Most patients recover shortly after SARS-CoV-2 infection without further complications. However, up to 10% develop symptoms and complications that persist or appear after the initial infection. Based on current epidemiological data in Greece, approximately 3 million people have been infected since the beginning of the pandemic. Of these, around 300,000 are expected to develop Long COVID syndrome, while approximately 140,000 patients experienced severe illness and may develop serious and persistent health complications.
Long COVID is a serious condition that significantly affects a large number of individuals and requires timely and specialized management.
For the optimal management of each patient with Long COVID, Metropolitan General has established the specialized Long COVID Unit, offering comprehensive care to individuals presenting complications or symptoms that persist or appear four weeks after recovery from coronavirus infection.
The monitoring program includes evaluation by a specialized multidisciplinary medical team consisting of an Internist-Infectious Diseases Specialist, respiratory and cardiac assessment by Pulmonologists and Cardiologists, as well as a series of diagnostic investigations depending on the severity and type of symptoms.
Following completion of the clinical and laboratory evaluation, diagnosis of the underlying medical condition associated with the previous infection is established and the appropriate therapeutic intervention is initiated.
The Long COVID Unit is coordinated by Charalampos Gogos, Professor of Internal Medicine and Infectious Diseases Specialist, Director of the Internal Medicine-Infectious Diseases Clinic at Metropolitan General.
The program is intended for patients who have recovered from COVID-19 and:
- Continue to experience symptoms more than four weeks after onset of infection
- Developed signs and symptoms that were not present during the acute phase and persist for more than 12 weeks
- Required prolonged hospitalization in an ICU and/or COVID Clinic
- Developed severe respiratory, cardiovascular, or other organ dysfunction requiring therapeutic support
- Present atypical symptoms such as fatigue, dyspnea, impaired concentration and memory, headaches or generalized pain, persistent cough, altered smell or taste, diarrhea, sleep disturbances, anxiety, depression, palpitations, chest tightness or pain, joint or muscle pain, and other unexplained symptoms
Long COVID Symptoms
The most common symptoms of Long COVID include fatigue, dyspnea, cognitive impairment, concentration and memory difficulties (“brain fog”), headaches and generalized pain, persistent cough, altered smell or taste, diarrhea, sleep disturbances, anxiety and depression, palpitations, chest tightness or pain, and joint or muscle pain.
Indicative Long COVID Symptoms by Organ System
Respiratory System
- Chest pain
- Cough
- Exertional dyspnea
The duration of respiratory symptoms depends on the patient’s pre-existing respiratory condition and the severity of the infection. Some symptoms may persist for up to three months or longer.
Cardiovascular System
- Chest pain
- Dyspnea
- Palpitations / arrhythmias
- Fatigue
Anosmia and Ageusia
COVID-19 may lead to disturbances of taste and smell. In addition to loss of smell detection, reduced or absent taste and smell can negatively affect nutritional intake, psychological well-being, and ultimately quality of life.
These disturbances usually resolve within a few weeks; however, persistent symptoms may require specialized management.
Neurological Disorders
Neurological complications may involve:
- Cognitive functions
- Speech and language abilities
- Academic skills
- Motor functions
- Mood and behavioral changes
Acute COVID-19 infection may lead to inflammatory processes affecting the brain, such as stroke or encephalitis, potentially resulting in cognitive decline, motor impairment, and speech difficulties. Persistent symptoms that fail to improve over time usually require imaging investigations and multidisciplinary specialist evaluation.
Memory and Concentration Disorders
- Attention and concentration difficulties
- Memory loss or learning difficulties
- Difficulties with reading and spelling
Fatigue
A number of patients report physical fatigue, myalgia, and reduced exercise tolerance for several weeks following acute infection, even during mild activities that they were previously able to perform without difficulty. In such cases, complications involving the respiratory and cardiovascular systems should be excluded. Post-infectious fatigue usually improves within a few weeks, while a structured individualized daily activity program and gradual increase in physical activity are generally recommended.
Headache
Headache is a common symptom both during the acute phase of COVID-19 infection and within the context of Long COVID syndrome. Management follows the same principles applied to any patient with persistent headache, including detailed medical history, characterization of headache features, and neurological evaluation.
Other Less Commonly Reported Symptoms
- Gastrointestinal disorders (diarrhea, irritable bowel syndrome)
- Skin rash
- Depression
- Insomnia
- Thromboembolic events
- Arthritis
Diagnostic Evaluation for Long COVID
The diagnostic assessment includes:
- Evaluation by an Internist-Infectious Diseases Specialist
- Evaluation by a Pulmonologist
- Evaluation by a Cardiologist
- Evaluation by additional specialists when indicated (Psychiatrist/Psychologist, Neurologist, Rheumatologist, Hematologist, etc.)
Imaging & Diagnostic Tests
- Chest CT scan
- Complete dynamic spirometry
- Color Doppler echocardiography (triplex heart ultrasound)
- Electrocardiogram (ECG)
Laboratory Investigations:
- Complete blood count (CBC)
- Potassium
- Sodium
- Creatinine
- Urea
- Glucose
- SGPT (ALT)
- γ-GT
- Bilirubin (total & direct)
- Total proteins
- Albumin
- Urinalysis
- CPK
- High-sensitivity troponin I (hs-cTnI)
- D-Dimers
- Cholesterol
- Triglycerides
- Uric acid
- LDH
- Ferritin
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR)
- Antinuclear antibodies (ANA - quantitative determination)
- TSH (thyroid-stimulating hormone)
Depending on disease severity and medical evaluation, additional investigations such as CT angiography or brain MRI may also be required.