Patient History and Physical Examination| Evaluating and Caring for Patients with Post-COVID Conditions

A Suggested Workup for Post-COVID Conditions

Patient history

The history of present illness should include the patient’s COVID-19 disease course, severity of illness, and treatments received. When possible, healthcare professionals should establish a timeline of when symptoms emerged during acute illness and afterwards. Commonly reported symptoms are included in Table 1.⁽^{1-4, 6-9, 12, 20, 39-46)}

Table 1. Symptoms commonly reported among people with post-COVID conditions

Dyspnea or increased respiratory effort
Fatigue
Post-exertional malaise and/or poor endurance
“Brain fog,” cognitive impairment
Cough
Chest pain
Headache
Palpitations and/or tachycardia
Arthralgia
Myalgia
Paresthesia
Abdominal pain
Diarrhea
Insomnia and other sleep difficulties
Fever
Lightheadedness
Impaired daily function and mobility
Pain
Rash (e.g., urticaria)
Mood changes
Anosmia or dysgeusia
Menstrual cycle irregularities

* Post-exertional malaise (PEM) is the worsening of symptoms following even minor physical or mental exertion, with symptoms typically worsening 12 to 48 hours after activity and lasting for days or even weeks.

The broad spectrum of signs and symptoms reported thus far in persons with post-COVID conditions warrants a broad approach to the review of systems. Since information on post-COVID conditions in children and adolescents is limited, it is possible that other signs and symptoms than those listed in Table 1 may be present or more common in younger age groups. Both for children and adults, healthcare providers should elicit the frequency, severity, and evolution of symptoms and their impact on quality of life and functional ability, including the degree to which symptoms interfere with their ability to return to school or work.

Past medical history should include assessment for prior conditions that could impact the severity of COVID-19 disease, including but not limited to asthma, allergies, chronic obstructive pulmonary disease, interstitial lung disease, chronic kidney disease, diabetes mellitus, obesity, sleep disorders, prior autoimmune disease, mood disorders (e.g., anxiety or depression), trauma and stressor-related disorders (e.g., adjustment disorder or PTSD), hypertension, migraines, fibromyalgia, or chronic fatigue.

Social history should include assessment of the level of material and social supports and resources available to the patient (e.g., finances, employment, housing, access to food) and their potential impact on the capacity of patients to access health and recuperation services. Healthcare professionals should establish the patient’s current and pre-infection level of activity (e.g., nature of work or school activities, activities of daily living) as well as screen for potential or known substance use disorder. The Centers for Medicare and Medicaid Services provide a useful toolexternal icon for assessing these and other social needs and determinants of health.

For patients with clinical features warranting further evaluation, healthcare professionals might consider the broad range of possible post-COVID conditions. These could have been present prior to and unmasked by SARS-CoV-2 infection or they may have been caused more directly by SARS-CoV-2 infection. Additional system-based conditions that have been reported following SARS-CoV-2 infection can be found in Table 2.⁽^{1-3, 6, 39, 40, 46, 47)}

Table 2. System-based conditions reported following SARS-CoV2 infection