Every first-year medical student learns about the “differential diagnosis.”

When presented with a complaint or set of symptoms in a patient, we train our students to develop a prioritized list of what the problem might or could be.

For example, fatigue might be caused by anemia, low thyroid, depression (or about a jillion other things). An upper respiratory complaint might be a cold, allergy or strep throat. Pain in the back shooting down the leg is called sciatica but may be caused by a ruptured disc, arthritis or a muscle problem.

These days, the differential diagnosis for almost any condition beyond a car wreck or gunshot could include COVID-19. In addition to the cough, fever, sore throat and shortness of breath that the acute COVID infection usually presents, many kinds of symptoms can continue or develop weeks and months afterward.

These symptoms are variously thought to be because of continued viral presence, autoimmune reactions, inflammation or other physiological processes. They may develop in those whose COVID infection was mild, not requiring hospitalization or medication, or even in those whose infection was “asymptomatic,” meaning someone who was a carrier but didn’t even know or feel they were sick.

According to the U.S. Centers for Disease Control and Prevention, the most reported long-term symptoms include:

• Fatigue

• Shortness of breath

• Cough

• Joint pain

• Chest pain

Other reported long-term symptoms include:

• Difficulty with thinking and concentration (sometimes referred to as “brain fog”)

• Depression

• Muscle pain

• Headache

• Intermittent fever

• Fast-beating or pounding heart (also known as heart palpitations)

More serious long-term complications appear to be less common but have been reported. These have been noted to affect different organ systems in the body. These include:

• Cardiovascular: inflammation of the heart muscle

• Respiratory: lung function abnormalities

• Renal: acute kidney injury

• Dermatologic: rash, hair loss

• Neurological: smell and taste problems, sleep issues, difficulty with concentration, memory problems

• Psychiatric: depression, anxiety, changes in mood

For now in medical practice and medical education, for a broad range of complaints, COVID can and should enter into the differential diagnosis. Initially, some physicians attributed the aftereffects of COVID on anxiety or some other mental condition. It’s now clear the physical causes of these symptoms are real enough and can cause mental anguish in addition to their physical suffering.

One example is diabetes. Loss of control of blood sugar during the COVID pandemic has been widely observed in practice, partially because of effects of lockdown decreasing exercise options and subsequent increasing calorie intake, stress eating and weight accumulation. It’s also impacted by changes in insulin production, increased insulin resistance, inflammation and the stress of the infection.

The bottom line is that if you’re developing new or worsening health problems, COVID may be the culprit. Many of these can be adequately managed using current standard or integrative practices. If in doubt, share your concerns with your doctor.

Oh, and did I mention? Get your vaccine as soon as you can.

Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.

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