Abstract Four years post-pandemic, SARS-CoV-2 continues to affect many lives across the globe. An estimated 65 million people suffer from long COVID, a term used to encapsulate the post-acute sequelae of SARS-CoV-2 infections that affect multiple organ systems. Known symptoms include chronic fatigue syndrome, brain fog, cardiovascular issues, autoimmunity, dysautonomia, and clotting due to inflammation. Herein, we review long COVID symptoms, the proposed theories behind the pathology, diagnostics, treatments, and the clinical trials underway to explore treatments for viral persistence, autonomic and cognitive dysfunctions, sleep disturbances, fatigue, and exercise intolerance. Open access, https://www.mdpi.com/2075-4418/14/7/711
2.3. Dysautonomia and Myalgic Encephalomyelitis and Chronic Fatigue Syndrome Dysautonomia and symptoms related to Myalgic Encephalomyelitis and Chronic Fatigue Syndrome (ME/CFS) overlap with the clinical manifestations of LC. Common symptoms and include persistent fatigue, post-exertional malaise, postural orthostatic tachycardia syndrome (POTS), disrupted sleep, cognitive issues, mitochondrial fragmentation, myalgias, and arthralgias [25]. While the onset of ME/CFS has been associated with EBV, Q fever, and influenza, there is currently insufficient evidence to classify SARS-CoV-2 as another infectious trigger in the ME/CFS [31]. Bonilla et al. collected retrospective data from 140 patients with LC, using the Institute of Medicine 2015 criteria to determine the ME/CFS phenotype, and found that about 43% of the LC patients had the ME/CFS subtype. Most of the patients in the cohort, however, were female subjects in an affluent area, with little representation of minority populations. A larger and more diverse population is needed to substantiate these findings [32]. Interestingly, cyclical variations in menstrual symptoms have also been recognized in female ME/CFS and LC patients [33].
Management of children with long COVID continues to evolve according to protocols that (1) are based on expert opinions, (2) are extrapolated from guidelines in adult medicine, and (3) rely on already established approaches used to manage other chronic pediatric conditions like chronic fatigue syndrome and migraine headaches. Parent involvement is crucial in managing the stress of a child with long-term COVID-19. Given a child’s limited ability to communicate what they feel, a perceptive parent can pick up more subtle signs of distress, e.g., frustration at being unable to complete once routine tasks, symptoms of dysautonomia, and somatization signs, e.g., headaches, fatigue, and nausea. An integrated approach that combines physical and mental health is clearly indicated.
and somatization signs, e.g., headaches, fatigue, and nausea. An integrated approach that combines physical and mental health is clearly indicated.
