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What Nurses Need to Know About Long-COVID

Most people who contract COVID-19 have a short course of mild to moderate symptoms. Still, a subset of patients may experience "long-COVID," where residual side effects linger for weeks and months after the initial infection. As the healthcare workers who most frequently interact with patients, nurses must understand how long-COVID syndrome presents, how to support struggling patients and the latest research and treatment options.

What Is Long-COVID?

Long-COVID is still a relatively new phenomenon, and there is currently no universal consensus on how it should be defined. In general, long-COVID is a constellation of symptoms that persists more than 28 days after the initial onset. Due to a concerted worldwide effort to better understand the condition and guide best practices for managing "long-haulers" – the patients who experience lingering symptoms – this definition may change in the future.

How Common Is Long-COVID and Who Is Affected?

A 2020 study partially funded by the National Institutes of Health (NIH) found that as many as one in 20 people who contract COVID-19 go on to have symptoms that last eight weeks or longer. Roughly one in 50 people may have symptoms that persist at least 12 weeks. Other research, like that reported in the American Journal of Nursing (December 2020), has indicated that the number of long-haulers may be much higher, ranging from 10% to more than 50% of all infections.

Essentially anyone who contracts the virus has the potential to develop long-COVID, but there remains conflicting data on who is most affected and to what extent. It has been theorized that individuals who experience mild illness have lower rates of long-COVID. Those who require hospitalization may have a higher incidence of lingering effects, though the data is still unclear.  

What Are the Symptoms and 4 Stages of Long-COVID?

COVID-19 is a multisystem disease, which means patients can present with symptoms in virtually any body system. Symptoms often ebb and flow in intensity, from mild to debilitating, and move from one part of the body to another, complicating diagnosis and treatment. The most reported symptoms are:

  • Fatigue
  • Dyspnea
  • Cough
  • Heart palpitations
  • Chest pain
  • Joint pain
  • Headaches
  • Fevers
  • Decreased exercise tolerance
  • Anxiety
  • Depression
  • Gastrointestinal upset
  • Rashes
  • Memory loss
  • Difficulty concentrating
  • Insomnia
  • Hair loss

While research is still early and there are no official conclusions, researchers at the National Institute for Health Research (NIHR) suggest that long-COVID patients could be grouped into four separate stages or syndromes, including:

  1. Post-intensive care syndrome
  2. Post-viral fatigue syndrome
  3. Long-term COVID syndrome
  4. Permanent organ damage

Are There Resources Available for Long-COVID Patients?

Because of the wide-ranging and nonspecific symptoms, long-COVID can be challenging to diagnose and result in delayed care. However, emerging research and clinical trials have been instrumental in raising public awareness as well as keeping nurses and healthcare providers informed. Several hospitals have also opened specialty clinics designed to streamline the diagnosis, treatment and management of long-COVID patients. These clinics typically use a multidisciplinary care approach encompassing neurology, neuropsychology, cardiology, nutrition, mental health and occupational and physical therapy services.

Although evidence-based practices are still being defined, many of the post-COVID care strategies focus on ensuring patients do not have underlying diseases contributing to symptoms. Once those are excluded through an extensive workup, patient education and support is key. Patients will likely need to optimize diet and sleep, minimize stress and gradually rebuild stamina through a self-paced exercise program. Healthcare workers should strive to be empathetic to patients' concerns and offer all available resources.  

Caring for COVID Long-Haulers  

It is estimated that there may be millions of individuals suffering from the long-COVID syndrome. While these long-COVID symptoms are sometimes difficult to identify and treat, nurses who understand the presentation and ongoing effects can provide the support and resources necessary to help patients manage their condition.

Learn more about Northern Kentucky University's online RN to BSN program.


American Journal of Nursing: The Lingering Effects of COVID-19

BMJ: Management of Post-Acute Covid-19 in Primary Care

CNN: Some Covid-19 Long Haulers Say Vaccines May Be Relieving Their Symptoms. Researchers Are Looking into It

National Institutes of Health:
NIH Launches New Initiative to Study "Long COVID"
Living with COVID19

NIH Director's Blog:
Predicting 'Long COVID Syndrome' with Help of a Smartphone App
Trying to Make Sense of Long-COVID Syndrome

Pulse: Long Covid Can Be Split into Four Different Syndromes, Review Suggests

WebMD: Programs Help COVID Long Haulers Recover

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