Proposed subtypes of post-COVID-19 syndrome (or long-COVID) and their respective potential therapies, 2021, Shin Jie Yong et al.

Moved from the general Long Covid thread.

Reviews in Medical Virology Proposed subtypes of post-COVID-19 syndrome (or long-COVID) and their respective potential therapies by Shin Jie Yong, Shiliang Liu

Summary
The effects of coronavirus disease 2019 (COVID-19), a highly transmissible infectious respiratory disease that has initiated an ongoing pandemic since early 2020, do not always end in the acute phase.

Depending on the study referred, about 10%–30% (or more) of COVID-19 survivors may develop long-COVID or post-COVID-19 syndrome (PCS), characterised by persistent symptoms (most commonly fatigue, dyspnoea, and cognitive impairments) lasting for 3 months or more after acute COVID-19. While the pathophysiological mechanisms of PCS have been extensively described elsewhere, the subtypes of PCS have not.

Owing to its highly multifaceted nature, this review proposes and characterises six subtypes of PCS based on the existing literature.

The subtypes are non-severe COVID-19 multi-organ sequelae (NSC-MOS), pulmonary fibrosis sequelae (PFS), myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS), postural orthostatic tachycardia syndrome (POTS), post-intensive care syndrome (PICS) and medical or clinical sequelae (MCS).

Original studies supporting each of these subtypes are documented in this review, as well as their respective symptoms and potential interventions. Ultimately, the subtyping proposed herein aims to provide better clarity on the current understanding of PCS.

(also adding what they write about ME and treatments: )

3.3 Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)

For this subset of PCS survivors who develop ME/CFS, existing ME/CFS therapies may provide clinical benefits.

A systematic review of 56 RCTs has identified five non-pharmaceutical (i.e., involving cognitive behavioural therapy; CBT, graded-exercise therapy; GET, rehabilitation, and acupuncture and abdominal tuina) and three pharmaceutical (i.e., Staphypan Berna vaccine, rintatolimod and coenzyme Q10 + NADH) therapies that significantly improved symptoms of ME/CFS113 (Table 2).

Reviews and clinical practice have also suggested using other pharmaceuticals to treat specific symptoms of ME/CFS, rather than the syndrome itself, such as sleep and pain medications and antidepressants.114, 115

For CBT and GET, their effectiveness and even potential harm in ME/CFS have been debated, possibly due to the flawed RCTs and incompatibility with underlying pathophysiology.116-118

Recently, the UK NICE has ceased recommending GET and CBT for treating ME/CFS, although CBT may still be used to manage patients' psychological symptoms.119 Thus, similar precautions may be needed for patients with PCS.