Expert panel shares best practices for managing patients with long COVID

As patients continued to experience the acute sequelae of SARS-CoV-2 or long COVID, a panel of experts discussed best practices and approaches for managing many different symptoms of this condition.

There is also a panel of members from the American College of Physicians Announced their guidance In Annual report of internal medicine..

One of the main concerns about long COVID, Dr. H. Clifford Lane, MD, National Institute of Allergic Infectious Diseases, is that the condition is not yet clearly defined.

“I think we need to get some uniformity,” Lane said in the long definition of COVID. “This is a diagnosis of exclusion and I don’t want to use it as an excuse for not looking for something else.”

Panelists agreed that it was important to know what to look for and how to approach patients with potentially long COVIDs.

Common symptoms are complaints of cognitive impairment such as fatigue, poor concentration and memory loss. Lindsay Lief, MD, director of Weill Cornell Post-ICU Recovery Clinic in New York City, said these symptoms need to be carefully monitored.

“The important thing is to find an accessible cognitive psychologist or occupational therapist in your area, which is actually a limiting factor,” she said. “There is an improvement and there is a coping mechanism that can be taught.”

Lief suggested regular diagnostic imaging until patients with lung concerns, especially those previously hospitalized with COVID-19, were normal or stable. It is also important to continue testing patients for potential heart or vascular causes of these symptoms, she added.

Notably, some patients may show certain concerns about long COVID, even though they have never tested positive for acute COVID-19 infection. Carlos del Rio, MD, MD of Emory University School of Medicine in Atlanta, states that understanding a patient’s medical history and vaccination status is important for taking the next step.

If the patient is uncertain about the previous infection, it is appropriate to test SARS-CoV-2 antibody levels to confirm COVID-19 infection. The next steps are liver, thyroid, respiratory function tests, chest x-rays, and echocardiography as needed.

In addition to this standard test, Del Rio warned that there is no evidence that the vaccine is therapeutic at this time, but said he would recommend vaccination to patients if they had not yet been vaccinated.

It is also worth remembering that long COVIDs are not the condition after the first viral infection seen by the medical community, so there is available literature on other similar conditions that may inform patient care. It is important. Oregon Health & Science University’s long COVID-19 program.

“At the heart of what we see in these clinics is post-viral fatigue syndrome,” Hope said. “And it was actually studied before this, and we want to integrate what we are doing with our previous work.”

Experts agreed that the best course of action would ultimately be to refer these patients to a post-COVID center for further assistance. It is also worth considering whether the nearest center is participating in the NIH Researching COVID to Enhance Recovery (RECOVER) initiative, a national study to study the long-term effects of COVID-19. Said.

Del Rio emphasized that primary care physicians need to be prepared to treat these patients because the number of patients with long COVID symptoms is too large to be managed in all post-infection clinics.

He noted similarities to the early stages of the HIV epidemic and said that many of the people considered HIV specialists today began as internists treating HIV patients. These doctors learned about the virus from a case-by-case method and ultimately developed their therapeutic expertise. He said the medical community has the same opportunity with a long COVID.

“In the end, I think we’ll learn and learn more as we go,” Del Rio added.