National Academies release new definition of Long COVID

Long COVID should now be defined as “a chronic infection-related illness that arises after COVID-19 infection and is present for at least three months as a continuous, relapsing, remitting, or progressive condition affecting one or more organ systems,” according to a new report from the National Academies of Sciences, Engineering, and Medicine. report.

“Currently, although several tentative definitions exist, no common definition of long COVID has been agreed upon. The lack of an agreed-upon definition poses challenges for patients, clinicians, public health workers, researchers, and policymakers,” the report noted. For patients, diverse disease manifestations and competing definitions can lead to difficulties accessing health care and obtaining support, skepticism or denial of patients' experiences, delayed or refusal of treatment, and social stigma.

Recognizing the wide range of input and the need for an improved definition, the Office of Strategic Preparedness and Response (ASPR) and the Office of the Assistant Secretary for Health (OASH) commissioned the National Academies to define Long COVID. The committee that produced the report stated: Engaged More than 1,300 people participated in the activities, which focused on interdisciplinary dialogue and the patient perspective.

The report said the new Long COVID definition can be applied for many purposes, including clinical care and diagnosis, health care services, insurance coverage, disability benefits, eligibility for school and workplace accommodations, public health, social services, policy development, epidemiology and surveillance, private and public research, and public awareness and education, especially for patients and their families and caregivers.

“Due to the lack of a consistent definition, Long COVID “This definition has hindered research and delayed diagnosis and treatment for patients,” said Harvey Feinberg, president of the Gordon and Betty Moore Foundation and chair of the writing committee. “Our committee hopes that this single definition, developed with input from researchers and the patient community, will help educate the public about this widespread and significant medical condition.”

OASH’s Office of Long COVID Research and Practice and the Long COVID Coordinating Council, comprised of 14 federal agencies, will lead efforts to disseminate and implement the new definition.

“Long COVID is a devastating, lasting impact of the COVID-19 pandemic that the medical community has yet to fully address,” said Victor J. Dzau, president of the National Academy of Medicine. “Serving this patient population through better coordinated care, clearer diagnoses, and more efficient, streamlined research is a critical next step in addressing its impact.”

Full definition

Long COVID (LC) is a disease that develops after SARS-CoV-2 infection and is characterized by at least Three months A continuous, relapsing-remitting, or progressive medical condition affecting one or more organ systems.

LC can manifest in many different ways. The full list of signs, symptoms and diagnosable conditions for LC can number in the hundreds. Any organ system can be affected, and people with LC may experience the following symptoms:

• One or more symptoms such as shortness of breath, cough, persistent fatigue, fatigue after exertion, difficulty concentrating, poor memory, recurring headaches, dizziness, fast heart rate, trouble sleeping, problems with taste or smell, bloating, constipation, or diarrhea.
• Single or multiple diagnosable conditions, such as interstitial lung disease and hypoxemia, cardiovascular disease and arrhythmias, cognitive impairment, mood disorders, anxiety, migraines, stroke, blood clots, chronic kidney disease, orthostatic intolerance (POTS) and other autonomic dysregulations, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), mast cell activation syndrome (MCAS), fibromyalgia, connective tissue disorders, hyperlipidemia, diabetes, and autoimmune diseases such as lupus, rheumatoid arthritis, and Sjogren's syndrome.

Important features include:

• LC can occur after asymptomatic, mild, or severe SARS-CoV-2 infection, and prior infection may or may not have been recognized.
• LC may persist from the time of acute SARS-CoV-2 infection or may develop with a delayed onset of weeks or months after a person appears to have fully recovered from acute infection.
• LC can affect both children and adults regardless of health condition, disability, socioeconomic status, age, sex, gender, sexual orientation, race, ethnicity, or geographic location.
• LC can worsen existing health conditions or present as a new condition.
• LC can range from mild to severe. It may subside over a few months or may persist for months or years.
• LC can be diagnosed on clinical grounds, and no currently available biomarkers conclusively prove the presence of LC.
• LC can impair your ability to work, go to school, care for your family, and take care of yourself. It can have serious mental and physical effects on patients, their families, and their caregivers.

Causes of infection

Long COVID occurs following COVID-19 infection but does not require laboratory confirmation or other evidence of initial infection. The definition emphasizes that Long COVID can occur following infection of any severity, including asymptomatic infection, whether or not it was initially recognized.

Onset and duration

By definition, to make a diagnosis of Long COVID, symptoms must persist for at least three months, whether ongoing or relapsing and remitting. Because there remains uncertainty about the relationship between the timing of COVID-19 infection and the development of Long COVID, the committee chose not to include a maximum incubation period.

Symptoms

This definition does not list any required or excluded symptoms or conditions. Although the definition includes some examples of specific symptoms, they are not exhaustive and do not negate the importance of other symptoms or conditions. A complete enumeration of the signs, symptoms, and diagnosable conditions of Long COVID would exceed 200.

Dysfunction

This definition highlights that some people with Long COVID may be severely affected and experience various activity limitations, which can have a profound impact on the lives of patients and their caregivers and is a key feature of Long COVID.

fairness

The report recognizes that socioeconomic factors, inequalities, discrimination (e.g., based on race or gender), bias, and stigma affect whether patients receive a diagnosis and whether they benefit from medical care or services targeted at Long COVID. These factors include, but are not limited to, access to COVID-19 testing during acute illness, access to evaluation for possible Long COVID, physicians' willingness to diagnose certain patients, access to insurance benefits, and patients' fears of the stigma that may result from a Long COVID diagnosis.

Further research

Research questions centered around improving the definition could focus on key definitional elements clearly stated in the report: attribution to infection, time, clinical features, equity, functional impairment, exclusion and alternative diagnoses, biomarkers and testing criteria, and risk factors.

Practitioner Committee on Provisional Definition of Long COVIDThe study was sponsored by the Office of Strategic Preparedness and Response and the Office of the Under Secretary of Health.