Long COVID: mechanisms, risk factors and recovery

Astin, Rónan, Banerjee, Amitaya, Baker, Mark R, Lim, Phang Boon, Dani, Melanie, Ford, Elizabeth, Hull, James H, McNarry, Melitta, Morten, Karl, O’Sullivan, Oliver, Pretorius, Etheresia, Raman, Betty, Soteropoulos, Demetris S, Taquet, Maxime and Hall, Catherine (2022) Long COVID: mechanisms, risk factors and recovery. Experimental Physiology. pp. 1-16. ISSN 0958-0670

[img] PDF - Accepted Version
Restricted to SRO admin only

Download (494kB)
[img] PDF - Published Version
Available under License Creative Commons Attribution.

Download (689kB)


Long COVID, the prolonged illness and fatigue suffered by a small proportion of those infected with SARS CoV-2, is placing an increasing burden on individuals and society. A Physiological Society virtual meeting in February 2022 brought clinicians and researchers together to discuss current understanding of long COVID mechanisms, risk factors and recovery. This review highlights the themes arising from that meeting. It considers the nature of long COVID, exploring its links with other post-viral illness such as myalgic encephalolmyelitis/ chronic fatigue syndrome, and highlighting how long COVID research can help us better support those suffering from all post-viral syndromes. Long COVID research started particularly swiftly in populations routinely monitoring their physical performance - namely the military and elite athletes. The review highlights how the high degree of diagnosis, intervention and monitoring of success in these active populations can suggest management strategies for the wider population. We then consider how a key component of performance monitoring in active populations, cardiopulmonary exercise training, has revealed long COVID-related changes in physiology – including alterations in peripheral muscle function, ventilatory inefficiency, and autonomic dysfunction. The nature and impact of dysautonomia are further discussed in relation to Postural Orthostatic Tachycardia Syndrome, fatigue and treatment strategies that aim to combat sympathetic overactivation by stimulating the vagal nerve. We then interrogate the mechanisms that underlie long COVID symptoms, with a focus on impaired oxygen delivery due to micro-clotting and disruption of cellular energy metabolism, before considering treatment strategies that indirectly or directly tackle these mechanisms. These include remote inspiratory muscle training and integrated care pathways that combine rehabilitation and drug interventions with research into long COVID healthcare access across different populations. Overall, this review showcases how physiology research reveals the changes that occur in long COVID and how different therapeutic strategies are being developed and tested to combat this condition.

Item Type: Article
Schools and Departments: School of Psychology > Psychology
SWORD Depositor: Mx Elements Account
Depositing User: Mx Elements Account
Date Deposited: 01 Nov 2022 10:34
Last Modified: 01 Dec 2022 13:30
URI: http://sro.sussex.ac.uk/id/eprint/108802

View download statistics for this item

📧 Request an update