Post COVID-19 Syndrome: 5 Reasons to Learn about Long COVID Now

Written By: Dr. Catherine Lewan, PT DPT, C-IAYT

Long COVID is the term created by patients to describe persistent symptoms in the weeks or months after COVID-19. It is considered a first as it was identified by patients, not by medical professionals. While it shares features of other virus-triggered conditions, we have much to learn about Long COVID. Evolving research points to upregulation of the neuroimmune system that contributes to sensitization/dysfunction of the central nervous system, autonomic nervous system and immune system in those with persistent symptoms, with activity intolerance as a key feature. Skilled rehabilitation will be needed to restore function.

If we don’t yet understand Long COVID, then why is it imperative to learn about it now? I have asked myself this question frequently in preparing to teach a course on Long COVID. Why not wait a few years until we have more data and a better understanding of this phenomenon?

We simply can’t afford to wait until we fully understand Long COVID to begin treating it. Long-haulers are reporting a variety of symptoms that limit functional capacity and ability to work. If you haven’t started seeing these folks, you will soon.

5 Reasons to Learn about Long COVID Now

1. Rehab specialists are experts in identifying impairments and restoring function… even when the exact cause is unknown. We don’t need to know exactly how a patient became a fall risk to begin targeting deficits in strength, righting responses and proprioception.

2. We can identify interventions that have a low risk of adverse effects and high potential for benefit in COVID survivors and start the process of repair before we fully understand the mechanisms of Long COVID.

3. Emerging data shows that some forms of rehabilitation are better tolerated than others. Standard rehab in this population can cause more harm than good, and we need to be part of the solution rather than contribute to the problem.

4. COVID is a risk factor for thrombolytic events that every therapist should be aware of. While most of these events are reported in the weeks after infection, catastrophic events are reported months after infection in some cases. Whether you work in acute, inpatient, outpatient, or pediatric settings, vigilant monitoring for red flags is needed to prevent further loss of lives.

5. As an outpatient PT who sees a large volume of patients with autonomic dysfunction (dysautonomia) and immune dysfunction (Mast Cell Activation Syndrome, which has also been implicated in Long COVID) with increasing numbers that are triggered by COVID, I can tell you that these cases demand a high level of clinical reasoning and it helps to be prepared!

Want to learn more?

Here is a quick tutorial on how to adapt orthostatic vital signs to capture markers of autonomic dysfunction:

In my webinar Post-Acute COVID-19 Syndrome: Considerations for Rehabilitation, we’ll take a closer look at what neuroimmune upregulation looks like clinically, and how to adapt rehabilitation accordingly, based on emerging evidence. Join in live on November 6th during the CE Acceleration Virtual Conference, or register for the online course at a later date that works for you.

Resources:

Yong SJ. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infect Dis (Lond). 2021;53(10):737-754. doi:10.1080/23744235.2021.1924397

Porzionato A, Emmi A, Barbon S, Boscolo-Berto R, Stecco C, Stocco E, Macchi V, De Caro R. Sympathetic activation: a potential link between comorbidities and COVID-19. FEBS J. 2020 Sep;287(17):3681-3688. doi: 10.1111/febs.15481. Epub 2020 Aug 1. PMID: 32779891; PMCID: PMC7405290.

Arthur JM, Forrest JC, Boehme KW, Kennedy JL, Owens S, Herzog C, Liu J, Harville TO. Development of ACE2 autoantibodies after SARS-CoV-2 infection. PLoS One. 2021 Sep 3;16(9):e0257016. doi: 10.1371/journal.pone.0257016. PMID: 34478478; PMCID: PMC8415618.

Arnold AC, Ng J, Raj SR. Postural tachycardia syndrome – Diagnosis, physiology, and prognosis. Auton Neurosci. 2018 Dec;215:3-11. doi: 10.1016/j.autneu.2018.02.005. Epub 2018 Feb 28. PMID: 29523389; PMCID: PMC6113123.

Shibao C, Lipsitz LA, Biaggioni I. ASH position paper: evaluation and treatment of orthostatic hypotension. J Clin Hypertens (Greenwich). 2013 Mar;15(3):147-53. doi: 10.1111/jch.12062. Epub 2013 Jan 14. PMID: 23458585.