Chronic COVID syndrome: Need for an appropriate medical terminology for long‐COVID and COVID long‐haulers

Abstract

With the ongoing pandemic of coronavirus diseases (COVID-19) caused by SARS-CoV-2, there has been a surge in research and publications related to its pathogenesis and the clinical presentation of the affected patients. Many aspects of this novel virus have raised confusion including the naming of the virus and the disease it causes, the staging of its clinical presentation to highlight a few such occurrences. An emerging aspect of the clinical presentation related to COVID-19 is the long-term effects, which in the absence of any consensus has been termed as long-COVID and long-haulers in recent publications.1, 2 As the COVID-19 is a zoonotic infection and comes under a medically related disease, the term chronic covid syndrome (CCS) would be a more traditional way of symbolizing the so-called long-covid and long-haulers in COVID-19. Though the renaming of this chronic state of now well-recognized chronicity seen in COVID-19 would not affect its prognosis, this is much needed to recognize this entity with a more appropriate nomenclature as published work is making its way into databases like Google Scholar and PubMed.1, 2 Also, needed is an organ-based staging system of COVID-19 that can segregate the diseases based on the major organ in threat in COVID-19. A fraction of the COVID-19 patients who undergo a variable acute symptomatic phase of the disease are coming forward with continuing effects of the disease, with complaints like mental fog, delayed latent periods in recalling events of recent past, tachycardia, extreme fatigue,3 inability to perform daily physical tasks to name a few of a complex series of signs and symptoms. The signs and symptoms are so diverse and related to multiorgan and systems that it is challenging to ascribe it a proper terminology. In an attempt to recognize this unique state of COVID-19 related discomfort and disability there is a need to provide this syndromic state a better term. Of the other diseases, infectious and noninfectious nature, that progress from an initial phase into a prolonged one are commonly termed acute and chronic, respectively.4 Terms like acute and chronic viral hepatitis, osteomyelitis, gastroenteritis, and bronchitis are a few of the many examples in medicine where after a period of commonly 3 weeks the term chronic is phrased to reflect the prolonged status of symptomatic disease. Through this communication, it is intended that the scientific community should come to a consensus to ascribe an appropriate terminology to the symptomatic prolonged (beyond 3 weeks) COVID-19, which is very much needed in the ongoing pandemic caused by SARS-CoV-2. Staging the COVID-19 is another proposal that this communication intends to invite and debate. It is now well recognized that COVID-19 presents with an organ dominant syndromic disease in which the lungs are mostly the commonest organ being involved. It has also been recognized that there are COVID-19 affected patients in which renal, cardiac, neural, gastrointestinal, and coagulative features dominate5 and threaten the life of the patient. We previously have shown a list of organ and system that are expected to be targeted in COVID-19 based on the ACE2 expression,6 and through this communication, we propose staging-based segregation of the patients with predominant organ involvement, which is expected to prioritize the patients for the immediate care needed in particular organ-care units in the hospitalized COVID-19 patients. Although, such a prioritization must be already in effects without formally classifying the patients, early segregation of the patients into an organ-dominant type of COVID-19 is expected to make the selection of the organ-specific units of the hospital for patient admissions with COVID-19 or the transfer of the affected patients if such an organ-dominant sign and symptoms emerge during their management. The cascade (Figure 1A) of how the disease spread from lungs to organ in the timeline of COVID-19 patients and the proposal of segregation of COVID-19 based on the dominant organ being involved (Figure 1B) is expected to reduce the mortality in the ongoing pandemic. Another benefit of this organ stage-based classification of the patients is that it would enable the hospital units to act in concert to anticipate complications and clinically manage the patients affected by the chronicity of COVID-19. This communication implores the textbooks of medicine, scientific journals, and clinical practice handbooks to consider the CCS as a distinct entity as a disease, and prefer it over the terms mentioned above to describe the prolonged COVID-19 syndrome. Though more disabling than lethal, CCS is proving to be an enormous burden on the mental health of the affected patients who find it very distressing to coup up with this new but ominous syndromic condition.