As of August 2021 more than 37 million Americans have been infected with COVID-19. A significant number of these patients either continue to experience clinical symptoms or develop new symptoms 4 weeks and later after a COVID-19 infection, including patients with initial mild or asymptomatic infections. Post-COVID conditions present with a wide range of physical and mental health consequences and may be referred to as long COVID, post-acute COVID-19, or chronic COVID, among other names.
| Dyspnea | Diarrhea |
| Fatigue or post-exertional malaise | Sleep difficulties |
| Cognitive impairment (“Brain Fog”) | Fever |
| Cough | Lightheadedness |
| Chest Pain | Impaired daily function and mobility |
| Headache | Pain |
| Palpitations | Skin rash |
| Musculoskeletal pain | Mood changes |
| Paresthesia | Anosmia or dysgeusia |
| Abdominal pain | Menstrual cycle irregularities |
| The most commonly reported symptoms include: |
|---|
A recent study conducted by the CDC reported patients experiencing ongoing or "long-haul" symptoms after COVID-19 illness were more likely to report pain, challenges with physical activities, and "substantially worse health" compared with people needing rehabilitation because of cancer1.
It should be noted that currently there is no clearly delineated consensus case-definition for long COVID. The criteria adopted are based on literature and case-reports, so estimates of the scope of the problem among different studies vary. However, based on conservative estimates it is likely that millions of patients may experience post-acute sequela of COVID, which will require proper evaluation and management2. Because of test constraints early in the pandemic, some COVID patients do not have molecular, antigen or serologic confirmation of infection. As a consequence, prior positive COVID test results are not absolutely required to establish a conclusion of long COVID.
Post-COVID conditions may include cardiovascular, pulmonary, renal, dermatologic, rheumatologic, endocrine, neurologic, hematologic, urologic, or psychiatric manifestations or signs. Patients with ongoing or new symptoms might be considered for basic panels of laboratory tests (including testing for non-COVID conditions that may be contributing to illness) to assess for conditions that may respond to treatment, until more information and evidence is available for specific laboratory tests for post-COVID conditions. However, it should be noted that according to current CDC interim guidance there is no laboratory test that can definitively distinguish post-COVID conditions from other etiologies, in part due to the heterogeneity of post-COVID conditions. Before ordering laboratory tests for post-COVID conditions, the goals of these tests should be clear to the healthcare professional and to the patient. Laboratory testing should be guided by patient history, physical examination, and clinical findings.
| Post-COVID Basic Panel | 3596 | CBC, CMP, Urinalysis, C-Reactive Protein, ESR, Ferritin, TSH with non-reflex, Free T4, Vitamin D, 25 OH, Vitamin B12 |
| Post-COVID Rheumatologic Panel | 3597 | ANA with Reflex Pattern and Titer, RA, CCP IgG, Cardiolipin Ab’s, CPK |
| Post-COVID Coagulation Panel | 3598 | D-Dimer, Fibrinogen |
| Post-COVID Cardiopulmonary Panel | 3599 | Cardiac TnT, NT-proBNP |
| Panel Name | Unit Code | Components |
|---|
Key Points
- No laboratory test can definitively distinguish post-COVID conditions from other etiologies
- Consider testing symptomatic patients with a basic panel of laboratory tests to assess for treatable conditions
- COVID PCR, Antigen, or Antibody laboratory tests are not required to establish a diagnosis of post-COVID conditions but can help assess for current or previous COVID-19 infection
- Consider the possibility of SARS-CoV-2 reinfection, especially in persons with new or worsening post-COVID conditions
References:
1Rogers-Brown JS, Wanga V, Okoro C, et al. Outcomes Among Patients Referred to Outpatient Rehabilitation Clinics After COVID-19 diagnosis — United States, January 2020–March 2021. MMWR Morb Mortal Wkly Rep 2021;70. DOI: http://dx.doi.org/10.15585/mmwr.mm7027a2
2Nalbandian, A., Sehgal, K., Gupta, A. et al. Post-acute COVID-19 syndrome. Nat Med 27, 601–615 (2021). https://doi.org/10.1038/s41591-021-01283-z
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-index.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-conditions.html
https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-assessment-testing.html