SCIENTIFIC NEWSLETTER“Long COVID” (also long-haul COVID, chronic COVID, chronic COVID syndrome) describes long- term sequalae of coronavirus disease 2019 (COVID-19)

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Volume 01

JAN 2021

With improved survival of critically ill patients, thanks to expanded healthcare resources and more appropriate

therapies, the world’s focus has been shifting from ‘short COVID-19’ – where patients usually recover from their

symptoms in two or three weeks – to ‘long-haul COVID-19‘.

10 to 20 percent of people who have been diagnosed with COVID-19 report experiencing a range of symptoms

which last longer than a month, 2.3 per cent (1 in 44 people) report having symptoms which last longer than 12

weeks.

Dr. Anthony Fauci said “Between 25% and 35% of COVID-19 patients have lingering symptoms such as fatigue,

shortness of breath, muscle aches, sleep disturbances and ‘brain fog”

It may be related to antibody or immunity-related reactions or associated with other factors.

INTRODUCTION

THE LASTING

SYMPTOMS OF

“COVID-19“

Dr. Parag DharapDiagnostics Center,

Mumbai, India.

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Way Forward

Most common reported long-term symptoms:

Other reported long-term symptoms:

More serious long-term complications (less common)

FatigueDifficulty with thinking and concentration (sometimes referred to as “brain fog”)

Cardiovascular: inflammation of the heart muscle

Cough Muscle pain Renal: acute kidney injury

Joint pain Headache Dermatologic: rash, hair loss

Chest pain Intermittent fever

Neurological: smell and taste problems, sleep issues, difficulty with concentration, memory problems

 Fever

◆ Fast-beating or pounding heart (also known as heart palpitations)◆ Anosmia◆ Teeth loss

◆ Psychiatric: depression, anxiety, changes in mood◆ Mucormycosis fungus ( recent )

SYMPTOMS

Troponin

Brain natriuretic peptides

ECG

Others

Chest X-ray

HRCT - chest

APPROCH

Respiratory rate

Temperature

Pulse rate

Blood pressure

SPO2

Respiratory rateCBC+CRP

LFT, KFT

D-Dimer, Ferritin

Vitals Respiratoryexamination Functional status Managing

comorbidities Clinical testing

CLINICAL SYMPTOMSFULL HISTORY & EXAMINATION

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INVESTIGATIONS

PARAMETERS IN COVID - 19

PARAMETERS EFFECTCRP

D-DimerFibrinogen

WBCLymphocytes

Ferritin←

←←

←←←

Reference: COVID-19 screening, prognosis and severity assessment with biomarkers for management of patients

◆ Clinical testing is not always needed, but in long COVID, blood tests should be ordered depending on symptoms and after a careful history and examination, and to exclude conditions like pulmonary embolism or myocarditis. Tests should depend on symptoms (mild, moderate and severe)

◆ Blood tests CBC, CRP, Electrolytes, LFT, KFT, TROPONIN, D-Dimer, Ferritin, ECG remains important but few tests particularly inflammatory markers like CRP and CBC remain significant not only for accessing

disease progression, severity and prognosis but also in long COVID.

◆ The identification of genetic material of the virus by RT-PCR is the gold standard test, but its sensitivity is not satisfactory.

◆ CBC, CRP, Ferritin, Clinical data, epidemiological history are important, particularly in false negative cases.

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Tan says CRP increased significantly at the early stage in severe COVID‐19 patients, before identification of any change by the CT scores. Importantly, CRP was associated with disease development and showed good performance in predicting severity in an early stage of COVID‐19.

Wang Says at the early stage of COVID-19, CRP levels were positively co-related with lung lesions. CRP levels could reflect disease severity and should be used as a key indicator for disease monitoring.

Tsai says lower serum sodium level, lower platelet or lymphocyte count, and higher CRP level may be associated with developing pneumonia or longer quarantine duration.

Herold says the CRP level, was highly predictive of the need for mechanical ventilation. This suggests the possibility of using CRP level to guide escalation of treatment in patients with COVID-19–related hyperinflammatory syndrome.

Chaochao Tan et al. C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 earlyL. Wang et al. C-reactive protein levels in the early stage of COVID-19Chun-Chou Tsai et al. Successful treatment of 28 patients with coronavirus disease 2019 at a medical center in TaiwanTobias Herold et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19

Medical Management

symptomatic such as treating fever with paracetamol & others

Optimise control oflong term conditions

Listening and empathy

Consider Antibiotics forSecondary Infection

Treat specificcomplicationsas indicated

Self Management

Daily pulse oximetryDaily temperature Monitoring

Attention to generalhealth

Rest and relaxation,Yoga & Meditation

Set achievabletargets

Self pacing and gradualincrease in exercise astolerated

Sleep

Quittingsmoking

Limitingalcohol

Limitingca�eine

Diet

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CONCLUSION

◆ With newer strains emerging and increase in number of long COVID patients, proper history, examination, relevant investigations and follow up with holistic approach is necessity of time.

◆ Mild or no symptoms -> No recommended follow-up schedule. Those who have prolonged periods of fatigue are commonly required to do CBC and inflammatory markers ( CRP and Ferritin) tests.

◆ For Critically ill -> close and regular follow-ups are essential . And most often, these patients will

and do need a structured, long-term rehabilitation process.

◆ Long COVID clinics are being rolled out across country.

◆ The pandemic has also reiterated that young, fit and healthy individuals are not ‘safe’ by virtue of the low mortality rate, and that herd immunity  is untenable, especially in a population like India’s. We must continue to observe precautions, maintain social distancing, work together and replace data with better data to see this through.

LOREM IPSUMINFECTION SCREENINGBacteria, Virus

ParasiteTYPE OF FEVER

Assess in first run

MALARIAParasite Marker

CBC+CRPWithin 4 minutes from whole blood

GLRCOVID MarkerSepsis Marker

COVID MarkerInflammation Marker

CRP

YUMIZEN CS D-DiClinical Chemistry

◆ Baig AM (October 2020). "Chronic COVID Syndrome: Need for an appropriate medical terminology for Long-COVID and COVID Long-Haulers". Journal of Medical Virology. doi:10.1002/jmv.26624. PMID 33095459.

◆"Long-Term Effects of COVID-19". Centers for Disease Control and Prevention. Retrieved 27 November 2020.

◆ "Overview | COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance | NICE". National Institute for Health and Care Excellence. 18 December 2020. Retrieved 18 December 2020.

◆  "Long Covid: I used to run, now I can walk 200 metres". BBC News. 19 December 2020. Retrieved 19 December 2020. Kermali M., Khalsa R.K., Pillai K., Ismail Z., Harky A. The role of biomarkers in diagnosis of COVID-19 - a systematic review. 2020;254:117788. [PMC free article] [PubMed]

REFERENCE

Compiled By : Dr. Ankur Lath