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When the symptoms of the new crown exceed 12 weeks, it is called "long new crown"
.
There are increasing reports of long coronaries worldwide, but the manifestations of long coronas are diverse and there is an increasing
need for proper assessment and management.
Recently, South Korea published the first preliminary management guide on the long new crown, mainly for answering 12 key questions related to the long new crown
.
Key question 1: When should you doubt the long crown?
new crown •First, exclude whether the patient's symptoms are caused by other underlying diseases, complications of the new crown (such as thromboembolism, myocarditis or encephalitis, etc.
) or other diseases with the same symptoms (such as allergic rhinitis, asthma, adrenal insufficiency, tumors, etc.
), and test
for suspicious diseases.
•Symptoms persist 12 weeks after the diagnosis of the new crown, and other underlying diseases, complications of the new crown and other diseases with the same symptoms are excluded
.
Long new crown can be diagnosed
by exclusion.
First of all, complications related to the new crown or other diseases, such as cardiopulmonary sequelae, coagulation-related sequelae, etc
.
, should be ruled out.
1.
Cardiopulmonary sequelae
Coronavirus-related cardiopulmonary sequelae can lead to persistent symptoms (such as fatigue, dyspnea, chest pain, and cough) and abnormal laboratory test results
.
Several studies have shown that within 1 month of infection, a significant proportion of patients will have respiratory dysfunction (54%) and chest computed tomography images (40%-94%)
.
Myocarditis in patients with the new crown usually occurs within the first two weeks of the new crown, but there are reports that myocarditis
also occurs within weeks after the infection has resolved.
In addition, reports show that 5% of new crown patients will have pericardial effusion, most of them are myocarditis patients
.
Pericardial tamponade
occurs in 1% of hospitalized patients.
Therefore, some patients have persistent symptoms or are due to
cardiac and pulmonary complications.
2.
New crown-related coagulopathy
Some COVID patients may develop thrombosis-related complications
.
The incidence of thrombosis in patients discharged from hospital with acute novel coronary pneumonia is usually 0.
5% to 2.
5%.
COVID-related thromboembolism can come in various forms, such as venous thrombosis (deep vein thrombosis and pulmonary embolism) and arterial thrombosis (stroke and myocardial infarction).
Studies have shown that up to 1/3 of severe new crown patients admitted to the ICU may have thromboembolic complications
.
Thromboembolism-related complications may occur in patients with novel coronary pneumonia, which can manifest in a variety of ways, and the possibility of
thromboembolism-related complications must be considered in patients with persistent symptoms for a long time.
In addition, new crown patients may also have endocrine complications, neurological complications, and other sequelae unrelated to the new crown; Exclusionary diagnosis
should also be made first in patients with long COVID.
Key question 2: What tests do patients with long COVID symptoms need?
to diagnose COVID.
•Blood tests should be performed for disorders that explain the patient's symptoms and signs to exclude the diagnosis
.
1.
Difficulty breathing
.
Regardless of symptoms, it can be considered in patients with severe or critical illness, persistent dyspnea after acute COVID
, or underlying lung disease.
•When respiratory symptoms persist for three months, a chest X-ray may be considered to rule out other conditions and detect early pulmonary fibrosis
.
If the chest x-ray is abnormal or the chest x-ray is absent but symptoms persist, a computed tomography (CT) chest scan (CT)
may be considered.
2.
Cough
•If cough persists for > three months, a chest X-ray and CT may be considered to check for parenchymal fibrosis or bronchial inflammation
.
3.
Chest pain
.
•Cardiopulmonary function tests, such as a 6-minute walk test (6MWT) or a 15–30s sit-stand test
, may be considered at the beginning of patient evaluation or rehabilitation.
•For patients without chronic chest pain after 12 weeks of acute COVID, evidence does not recommend or discourage cardiac or cardiopulmonary function tests
.
4.
Fatigue
.
•A fatigue severity scale can be applied to measure a patient's level of
fatigue.
•Patients require a detailed history to distinguish between underlying conditions that explain symptoms of fatigue, complications of COVID, and other underlying conditions
unrelated to COVID.
•If an organic cause of the fatigue cannot be identified, the possibility of
chronic COVID-related fatigue syndrome should be considered.
In addition, patients with headaches, muscle pain, cognitive symptoms, etc.
should also be examined
accordingly.
Key question 3: Should patients with long new crowns undergo thromboprophylaxis?
.
•Whether thromboprophylaxis should be pursued in patients with COVID should depend on the assessment
of thrombosis and bleeding risk.
•If thromboprophylaxis is necessary, patients should be referred to an expert in the relevant field for treatment
.
Key question 4: Do patients with long new crown need rehabilitation and respiratory rehabilitation?
•If a patient with severe COVID in the ICU or a patient > 65 years of age has a prolonged duration of COVID symptoms, an appropriate and specific respiratory rehabilitation treatment can be consulted
.
Key Question 5: How are persistent respiratory symptoms treated?
•For patients with respiratory symptoms (dyspnea and cough), there is insufficient evidence to support or oppose specific pharmacological treatments, such as corticosteroids, antihistamines, ipratropium bromide, aminophylline, or codeine
.
Key question 6: How to deal with smell and taste disorders?
for people with coronavirus-related smell or taste disorders.
These symptoms usually resolve
slowly over weeks to months.
• Olfactory training is a safe and accessible treatment that helps treat olfactory dysfunction
after COVID infection.
Key question 7: How should COVID patients cope with fatigue?
•There is insufficient evidence to recommend or limit specific treatments
related to fatigue in people with prolonged COVID.
Key Question 8: How are COVID-related headaches and cognitive symptoms treated?
related to primary headache may be considered, after excluding organic causes.
•When patients with COVID develop long-term cognitive impairment, the evidence is insufficient to recommend or limit specific treatments
.
Key question 9: How are COVID-related psychological/psychiatric symptoms treated?
.
•Referral to a psychiatric unit is recommended if a patient with a prolonged COVID has a comorbid psychiatric
disorder or requires medication.
Key question 10: Do patients with long new crown need steroid administration?
use in people with prolonged COVID.
•Steroid treatment should be weighed against its benefits and side effects
.
Key Question 11: What are the precautions regarding the diagnosis and treatment of COVID in children and adolescents?
is diagnosed with caution.
•Currently, there is no evidence to recommend or limit specific treatments
for children and adolescents with COVID-19.
However, symptomatic treatment should begin with general recommendations, and if symptoms are prolonged or severe, patients should be referred to paediatric specialists in various fields for additional evaluation and management
.
Key question 12: Will vaccination affect the development of the new crown?
•Currently, there is no evidence that vaccination increases the incidence
of prolonged COVID after acute coronavirus infection.
Therefore, there is no need to avoid vaccination
because of this concern.
Compiled by: Yoonjung Kim, Seong Eun Kim, Tark Kim, et al.
Preliminary Guidelines for the linical Evaluation and Management of Long COVID.
Infect Chemother.
2022, 54(3): 566-597.
