Long COVID, officially termed postacute sequelae of SARS-CoV-2 infection (PASC), represents a multifaceted and severe illness that can result in persistent chronic conditions necessitating extensive multidisciplinary care. In numerous cases, individuals grapple with long COVID symptoms extending for weeks, months, or even years following their initial bout with COVID-19, substantially diminishing their overall quality of life.
Here are 5 critical insights every managed care professional should understand about long COVID. | Image credit: Anucha – stock.adobe.com
Understanding long COVID is crucial for offering necessary support to patients and addressing the operational and economic hurdles it presents to healthcare systems. Here are 5 essential points about long COVID that every managed care professional should familiarize themselves with.
1. Symptoms and Severity
Long COVID exhibits a wide spectrum of symptoms, varying from mild to severe, which frequently mimic those of other medical conditions, complicating both diagnosis and management. While many patients report debilitating symptoms such as fatigue, cognitive dysfunction commonly referred to as brain fog, and postexertional malaise (PEM), researchers have identified over 200 distinct symptoms affecting nearly every organ system. Notably reported problems include difficulty in breathing, persistent chest pain, chronic headaches, gastrointestinal disturbances, and alterations in sensory perception, such as changes in taste or smell. Importantly, long COVID can lead to widespread effects across multiple organ systems, resulting in complications like diabetes, cardiovascular diseases, or nervous system disorders.
Some patients experience unusual clusters of symptoms that elude explanation or effective management, resulting in diagnostic and treatment delays. The lack of a definitive laboratory test for long COVID, compounded by stigma and misunderstanding by society, has further complicated these challenges. Additionally, the overlapping nature of long COVID symptoms with other poorly defined illnesses, such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), adds another layer of complexity for healthcare providers.
2. At-Risk Populations
Anyone who contracts COVID-19 is at risk of developing long COVID; however, specific demographic, health, and social factors place certain populations at a heightened risk. Women, Hispanic and Latino individuals, and those who experienced severe COVID-19 illness—especially those requiring hospitalization—are disproportionately impacted. A study featured in JAMA Network Open emphasized that undocumented Latinx immigrants, who represent about 7% of the U.S. population, are bearing a disproportionately heavy burden associated with long COVID. These individuals are often uninsured and have limited access to primary care resources, exacerbating their vulnerability. Alarmingly, only 11.1% of this group reported a clear understanding of long COVID and its implications.
Additionally, older adults, particularly those aged 65 and above, individuals with pre-existing health conditions, and those who remain unvaccinated exhibit elevated vulnerability to long COVID symptoms. Health disparities compounds the challenges faced by these at-risk groups, as social determinants such as disability, economic hardship, and geographic isolation significantly affect their health outcomes and increase the burden of long COVID.
3. Testing and Diagnosis
The diagnosis of long COVID poses major challenges due to its non-uniform presentation and the absence of a definitive laboratory test. A recent study backed by the National Institutes of Health (NIH) published in Annals of Internal Medicine underscores the intricacies involved in identifying a novel condition like long COVID and emphasizes the urgent need for reliable biomarkers to distinguish it from other illnesses.
Dr. David Goff, MD, PhD, director of the NIH’s Division of Cardiovascular Sciences, stated, “Our challenge is to discover biomarkers that can help us quickly and accurately diagnose long COVID to ensure people struggling with this disease receive the most appropriate care as soon as possible.” He continued to stress the urgency of rapid diagnosis, noting that long COVID symptoms often impede individuals from returning to work or fulfilling daily responsibilities.
4. Effective Management Approaches
Addressing long COVID necessitates a tailored management strategy, as no singular treatment effectively addresses all facets of the illness. Healthcare providers often adopt a multidisciplinary approach, employing a blend of therapies to alleviate diverse symptoms and enhance patients’ quality of life. Medications can target specific challenges like chronic cough, headaches, anxiety, and depression while addressing underlying issues, such as identified blood clots. Cutting-edge interventions like stellate ganglion blocks or olfactory retraining have shown promise in helping restore impaired senses of smell and taste.
Integrating physical therapy and pulmonary rehabilitation programs is instrumental in addressing pain, mobility limitations, and respiratory difficulties, while psychotherapy offers essential emotional support to help individuals cope with the chronic stress of long COVID. Effective management typically involves a process of experimentation to identify the optimal strategies tailored to each patient’s individual needs.
5. Prevention Strategies
The foundation of preventing long COVID is primarily grounded in diminishing the risk of COVID-19 infection. Staying current with COVID-19 vaccinations emerges as the most effective approach, significantly reducing the risks of severe illness, hospitalization, or mortality associated with the virus.
However, recent polling data from the Pew Research Center reveals a troubling trend: 60% of respondents indicated they are “probably not” inclined to receive an updated vaccine. Less than a quarter (approximately 25%) expressed that they would “probably” seek a booster, while only 15% confirmed they have already received the latest vaccination, according to The Hill.
This insight surfaces amid ongoing recommendations from the CDC for individuals aged 65 years and older or those who are immunocompromised to consider a second dose of the latest COVID-19 vaccine. Renowned researcher Dr. Andrew Pekosz from Johns Hopkins Bloomberg School of Public Health commented that this year’s newly formulated vaccines, rolled out within the last couple of months, demonstrate a “fairly good match” to prevalent variants in circulation.
Moreover, essential preventive measures encompass adhering to good hygiene practices, enhancing indoor air quality, and refraining from public activities when experiencing respiratory symptoms to curb the spread of infection. Early testing and treatment remain vital for individuals with higher risks for severe outcomes, as timely intervention has the potential to substantially mitigate complications.
Additional precautions, such as utilizing masks and maintaining physical distancing, become especially crucial during spikes in transmission or when engaging with those at increased risk. By adopting these proactive strategies, individuals can protect not just themselves, but also the wider community, thereby reducing the risk of long COVID in society.
References
1. Long COVID basics. CDC. July 11, 2024. Accessed November 21, 2024. https://www.cdc.gov/covid/long-term-effects/index.html
2. Signs and symptoms of long COVID. CDC. July 11, 2024. Accessed November 21, 2024. https://www.cdc.gov/covid/long-term-effects/long-covid-signs-symptoms.html
3. Grossi G. Data show undocumented Latinx people face disproportionate burden of long COVID. AJMC®. October 17, 2024. Accessed November 21, 2024. https://www.ajmc.com/view/data-show-undocumented-latinx-people-face-disproportionate-burden-of-long-covid
4. Erlandson KM, Geng LN, Selvaggi CA, et al. Differentiation of prior SARS-CoV-2 infection and postacute sequelae by standard clinical laboratory measurements in the RECOVER Cohort. Ann Intern Med. 2024;177(9):1209-1221. doi:10.7326/M24-0737
5. Routine lab tests are not a reliable way to diagnose long COVID. NIH. News release. August 12, 2024. Accessed November 21, 2024. https://www.nih.gov/news-events/news-releases/routine-lab-tests-are-not-reliable-way-diagnose-long-covid
6. Long COVID. Cleveland Clinic. Accessed November 21, 2024. https://my.clevelandclinic.org/health/diseases/25111-long-covid
7. How to protect yourself and others. CDC. July 12, 2024. Accessed November 21, 2024. https://www.cdc.gov/covid/prevention/index.html
8. Suter T. Most say they probably won’t get updated COVID vaccine: Survey. The Hill. November 20, 2024. Accessed November 21, 2024. https://thehill.com/policy/healthcare/5000039-most-wont-get-updated-covid-booster-survey/
9. Martichoux A. Is this year’s COVID booster a good match for new variants? The Hill. November 20, 2024. Accessed November 21, 2024.
