A Presentation on Long COVID Syndrome which became an alarming issue in post COVID era

A presentation on Long COVID Syndrome which is basically the long term or delayed effects of COVID-19 among affected patients.

1. Dr. Suvash Debnath Snigdha Intern Doctor Medicine Unit 2 SSMCMH

2. Presentation On Long COVID Syndrome 3/2/2022 ‹#›

3. Long COVID syndrome is an UMBRELLA term 3/2/2022 ‹#› It is associated with a spectrum of physical, social and psychological consequences

4. What Is Long Covid ? 3/2/2022 ‹#› Post COVID-19 Syndrome Long Haul COVID Post Acute Sequelae of COVID 19 Chronic COVID syndrome

5. What Is Long COVID ? 3/2/2022 ‹#› A wide range of new , returning or ongoing health problems people can experience Four or more weeks after COVID-19 1 A history of probable or confirmed SARS-CoV-2 infection usually 3 months from the onset of COVID-19 with symptoms that last at least for 2 months and cannot be explained by an alternative daignosis. 2 Sign symptoms of COVID-19 from 4 weeks up to 12 weeks [ongoing symptomatic COVID-19] or sign symptoms that develop during or after an infection consistent with COVID-19,continue for More than 12 weeks and not explained by alternative diagnosis [Post COVID-19 syndrome]. 3

6. According to CDC most commonly reported persisting symptoms include 1 Dyspnoea Fatigue Post exertional malaise Brain Fog or Cognitive impairment Cough Chest pain Headache Palpitation Arthalgia Myalgia Diarrhea Abdominal pain Insomnia Fever Pain Rash Anosmia or Dysguesia Menstrual irregularities

7. Clinical Features considering broad range of possible post COVID conditions

8. 3/2/2022 ‹#› It was estimated that 80% of the infected patients with SARS CoV-2 developed one or more long term symptoms 5 most common symptoms are 4 Fatigue (58%) Headache(44%) Attention Disorder(27%) Hair Loss (27%) Dyspnoea (24%)

9. Respiratory syndrome Cardiovascular syndrome Neuropsychiatric syndrome Post COVID infection 3/2/2022 ‹#›

10. At this time , no lab test can definitively distinguish post COVID conditions from other etiologies https://emergency.cdc.gov/coca/ppt/2021/COCA-Call-Slides-Post-Covid-Conditions-06.17.2021.pdf 3/2/2022 ‹#›

11. Investigations Lab test should be done according to clinical findings Consider base panel investigation between 4-12 weeks( blood count, liver function test, renal function test, inflammatory markers like ESR, CRP, ferritin, thyroid function, vitamin assay) Consider additional/specialized tests if symptoms persists >12 weeks [ Rheumatological (ANA,RA,AntiCCP,Anti cardiolipin,CPK), Coagulopathy (D dimer,fibrinogen) myocardial injury (troponin),BNP etc.] More evidence is needed to support the utility of specific imaging test for evaluation of post COVID conditions,specialist consultation needed. 3/2/2022 ‹#›

12. Management Comprehensive rehabilitation including physical ,mental and social rehabilitation As there is no definitive treatment, symptomatic management approach is recommended Studies are ongoing on different aspects of treatment of different post COVID conditions ,such as- 3/2/2022 ‹#›

13. Respiratory syndrome Dyspnoea 24% Red Pul Cap 10% Cough 19% Pul fibrosis 5% A follow up CXR in 6-8 weeks 6 min walk test with assessment of O 2 saturation Full Pulmonary function testing Echocardiography Sputum sample if expectorating for microbiological analysis If there are persistent CXR changes and/or evidence of physiological impairment consider HRCT and CTPA to asses for presence of both ILD and PE 3/2/2022 ‹#›

14. Refer to ILD and PE clinic Refer to physical rehabilitationPrednisolone low dose in tapering way for one month Steroid inhaler for 1-3 months Montelucast for 3-6 months Gabapentine / Pregabaline 3/2/2022 ‹#›

15. Cardiovascular syndrome Chest discomfort/tightness (16%) palpitation (11%) POTS (11%) Ivabradine and Carvedilol both are recommended and effective in controlling palpitation /POTS in Post COVID-19 patients Head to head comparison: Ivabradine is more effective in controlling heart rate compared to Carvedilol For 2-4 weeks should restore the normal rythm 3/2/2022 ‹#›

16. Neuropsychiatric syndrome For chronic anxiety : Escitalopram 10 mg daily For depression: Escitalopram 10-20 mg daily /sertraline 50 mg daily For sleep disturbance: relaxation therapy ,Benzo with a short half life for shortest possible duration 3/2/2022 ‹#›

17. Preventive measures 3/2/2022 ‹#›

18. references 1)https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html?CDC_AAfVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Flong-term-effects.html 2)https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1 3)https://www.nice.org.uk/guidance/NG188 4)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8352980/ 5)https://www.mdpi.com/1424-8247/14/8/807 6) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718803/ 7) https://emergency.cdc.gov/coca/ppt/2021/COCA-Call-Slides-Post-Covid-Conditions-06.17.2021.pdf 3/2/2022 ‹#›

19. THANK YOU