The RECOVER trial investigating long COVID (post-acute sequelae of SARS-CoV-2) identified the MOST common symptom cluster defining long COVID. Among the following, which symptom triad is MOST characteristic of post-COVID syndrome as per current WHO/CDC definitions?

• A Persistent fever, cough, and hypoxia beyond 4 weeks
• B Fatigue, post-exertional malaise (PEM), and cognitive impairment (brain fog) persisting >12 weeks after acute COVID-19 ✓
• C Acute myocarditis with troponin elevation beyond 4 weeks
• D Recurrent positive PCR for SARS-CoV-2 beyond 4 weeks

Explanation

WHO defines post-COVID-19 condition (long COVID) as symptoms persisting or newly occurring >12 weeks after acute COVID-19 infection, not explained by an alternative diagnosis. The most common and characteristic symptom cluster comprises fatigue (60–70%), post-exertional malaise (symptom worsening after physical or cognitive effort — a cardinal feature also seen in ME/CFS), and cognitive impairment ('brain fog': memory, concentration difficulties). Other common features include dyspnoea, palpitations, and autonomic dysfunction (postural orthostatic tachycardia syndrome — POTS). PCR positivity beyond 4 weeks indicates prolonged shedding, not long COVID.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.