With murky, variable symptoms, post-acute sequelae of SARS-CoV-2 (PASC) or colloquially, long COVID, can be illusive. But it’s still common: Estimates from the Centers for Disease Control and Prevention (CDC) suggest that as many as 140 million Americans—that’s 43 percent of people in the United States—have been infected by COVID-19. For 10 percent of those patients—or by some counts, many more—symptoms stick around or crop up more than four weeks after initial infection, according to a study from a team of British scientists. “It’s a complicated disease,” explains Dr. Devang Sanghavi, MD, assistant professor of medicine, vice chair of critical care medicine, and director of the medical intensive care unit at MayoClinic in Jacksonville, Florida. “There is a lack of clear consensus among the healthcare community about what qualifies as long COVID and the debate is still raging.” To wrap their heads around it, experts tend to categorize long COVID into three categories: The first is caused by direct damage to the organs following a severe case of COVID-19. “The symptoms linger and become chronic after initial infection,” Dr. Sanghavi says. The second type of long COVID is linked to prolonged hospitalization from COVID-19. “This type of long COVID is no different from Post Intensive Care Syndrom (PICS),” Dr. Sanghavi says, speaking to symptoms such as brain fog, post-traumatic stress disorder (PTSD), depression, anxiety, chronic fatigue, and musculoskeletal weakness. “It occurs when a person spends time at an acute care facility and becomes de-conditioned. Mental delirium sets in resulting in cognitive issues.” The last type of COVID is the least understood. In these cases, new and different symptoms show up after mild or asymptomatic infection three to four weeks after initial COVID-19 is confirmed, confounding healthcare workers and sometimes patients themselves: “We think this it has to do with the interplay between the body’s inflammatory system and response to virus particles but we don’t much about it, so it can be difficult for patients and providers to pin down a diagnosis,” Dr. Sanghavi says. “If someone did not have any symptoms during the time of COVID-19 diagnosis or many symptoms and now you have new symptoms, it may be this type of long COVID. But the first thing we need to do is rule out something else since long COVID is a diagnosis of exclusion,” he says. While research is clearly still underway, experts now know that the coronavirus infection can affect the body well beyond the respiratory system, potentially wreaking havoc on the circulatory and nervous systems. But which health issues warrant a doctor’s visit? Read on for symptoms of long COVID that you shouldn’t ignore.
Symptoms of long COVID you shouldn’t ignore
Let’s say you suspect you have long COVID. If symptoms get worse over a short period of time, don’t just brush them off. “There could be something else brewing with long COVID,” says Dr. Sanghavi. In cases where it’s hard tell whether a common long COVID symptom is an annoyance or serious threat, use the guide below to make that distinction. And if you’re on the fence about calling a doctor? Remember: There really is truth to the old adage, “better safe than sorry.”
Shortness of breath
Clinically referred to as dyspnea, shortness of breath is an objective feeling you experience when your body needs oxygen, Dr. Sanghavi explains. While a common complaint among long COVID patients, shortness of breath can be symptomatic of something worse, including heart damage, superimposed pneumonia, or lung clots, which lead to death immediately, he warns. If shortness of breath suddenly worsens a primary care, urgent care, or ER visit could be lifesaving.
Chest pain or heart palpitations
Another common long COVID symptom, chest pain can also be a sign of stroke, arrhythmia, or even heart attack, Dr. Sanghavi warns. After all, while the exact pathophysiology of how COVID affects the heart isn’t known, there’s no question that the virus can enter the pulmonary environment and mess with both circulation and electrical systems, Dr. Sanghavi says. Resulting inflammation and damage could be responsible for palpitations and shortness of breath, but more research is needed.
Brain fog
For the most part, brain fog, which is not a medical term but a common long COVID patient complaint, involves a generalized inability to think clearly, focus, and/or remember things. However, COVID-19 is far from the only condition that can contribute to cognitive dysfunction, says Dr. Tae Chung, MD, assistant professor of physical medicine and rehabilitation and neurology and director of the Postural Orthostatic Tachycardia Syndrome (POTS) Program at Johns Hopkins Medicine. While far less common, brain fog could be linked to a brain tumor or stroke—two conditions you definitely want a doctor treating, pronto. For the most part, more serious conditions will be marked by more specific cognitive issues than brain fog—say, loss of words, sudden confusion, or vision issues rather than overall fogginess. But it’s still well worth a doctor’s visit if you notice any cognitive changes, at all, since testing can help you get to the bottom of what’s going on—and ultimately, get better. Depression, anxiety, or PTSD After more than two years of relative isolation, it’s no wonder these psychosocial symptoms are more common than ever. And it should come as no surprise when chronic depression, anxiety, or PTSD follow a severe COVID case. “These conditions overlap with PICS and are overlooked too often,” Dr. Sanghavi says. “Patients stand to suffer.” While it can be hard to find a psychiatrist or psychologist—let alone one who takes your insurance—in non-COVID times, it’s worth the legwork, particularly long COVID is suspected, he says.
The bottom line
At the end of the day, if a symptom feels severe and bothersome, you should probably seek out medical care. But even then, if all other causes are ruled out and your doctor determines your symptoms are indeed due to long COVID, treatment varies by symptom and organ system, Dr. Sanghavi says. “There’s no pill we can provide to a patient feeling fatigued, but if someone has chronic dyspnea because of lung damage from COVID, we can provide oxygen support, or in exceedingly rare cases, a lung transplant.” Luckily, symptoms that are irksome but mild—like an altered sense of smell—will likely improve over time, Dr. Sanghavi says. That said, if you see a doctor who dismisses your symptoms and you’re not getting better, see another one—ideally at a dedicated post-COVID clinic. Next up: Here’s What You Need to Know About the Long-term Effects of COVID-19
Sources
Dr. Devang Sanghavi, MD, MayoClinicDr. Tae Chung, MD, Johns Hopkins MedicineCOVID ‘Long Haulers’: Long-Term Effects of COVID-19, Johns Hopkins MedicineFallout from the COVID-19 pandemic - should we prepare for a tsunami of post viral depression? Irish Journal of Psychological MedicineCOVID Data Tracker, Centers for Disease Control and PreventionManagement of post-acute covid-19 in primary care, BMJ
