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Abstract
The SARS-CoV-2 (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’ (known colloquially
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. We describe
a series of individuals with symptoms of ‘long COVID’, and we posit that this condition
may be related to a virus- or immune-mediated disruption of the autonomic nervous
system resulting in orthostatic intolerance syndromes. We suggest that all physicians
should be equipped to recognise such cases, appreciate the symptom burden and provide
supportive management. We present our rationale for an underlying impaired autonomic
physiology post-COVID-19 and suggest means of management.
This case series describes COVID-19 symptoms persisting a mean of 60 days after onset among Italian patients previously discharged from COVID-19 hospitalization.