As a clinical pharmacist, patients will need your help managing long COVID, when symptoms linger more than 12 weeks after initial infection. COVID-19 can leave lasting effects anywhere in the body, causing "brain fog", diarrhea, shortness of breath, etc. Symptoms seem to be more common in patients who’ve had severe COVID-19 (hospitalized, etc), a repeat infection, or are unvaccinated. But even those who had mild or no symptoms can be affected. Acknowledge that symptoms can be vague, can come and go or worsen with activity, and may take months to improve.
Tell patients that there’s still a lot to learn about long COVID, and there’s no proven treatment yet. Advise treating symptoms as you would otherwise. For example, suggest PRN acetaminophen (Panadol, Adol) or an NSAID for headache, honey for cough or loperamide (Imodium) for diarrhea.
Emphasize nondrug measures (meditation, limiting caffeine, etc) for sleep problems. Or advise patients with fatigue to schedule time for rest and pace themselves with exercise. Ask patients how they’re coping. Help connect them to support groups, physical therapy, or specialists (cardiology, ENT, pulmonology, etc) if needed. There’s no good evidence that COVID-19 vaccines improve symptoms if given to patients WITH long COVID. But point out that staying current with COVID-19 vaccination is the best bet for prevention and reducing long COVID risk.
Advise high-risk patients (diabetes, etc) who get COVID-19 to seek treatment, such as Paxlovid (nirmatrelvir/ritonavir). Preliminary data suggest that starting Paxlovid within 5 days of infection may also reduce risk of long COVID. You may hear that metformin (Glucophage) started within 3 days of infection lowers the potential for developing long COVID. But this is also based on preliminary data, and it’s too soon for widespread use.
REFERENCES
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Post–COVID-19 Condition "Guidance for Primary Care", available at: https://www.ontariohealth.ca/sites/ontariohealth/files/2021-12/PostCovidConditionsClinicalGuidance_EN.pdf
Post-COVID-19 Condition in Canada: What We Know, What We Don’t Know and a Framework for Action. (2022). Available at: https://science.gc.ca/site/science/sites/default/files/attachments/2022/Pre-Report_PCC_Dec2022.pdf.
Canada, P.H.A. of (2021). Post-COVID-19 condition. [online] www.canada.ca. Available at: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/symptoms/post-covid-19-condition.html
Support for rehabilitation: self-management after COVID-19-related illness, second edition. [online] Available at: https://www.who.int/europe/publications/i/item/WHO-EURO-2021-855-40590-59892