Abstract:
The terms “Post-COVID” or “Long-COVID” refer to a variety of physical and psychological symptoms that continue for weeks or months beyond the initial illness or develop as new-onset clinical manifestations after resolving of the acute phase. Moreover, these signs and symptoms are collectively referred to as post-acute sequelae of SARS-CoV-2 infection (PASC). Although the construction of solid epidemiological data is ongoing, the literature suggests that this phenomenon is a heterogeneous condition that can affect multiple organs and systems, with a potentially great impact on the quality of life. Furthermore, considering the millions of COVID-19 cases worldwide, these sequelae could have a high impact on health care systems.
In the context of long-COVID, many questions need to be answered. For example, it needs to be checked whether middle-aged women are at increased risk of developing debilitating long-term symptoms. To implement preventive and/or curative strategies, the data must be confirmed and the causes must be sought.
Neurological symptoms such as fatigue and muscle weakness, psychological conditions, including sleep disorders, anxiety, and depression, as well as neurocognitive problems can persist for months and can range from mild issues to serious and debilitating disorders. In particular, fatigue is one of the most common symptoms reported in the post-COVID-19 disease. It can affect up to 70% of patients and can last 6 months or more. Other neurological sequelae include smell and taste disorders (loss of smell or taste, altered sense of smell, and phantom smells), as well as dizziness, myalgia, joint pain, headache, blurred vision, and tinnitus. The incidence of each symptom and its duration after the acute phase vary greatly according to the type of study carried out, the timing, and the setting investigated.
About psychological consequences, if during the acute phase of the illness, fear, and the sense of abandonment, due to isolation at home or during hospitalization, are the most important psychological aspects of the disease, several problems of psychological distress may emerge after healing. Symptoms such as fear, mood changes, states of anxiety, depression, sleep disorders can occur alone or in combination by structuring, in turn, syndromes. Post-traumatic stress disorder and post-intensive care syndrome should not be underestimated. Likewise, potential neurocognitive sequelae need attention. What is the causal link between symptoms of cognitive impairment and the infection? The impact of the disease on mental health and cognitive performance will be well-elucidated in the coming years. To date, we can only speculate by referring to what has been observed about previous epidemics.
Taken together, data from the literature underline the need for longer follow-up studies and the organization of proper post-discharge care. In the meanwhile, the long-COVID issue requires a multiprofessional approach that involves neurologists, pain therapists, neurologists, nutritionists, neuroradiologists, physical therapists, otolaryngologists, and others. Follow-ups must be carefully scheduled in those who have suffered from the more severe forms of the disease and in individuals who have had mild or moderate COVID-19 acute manifestations. It is mandatory as, given the numbers of the pandemic, the public health implications could be considerable and the crashing wave of neurological and/or neuropsychiatric sequelae of COVID can have the effect of a tsunami.
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