbalance
Mood swings
Sensitivity to light
Sensitivity to sound
Gastrointestinal problems
Gynaecological issues
Stroke
Kidney disfunction
Diarrhoea
Loss of appetite
Nausea/vomiting
Stomach pain
Gastrointestinal bleeding
Infertility or sterility
Skin rashes
Pins and needles sensation

MIS-C/Multisystem Inflammatory Syndrome in Children

MIS-C is a new clinical condition. It is defined as fever, multiple organ dysfunction and increased inflammatory markers in a patient under 21 who has contracted COVID-19. It is likely caused by an excessive immune response. Symptoms include

fever
abdominal pain
vomiting
diarrhoea
rash
ulcers
low blood pressure
heart/brain problems

While earlier it was believed that children do not suffer as badly with the symptoms of COVID-19, the Delta variant has also proved infectious to children. They must also be protected from the effects and aftereffects of the disease.

How can you deal with it?

Because PACS is so new, there are no official guidelines right now. A patient might receive anticoagulants to prevent blood clots. Some doctors report that corticosteroid or systemic steroid treatment may be helpful. If you have developed PACS, the best way to deal with issues as they occur is to:

continue treatment for any existing conditions you may have
be extra vigilant while self-monitoring your pulse, blood pressure and blood glucose
eat a balanced and healthy diet
get a proper amount of sleep each night
limit alcohol consumption
quit smoking, or don’t start

Is there a cure or support for PACS?

There is currently no cure. A patient’s prognosis depends on the severity of their symptoms.

Various patient advocacy groups have been key in identifying the symptoms of PACS and advocating for more medical attention and research. These groups include

The current best way to prevent PACS is to not become infected by COVID-19, and prevent severe infections. Get vaccinated with the first vaccine available to you, and encourage others to do the same. Together, we can keep each other safe.

References

Centers for Disease Control and Prevention (2021) Post-COVID Conditions [Accessed: 10 Aug 2021] Available at: https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects.html

Chippa V, Aleem A, Anjum F. (2021) Post Acute Coronavirus (COVID-19) Syndrome. [Updated 2021 Jul 18] [Accessed: 10 Aug 2021] Available at: https://www.ncbi.nlm.nih.gov/books/NBK570608/

Dysautonomia International (2021) Coronavirus & Dysautonomia [Accessed: 10 Aug 2021] Available at: http://www.dysautonomiainternational.org/page.php?ID=227

Issa A., Khalid A., Adhra A. (2021) Al-Jahdhami, I., Al-Naamani, K., & Al-Mawali, A. (2021). The Post-acute COVID-19 Syndrome (Long COVID) [Accessed: 10 Aug 2021] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838343/

Nalbandian, A., Sehgal, K., Gupta, A. et al. (2021) Post-acute COVID-19 syndrome [Accessed: 10 Aug 2021] Available at: https://www.nature.com/articles/s41591-021-01283-z

Rakhee K. R., Tarek K., Qutayba H., Rabih H., Imad M. T. (2021) Unraveling the Mystery Surrounding Post-Acute Sequelae of COVID-19 [Accessed: 10 Aug 2021] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278217/

Stephen J H., Claire M., Gemma W., Anastasia A., Olivia H., Lyndsay M., Christopher W., Steven K., Joanna C., Rajinder S., Tamsin C., Rory J O., Manoj S. (2021) Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation [Accessed: 10 Aug 2021] Available at: https://pubmed.ncbi.nlm.nih.gov/32729939/

The risks of long COVID/PACS (Post Acute COVID-19 Syndrome)