Long COVID: Understanding Symptoms and the Journey to Diagnosis

Announcer:
Welcome to Clinician’s Roundtable on ReachMD. On this episode, we’ll learn about the signs and symptoms of long COVID with Dr. Michele Longo, who’s an Associate Professor of Neurology and the Vice Chair of Outpatient Neurology at Tulane University in Louisiana. She’s also a comprehensive neurologist with a special interest in long Covid. Here’s Dr. Longo now.

Dr. Longo:
People that had symptoms after an acute infection with COVID found that they had varied symptoms, like fatigue and brain fog chest pain, palpitations, shortness of breath, and the initial variant disturbances in taste and smell.  There’s been over 200 symptoms that have been described. But symptoms that last about three months after you’ve gotten over this acute phase is how we have conceptualized this disorder of long COVID. It’s the newest of the chronic diseases that we’ve come to understand that are triggered by an infection. So that is our concept of what long COVID is or post acute sequelae of SARS CoV-2 virus, which is the medical term.

The symptoms that we see most commonly with long COVID are very variable because COVID can affect any organ system in the body, so from a neurologic standpoint, we could see people complain about something that they refer to as brain fog, which is problems with word-finding, with their memory, or with their focus. Other symptoms are problems with sleep. We hear a lot about sleep disorders. We hear about mood disorders. There’s a lot of anxiety and depression that our patients will talk to us about, symptoms that are consistent with those diagnoses: persistent shortness of breath, fatigue, disturbances in taste and smell, which we saw more so with the initial variants of COVID than post Omicron, and then something called post-exertional malaise where people don’t tolerate exercise. It can flare pain and these other symptoms. Those are some of the most common, but there’s many more.

If your patient is not recovering and getting back to baseline after a month after COVID, I think it needs to be on your radar. I don’t think we need to wait three months. It needs to set off a red flag to a clinician that someone that is not improving and getting back to their normal function after four to six weeks after an acute infection; you need to be watchful because many of these patients will go on to have persistent symptoms that will meet this criteria for long COVID symptoms lasting three months. We learned from the RECOVER study that there are some symptoms that are quite differentiating for long COVID from other conditions. In fact, they developed a list of 12 symptoms and scored each of these symptoms to kind of get an idea of which cluster of symptoms would most predict that you had long COVID as opposed to another disorder. Now this isn’t being used clinically yet—this is a research tool—but I do think it highlights some differentiating features for people with long COVID. Having a disturbance of taste and smell and having post-exertional malaise—this exercise-intolerance—and certainly brain fog and fatigue are really common symptoms with long COVID.

When patients are talking about those symptoms, I think it needs to be on your radar that maybe this is someone that may be developing long COVID. And certainly, if your patient was hospitalized or had severe long COVID with the acute phase, you need to be watching for the potential for long COVID because we know the sicker you are acutely with long COVID, the more at risk you are for long COVID.

Announcer:
That was Dr. Michele Longo talking about how we can recognize the signs and symptoms of long COVID. To access this and other episodes in our series, visit Clinician’s Roundtable on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!