Credit: National Academies Press, modified

Long COVID is associated with multisystem dysfunction affecting the cerebrovascular, autonomic, peripheral, respiratory, and inflammatory systems, which may be caused by low-grade inflammation that is either systemic or targets the vascular system.

While it is widely recognized that the long-term consequences of COVID-19 infection are being felt by hundreds of thousands of Americans, there is no universal clinical case definition for long COVID. Symptoms that are present more than 4 weeks post-infection is the cutoff the Centers for Disease Control and Prevention (CDC) uses to define Long COVID; the World Health Organization defines it using a period of 3 months from the onset of COVID-19 with symptoms.

On 21-22 March 2022, the National Academies of Sciences, Engineering, and Medicine convened a workshop with subject-matter experts to examine the long-term health effects of COVID-19 and potential implications for the Social Security Administration. The speakers, panelists, and workshop participants presented a broad range of information relating to Long COVID and disability.

The following are key points and select excerpts by the from the committee report:

The CDC says that Long COVID can be diagnosed and managed by primary care, and suggests a conservative approach for the first 4 to 12 weeks, with an aggressive workup at 12 weeks if symptoms persist. A variety of physical tests may be employed, including orthostatic vital signs, ambulatory pulse, and exercise capacity. Laboratory testing can be conducted in order to confirm previous COVID-19 infection and to rule out common conditions with similar symptoms (e.g., arthritis, thyroid issues). Specialized testing for Long COVID may include the tilt test, a chest CT, or a brain MRI. Deeks warned that excessive testing can be harmful, as it can lead “down various rabbit holes.”

The goal of Long COVID treatment is to improve the patient’s quality of life, and a holistic approach is helpful for meeting this aim, observed Deeks. He listed some of the commonly used therapies, including compression stockings, physical therapy, pacing of activities, flexibility and strength exercises, and medications. There are medications for specific diagnoses (e.g., selective serotonin reuptake inhibitors for depression), and some clinicians prescribe other medications off-label (e.g., antivirals, intravenous immunoglobulin). Deeks said that a multidisciplinary, team-based approach for treatment is critical, as it can simultaneously address physical issues, mental health issues, social support, and rehabilitation. In addition, these types of clinics can validate the experiences of patients, help them cope with uncertainty, and help them access financial and other types of support.

Long COVID: Examining Long-Term Health Effects of COVID-19 and Implications for the Social Security Administration: Proceedings of a Workshop. National Academies of Sciences, Engineering, and Medicine. 2022. Washington, DC: The National Academies Press. https://doi.org/10.17226/26619.

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