Commentary: Why diagnosing symptoms of long COVID can be painstaking

NEW YORK CITY: My first patient that day was a woman in her early 40s, an avid marathon runner who had contracted COVID-19 in March 2020. Now, 13 months later, she noted that she still felt fatigued and short of breath.

Long COVID-19 often involves a constellation of symptoms affecting many parts of the body, but the most commonly reported are fatigue, shortness of breath, chest pains, cognitive changes, headaches, sensory changes and pain. We are also seeing many cases of “dysautonomia,” or impaired regulation of the nervous system that controls heart rate and blood pressure – the “fight or flight” part of the nervous system. This condition can lead to sensations of a racing heart and dizziness.

Although many long COVID-19 sufferers tend to report the same general symptoms, it is likely that there are different underlying causes leading to these symptoms in different people. For example, post-intensive care syndrome can occur in anyone who has had a prolonged stay in the ICU, whether or not it was related to COVID-19.

And tests of the nerves in the arms and legs may show damage in some cases – what we call neuropathy. But that is not always the case, and these can occur regardless of COVID-19 status. This makes it challenging to draw a direct link to COVID-19.Some fully vaccinated COVID-19 patients with mild or no symptoms to be isolated at home under MOH pilotThis doesn’t mean we are at a complete loss about what is happening.

Long COVID-19 symptoms can also closely resemble those of myalgic encephalomyelitis, often known as chronic fatigue syndrome, or another poorly understood disease called postural orthostatic tachycardia syndrome. The immune system involves a balance of many factors, and impaired regulation of this system after an infection can cause inflammation; this, combined with hormonal or metabolic changes, could potentially lead to long COVID-19 symptoms.

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