Multi-disciplinary post-COVID care centers have opened across the country to enable management of patients with lingering symptoms. Rehabilitation centers have developed physical therapy programs for patients with LC.
There are no basic nor clinical research studies to support any treatment for the few months of lingering symptoms after COVID-19 nor for LC, but healthcare providers may be able to help reduce or manage symptoms through simpler measures of rehabilitation services, symptomatic medications, and coordinated care. Mild disease is more likely to resolve without aggressive therapy. Particularly with milder illness, it is important to consider other possible diagnoses masquerading as LC. Conventional interventions can be used to address issues such as pain, poor appetite, headache, nausea, and diarrhea. Specialists are needed for patients with chronic kidney disease who may need long-term dialysis after COVID-19 infection. Clotting abnormalities have been reported that require consultation and treatment by hematologists.
Although registries to assess LC are being launched, there is an absence of research on self-management practices among individuals with LC. Patients and patient advocacy groups have reported an absence of timely support and poor recognition and definition of LC, partly attributable to insufficient understanding of LC infection and overwhelmed healthcare systems. The lack of support for these patients has led to loss of faith and disappointment in healthcare service delivery, leading people with LC to seek alternative sources of support and treatment.
Exercise is currently being evaluated as early management of these patients with encouraging results.
[9] Specific treatment for defined organ involvement should include specialists such as cardiologists, pulmonologists, gastroenterogists, psychologists, neurologists, and physical therapists, as well as specialists in other fields of medicine.
The various presentations of LC are accounted for by variations in the effect of the virus on the immune system and other organs and the extent of the host inflammatory response. This interaction is currently being evaluated.
There are now published series of LC in children, although treatment data are lacking.
[12, 15] A major difference between LC in adults and children is that the percent of COVID-19 infected children developing LC is significantly lower and the duration of illness is shorter. Early symptoms appear to be similar to adults, with fatigue and difficulty concentrating being most common. Difficulty concentrating is of greatest concern because of the interference with optimal learning and school performance. One contrasting feature is that insomnia is much less common than in adults. Some series have suggested that in addition to the duration of illness being shorter, long-term outcome is better than for adults.
Some people with LC have symptoms of CFS/ME, postural orthostatic tachycardia syndrome (POTS), dysautonomia, fibromyalgia, autoimmune disease, mast cell activation syndrome (MCAS), and other health conditions that require management that has been shown to be effective in clinical trials. When someone suspected of having LC receives a new diagnosis of these other conditions, medical and rehabilitation specialists may then be able to apply the appropriate treatments and therapies.
For some patients, their LC symptoms improve over time. It is unclear which LC patients have symptoms that are likely to be permanent or are reversible with time.
Cardiovascular therapies
In a retrospective study presented in February 2022 at the American College of Cardiology's virtual Cardiovascular Summit, scientists from Cleveland Clinic reviewed their data that used enhanced external counterpulsation (EECP).
[16] This intervention compresses the blood vessels in the lower limbs to increase blood flow to the heart. EECP uses contracting and relaxing pneumatic cuffs on the calves, thighs, and lower hip area to provide oxygen-rich blood to the heart muscle, brain, and the rest of the body. Each session takes 1 hour, and patients may undergo as many as 35 sessions over 7 weeks. The researchers evaluated the effect of the therapy in 50 COVID-19 survivors. Twenty patients had coronary artery disease (CAD), whereas 30 did not; average age was 54 years.
All patients completed the Seattle Angina Questionnaire-7 (SAQ7), Duke Activity Status Index (DASI), PROMIS Fatigue Instrument, Rose Dyspnea Scale (RDS), and the 6-minute walk test (6MWT) before and after they completed 15 to 35 hours of EECP therapy.
The analysis showed statistically significant improvements in all areas assessed, including 25 more points for health status on the SAQ7 (range, 0 to 100), 20 more points for functional capacity on DASI (range, 0 to 58.2), 6 fewer points for fatigue on PROMIS (range, 4 to 20), 50% lower shortness of breath score on the RDS, and 178 more feet on the 6MWT.
The change from baseline among participants who had LC but not CAD was significant for all end points, but there was no difference between LC patients with or without CAD.
Registries and databases for LC
Recover Initiative
The United States National Institutes of Health has launched the RECOVER Initiative (Researching COVID to Enhance Recovery). The New York University Grossman School of Medicine will take the lead in building the RECOVER research consortium, harmonizing and coordinating data within the consortium, and developing methods for monitoring protocols, including recruitment, data quality, and safety measures to identify adverse events. Additionally, they will guide communication and engagement efforts with key stakeholders, including patients and healthcare providers.
The Biostatistics Center at Massachusetts General Hospital will support the data resource core, which will help enable tracking and searchability of results across all sources of data, from clinical studies to electronic health records. In addition, they will provide expertise in statistical analyses and play a key role in ensuring data standardization, access, and sharing among RECOVER projects.
Therapies for LC (TLC) study
The Therapies for LC study will begin to explore self-management practices through a central database that surveys people with LC.
[7] This study aims to be a first step towards understanding this important and under-researched public health issue.
Finally as a warning: there are potential risks of self-prescription, such as harmful drug–drug interactions and use of inappropriate treatments. Research is needed to understand the self-management practices that are being used to manage LC symptoms; factors influencing their uptake; and the benefits, harms, and costs. There is also a need to assess the potential harmful effects of polypharmacy and drug–drug interactions in these individuals.
