Autonomic dysfunction in ‘long COVID’: rationale, physiology and management strategies (January 2021)

Summary

The COVID-19 pandemic has caused unprecedented morbidity, mortality and global disruption. Following the initial surge of infections, focus shifted to managing the longer-term sequelae of illness in survivors. ‘Post-acute COVID’ (also known as ‘Long COVID’) is emerging as a prevalent syndrome. It encompasses a plethora of debilitating symptoms (including breathlessness, chest pain, palpitations and orthostatic intolerance) which can last for weeks or more following mild illness.

Dani et al. describe a series of individuals with symptoms of ‘Long COVID’, and posit that this condition may be related to a virus- or immune-mediated disruption of the autonomic nervous system resulting in orthostatic intolerance syndromes. They suggest that all physicians should be equipped to recognise such cases, appreciate the symptom burden and provide supportive management. They present our rationale for an underlying impaired autonomic physiology post-COVID-19 and suggest means of management.