Systemic effects and disabilities in Long-Covid Syndrome: current approaches and clinical challenges in treatment and rehabilitation

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Background

Despite the evidence-based mitigation strategies or vaccines, the incidence of Long-Covid Syndrome is increasing as the pandemic evolves. Between 10 and 20% of COVID-19 patients will develop this disorder and will face the inability to perform daily physical activity. Long-Covid is a clinical condition which comprises both post-acute (4-12 weeks post-onset) and post-COVID-19 syndrome (>12 weeks post-onset). It encompasses a huge range of complaints - breathlessness, dysfunctional breathing, requirement for oxygen, post-viral cough, cardio-vascular and muscular changes, anxiety, chronic fatigue, cognitive impairment, and sarcopenia. These symptoms take months to resolve and are independent from disease severity, affecting even non-hospitalized persons with mild illness. In view of its multi-organ involvement a multi-disciplinary one-step approach should be set up to screen, diagnose, and treat the affected.

Early rehabilitation is vital for long-term recovery and functional independence of patients, therefore screening and rehabilitation should be started in a reasonable time-frame. Despite several professional bodies such as British Thoracic Society and Swiss Society for Pulmonology voicing their concerns over the lack of standardized early screening for Long-Covid, there is still a dearth of guidelines for reporting and assessment. Consideration should be given to functional assessment, self-reported symptoms, prognosis of multiorgan involvement, biomarkers, and radiological findings at different times after discharge in order to stratify high risk patients for Long COVID-19 and enable rehabilitation. Tests may include questionnaires, e.g. Yorkshire Rehabilitation Screen; thyroid, liver and renal function tests; clotting profiles; C-reactive protein; d-dimer; chest x-ray; pulmonary function tests and exercise stress test (6-MWT, shuttle tests or cardio-pulmonary exercise tests).

Revision of treatment and rehabilitation guidelines is required to optimize function, minimize disability, and facilitate early return to social activities in Long-Covid patients. Such guidance should consider the risks involved with rehabilitating those with irreversible pulmonary damage and poor oxygen saturation. Moreover, it should take into account the multiorgan involvement of this disorder and aim to address both cardiac and pulmonary function as well as fatigue and sarcopenia.

The aim of this research topic is to explore screening, treatment and rehabilitation in Long-Covid patients using a multisystem approach. The challenge of adherence and close risk assessments need to be considered, along with alternative methods of delivering such protocols, such as telemedicine.

The research topic welcomes articles focused on, but not limited to:
- Screening for high risk Long-Covid patients
- On-time implementation of cardiopulmonary exercise training protocols; their challenges and effectiveness
- Identification of high-risk groups after Covid recovery, the organization of follow-up and recruitment for rehabilitation
- Clinical approaches in both preliminary assessment of respiratory and cardiac function, and creation and implementation of cardiopulmonary rehabilitation programs
- Clinical issues during rehabilitation of these patients, both clinical and social.

Keywords: Long Covid, cardiopulmonary rehabilitation, exercise

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