From brain fog to COVID toe: A head-to-toe review of long COVID

Abstract

With the World Health Organization’s announcement of the end of the coronavirus disease 2019 (COVID-19) public health emergency, both clinicians and patients may think that the COVID-19 era is over. While the pandemic may have ended, acute infections continue to occur as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus transitions to the endemic phase. After initial COVID-19 infection, approximately 20% of patients experience persistent symptoms for more than 4 weeks. This clinical phenomenon is often termed “long COVID” but many other terms exist in the literature including “Post-COVID-19 syndrome,” “Chronic COVID-19,” “long haul COVID,” “post-acute COVID-19 syndrome,” “long-term sequelae,” and “post-acute sequelae of SARS-CoV-2 infection,” among others. For the purposes of this review, we define long COVID as symptoms occurring more than 4 weeks after initial infection. Long COVID manifests in a wide variety of symptoms, including cough, fatigue, muscle weakness, cognitive impairment, shortness of breath, and chest pain. In fact, current literature indicates that long COVID has effects throughout every major organ system. Within this review, we compile and summarize the available data regarding symptoms of long COVID using a head-to-toe approach. This review is meant to be comprehensive covering the following organ systems: neurologic, cardiac, pulmonary, gastrointestinal, hepatic, renal, genitourinary, hematologic, musculoskeletal, and integumentary. The purpose of this narrative review is to provide a broad and inclusive resource for clinicians on long COVID symptomatology, pathophysiology, and potential treatments.