How to Recognize Signs of Long COVID in Patients

Understand the Duration and Context

Key Point: Symptoms persisting beyond 12 weeks after initial COVID-19 infection, which cannot be explained by an alternative diagnosis, may indicate Long COVID.

• Inquire about the patient’s initial COVID-19 infection, its severity, and duration.
• Understand the timeline. If symptoms have lingered or emerged post the acute phase, it raises suspicion for Long COVID.

Respiratory Complaints

Look for: Persistent cough, shortness of breath, or chest tightness.

• Auscultate the lungs, noting any wheezing or crackles.
• Consider pulmonary function tests or a chest X-ray for patients with significant respiratory complaints.

Cardiovascular Symptoms

Look for: Heart palpitations, chest pain, or symptoms of postural orthostatic tachycardia syndrome (POTS).

• ECG, echocardiograms, or 24-hour Holter monitoring may be necessary for patients who report cardiac-related symptoms.
• Check orthostatic vital signs to evaluate for POTS.

Neurological and Cognitive Symptoms

Look for: Complaints of “brain fog”, memory problems, difficulty concentrating, dizziness, or persistent headaches.

• A thorough neurological exam can help rule out other potential causes.
• Consider referrals to neurologists or neuropsychologists for extensive evaluations.

Musculoskeletal Symptoms

Look for: Persistent joint pain, muscle aches, or weakness.

• Perform a detailed musculoskeletal exam.
• Consider imaging or rheumatologic consultation if symptoms are severe or specific.

Gastrointestinal Symptoms

Look for: Diarrhea, nausea, abdominal pain, or appetite changes.

• Abdominal examination and, if necessary, further investigations such as endoscopies might be warranted.
• Rule out other common GI pathologies.

Psychological and Mood Disturbances

Look for: Reports of depression, anxiety, sleep disturbances, or irritability.

• Administer standardized mood questionnaires or scales.
• Consider referral to mental health professionals for therapy or further assessment.

Miscellaneous Symptoms

• Dermatological: Skin rashes, hair loss, or chilblains.
• Sensory: Persistent loss or alteration of taste and smell.
• Reproductive: Menstrual irregularities or changes in cycle patterns.

Rule Out Other Conditions

Given the wide range of symptoms, it’s essential to rule out other possible conditions:

• Consider differential diagnoses based on the patient’s complaints.
• Use appropriate laboratory and imaging tests to exclude other potential causes.

Listen and Document

• Always listen to your patient’s full range of concerns. Long COVID symptoms can vary greatly among individuals.
• Document the presented symptoms meticulously, creating a baseline to monitor progression or improvement.

Recognizing Long COVID in patients requires a comprehensive approach, a high index of suspicion, and the understanding that its manifestations can be incredibly diverse. As with many syndromes, a holistic patient-centered approach, coupled with evidence-based practice, will offer the best outcomes for those navigating the long shadows of COVID-19.