Instruct PCP in post-COVID care and encourage CDC staff

Regarding the diagnosis of post-COVID status (or so-called long COVID), Michael Saag, MD of the University of Alabama at Birmingham, mentioned the first line of an old Buffalo Springfield song on a phone call with a clinician Thursday.

“Something is happening here. It’s not exactly what it is,” Saag said.

The CDC, which hosted the call, recently updated its interim guidance for healthcare professionals to assess and treat post-COVID conditions. Government staff emphasized the non-uniform nature of these conditions, but in most cases agreed that a patient-centric healthcare facility model could be diagnosed and managed by primary care physicians. In addition, some symptoms improve or resolve within 4-12 weeks and should be evaluated in stages 4 weeks after the patient’s COVID infection.

CDC MD Jennifer Chevinsky cautioned when going out of the primary care model, but symptoms lasting more than 3 months require a professional or interdisciplinary COVID care center referral. Said it might be.

“Use a step-by-step approach to referrals from other professionals, recognizing that referrals can be burdensome to patients,” she said, with the goal of “contradictory medical advice.” He added that it was to avoid it.

Chevinsky recommended a “conservative diagnostic approach” in the first 4-12 weeks. She said some patients may require diagnostic testing, but warned that laboratory tests would not only be indistinguishable after COVID, but would not require diagnosis of post-COVID status.

If the symptoms persist for more than 12 weeks, she said additional tests may be considered.

Chevinsky said this should be guided by “patient history and clinical findings,” as the evidence for the usefulness of diagnostic imaging for post-COVID status is also limited. More specialized tests, such as cardiac MRI, may be worth consulting with a specialist.

While a comprehensive rehabilitation program may help some patients, many conditions after COVID are well-established evidence-based symptomatology approaches to “optimize function and improve quality of life.” Can be improved by. These do not include herbal remedies, supplements, or other treatments that the patient may have used to treat the condition.

Since the ICD-10 code for post-COVID status does not yet exist, the CDC recommends using B94.8 (sequelae of certain other infectious and parasitic diseases) to document these statuses. did.

Alexis Vosoney, MD of the American Academy of Family Physicians, provided the primary care physician’s perspective and pointed out the importance of validating the patient’s experience, which the CDC also suggested in the guidance.

She also encouraged clinicians to discuss the patient’s goals, whether they were looking for an “answer” to their symptoms, returning to their pre-COVID status, or being afraid of another illness process. ..

“Keep transparent to the patient. Admit that we don’t know much about symptoms and recovery after COVID,” said Vosoney, “acknowledge when we don’t have much evidence. I need to. “

She said it was necessary to distinguish between post-COVID and other chronic conditions, citing the example of a patient with shortness of breath who had poorly controlled asthma prior to the pandemic.

Saag was infected with COVID in March 2020 and worked at the COVID clinic after recovery, so he expressed his view as both a patient and a clinician. He emphasized the importance of distinguishing between post-COVID symptoms and post-intubation syndrome in patients on mechanical ventilation.

Saag said former marathon runners and people without underlying illness had cases of post-COVID syndrome and are now “difficult to take a shower and walk to the mailbox.” In fact, experts have pointed out how post-COVID conditions can occur after asymptomatic, mild, or severe infections. They can occur in all patients, from children to adults, and persistence, recurrence, or new symptoms can occur over time.

“In a sense, if you see one long COVID, you see one long COVID,” Saag said.