Insights in the Management of Long COVID-19: Preliminary Observations

Goel, Nitin; Kumar, Raj; Goyal, Nitesh

doi:10.5005/ijcdas-63-2-65

Cited by 3 publications

(1 citation statement)

References 12 publications

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“… 5 , 6 Most common manifestations include fatigue, cough, or exertional dyspnea. 3 , 7 , 8 The long-term implications of COVID-19 infection are still not well documented and this is an area of active research. Therefore, it is universally recommended to closely follow COVID-19-infected patients in the post-COVID period, for persistent or new symptoms.…”

Section: Introductionmentioning

confidence: 99%

Initial COVID-19 Severity and Long-COVID Manifestations: An Observational Analysis

Goel¹,

Goyal²,

Spalgais³

et al. 2023

Thorac Res Pract

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OBJECTIVE: New-onset or persistent symptoms beyond after 4 weeks from COVID-19 are termed “long-COVID.” Whether the initial severity of COVID-19 has a bearing on the clinicoradiological manifestations of long COVID is an area of interest. MATERIAL AND METHODS: We did an observational analysis of the long-COVID patients after categorizing them based on their course of COVID-19 illness into mild, moderate, and severe groups. The clinical and radiological profile was compared across these groups. RESULTS: Out of 150 long-COVID patients recruited in the study, about 79% (118), 14% (22), and 7% (10) had a history of mild, moderate, and severe COVID-19, respectively. Fatigue ( P = .001), breathlessness ( P = .001), tachycardia ( P = .002), tachypnea ( P < .001), raised blood pressure ( P < .001), crepitations ( P = .04), hypoxia at rest ( P < .001), significant desaturation in 6-minute walk test ( P = .27), type 1 respiratory failure ( P = .001), and type 2 respiratory failure ( P = .001) were found to be significantly higher in the long-COVID patients with a history of severe COVID-19. These patients also had the highest prevalence of abnormal chest X-ray (60%) and honeycombing in computed tomography scan thorax (25%, P = .027). CONCLUSION: The course of long COVID bears a relationship with initial COVID-19 severity. Patients with severe COVID-19 are prone to develop more serious long-COVID manifestations.

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Section: Introductionmentioning

confidence: 99%

Initial COVID-19 Severity and Long-COVID Manifestations: An Observational Analysis

Goel¹,

Goyal²,

Spalgais³

et al. 2023

Thorac Res Pract

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Systemic corticosteroids for management of ‘long-COVID’: an evaluation after 3 months of treatment

Goel

Goyal

Ravishankar

et al. 2021

Monaldi Arch Chest Dis

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Some patients even 4 weeks after Corona Virus Disease 2019 (COVID-19) remain to be symptomatic and are known as “long-COVID”. In the present study we performed the follow up evaluation at 3 months of long-COVID patients, after treatment with systemic steroids. During the study duration, out of the 4,542 patients managed in the outpatient department of the particular unit, there were 49 patients of Long-COVID. The patients having abnormal computed tomography (CT) alongwith resting hypoxia or exertional desaturation were treated with systemic steroid (deflazacort) in tapering doses for 8-10 weeks. We retrospectively analysed the clinical and radiological findings of these patients at first presentation and at about 3 months of follow up visit. On follow up, all the 49 long-COVID patients showed improvement. The occurrence of breathlessness decreased from 91.83% to 44.89% (p<0.001) and cough from 77.55% to 8.16% (p<0.001). Twenty-four patients were prescribed systemic steroids. Out of these, nearly 58% patients had MMRC grade 4 breathlessness, which decreased to < 2 MMRC in about 86% of these patients. MMRC grade (median) decreased from 3 to 1 (p<0.001). Majority of patients who were tachypnoeic and hypoxic at rest (n=7) showed improvement (71%), post-treatment with corticosteroids. Occurrence of normal chest X-ray increased from 12% to 71% (p<0.001). All these patients had abnormal CT thorax initially, and post-treatment 25% had normal CT thorax. Hence, we conclude that systemic steroids are helpful in hastening recovery of select subset of long-COVID patients. Simultaneously, we should be cautious of immunosuppressive effects of steroids like tuberculosis reactivation, especially in tuberculosis endemic countries. These findings have therapeutic implications and may serve as guidance for future approach to the management of ‘long-COVID’ with pulmonary sequalae.

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Post-COVID Pulmonary Sequelae: The Management Strategy

Kumar¹

2022

The Indian Journal of Chest Diseases and Allied Sciences

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COVID-19 pandemic has placed a huge burden on health authorities worldwide. The epidemiology, clinical characteristics, management and complication of acute phase of COVID-19 has been well described. 1,2 However, the data for its long-term complications and management remain still unclear. Post-COVID patients may continue to report variety of signs and symptoms which may range from milder ones to serious organ specific manifestations. 3,4 Recently, some management strategies for Long COVID-19 has been formulated by Goel and co-authors, published in this issue of the journal. 5The terms like 'Post-COVID syndrome', Long Haul COVID' and 'Post-COVID Sequelae' have been used in the literature for such persistent signs and symptoms. 6 NICE (National Institute for Health and Care Excellence) describe Acute COVID, Ongoing COVID and Post-COVID having symptoms ≤4 weeks, 4-12 weeks, >12 weeks, respectively. It has coined the term 'Long-COVID' for symptoms persistent beyond four weeks from acute COVID-19 infection. 7,8 In most of the studies 8-12 , the most common observed post-COVID symptom are fatigue and weakness (63%), dyspnoea (26%), sleeping difficulty (26%), anxiety and depression (23%), hoarseness (22%), smell disorder (11%), palpitation (9%), joint pain (9%), etc. Post-COVID symptoms mostly depends on the severity of the infection during acute phase, patients who were more severely ill during their hospital stay had more sever impaired pulmonary diffusion capacity and abnormal chest imaging manifestations. 10,11 In another study 13 , at 8-12 weeks post admission, 74% persisted with symptoms (notably breathlessness and excessive fatigue) with reduced health related quality-of-life (HRQoL). Further 59%, 75%, 89% at least one symptom persisted in mild COVID (without oxygen), moderate COVID (with oxygen), and severe COVID (NIV [noninvasive ventilation]) at 8-12 weeks, respectively. The study demonstrate the persistence of symptom at 12 weeks in majority of patients even those with mild disease initially.

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Insights in the Management of Long COVID-19: Preliminary Observations

Cited by 3 publications

References 12 publications

Initial COVID-19 Severity and Long-COVID Manifestations: An Observational Analysis

Initial COVID-19 Severity and Long-COVID Manifestations: An Observational Analysis

Systemic corticosteroids for management of ‘long-COVID’: an evaluation after 3 months of treatment

Post-COVID Pulmonary Sequelae: The Management Strategy

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