A multidisciplinary review of long COVID to address the challenges in diagnosis and updated management guidelines
Abbas Hamza Abbas, Maryam Haji, Aya Ahmed Shimal, Yousif Hameed Kurmasha, Ali Al‐Janabi, Zainab Tawfeeq Azeez, Amenah Ridha Sahib Al-Ali, Hussein Mezher Hameed Al-Najati, Abdulrahman Raad Abdulkareem Al-waeli, Noor Alhussein S. Abdulhadi Abdulhadi, Abdullah Zeyad Hameed Al-Tuaama, Mustafa M. Al-Ashtary, Ominat Amir Hussin
Abstract
Long COVID has emerged as a significant challenge since the COVID-19 pandemic, which was declared as an outbreak in March 2020, marked by diverse symptoms and prolonged duration of disease. Defined by the WHO as symptoms persisting or emerging for at least two months post-SARS-CoV-2 infection without an alternative cause, its prevalence varies globally, with estimates of 10-20% in Europe, 7.3% in the USA, and 3.0% in the UK. The condition's etiology remains unclear, involving factors, such as renin-angiotensin system overactivation, persistent viral reservoirs, immune dysregulation, and autoantibodies. Reactivated viruses, like EBV and HSV-6, alongside epigenetic alterations, exacerbate mitochondrial dysfunction and energy imbalance. Emerging evidence links SARS-CoV-2 to chromatin and gut microbiome changes, further influencing long-term health impacts. Diagnosis of long COVID requires detailed systemic evaluation through medical history and physical examination. Management is highly individualized, focusing mainly on the patient's symptoms and affected systems. A multidisciplinary approach is essential, integrating diverse perspectives to address systemic manifestations, underlying mechanisms, and therapeutic strategies. Enhanced understanding of long COVID's pathophysiology and clinical features is critical to improving patient outcomes and quality of life. With a growing number of cases expected globally, advancing research and disseminating knowledge on long COVID remain vital for developing effective diagnostic and management frameworks, ultimately supporting better care for affected individuals.