Expanded long-COVID resources can help us hit a moving target
By Amra Resic, MD
As family physicians, we were on the front line against COVID. Today, almost six years beyond the pandemic’s start, some would say we’re working the rear guard. But now we face a different, sneakier adversary: long COVID.
To help us operate at the leading edge of this new front, the Academy has updated its long-COVID page with new resources. I can tell you firsthand how welcome this is.
Why family physicians need the latest long-COVID guidance
Earlier this month, I saw a patient who told me she often found herself short of breath. She said the problem had started months ago, but she hadn’t checked in with me about it. She’d had an echocardiogram already, with a normal result, but hadn’t seen a pulmonologist.
As we talked more, she recalled that her difficulty breathing had started after she’d had COVID, followed by influenza. I told her we still needed to test her pulmonary functions, but I cautioned that the issue could be long COVID.
That encounter shows some of the challenges that long COVID presents clinicians:
- Lots of people like my patient got their COVID diagnosis or treatment from urgent care or a walk-in clinic, so my chart may not reflect that part of their history.
- A patient long finished with COVID may be confused by the onset of one or more symptoms that weren’t necessarily present during the original illness.
- A patient may also be unaware that long-COVID symptoms often appear weeks or even months after the initial infection.
- We lack a test that would let us confirm long COVID, so we often start by ordering workups to rule out other issues.
- Because long COVID can affect every organ system but doesn’t have any one identifying characteristic, labs and imaging may not reveal exactly what’s happening.
New resources for long COVID
The Academy has added two updates to its long-COVID page:
- a long-COVID compendium report published by the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and
- a new resource repository from the Council of Medical Specialty Societies.
The AAPM&R report—“Multidisciplinary collaborative guidance on the assessment and treatment of patients with Long COVID: A compendium statement”—offers frontline clinicians the latest guidance.
The AAFP is bringing you this content in partnership with the Council of Medical Specialty Societies with support from the CDC and HHS.
Family physicians can spearhead a multidisciplinary approach
Family physicians can nevertheless lead the battle against long COVID. For me, it starts with three things.
- Long COVID reinforces the importance of believing our patients. From the honest conversations we have in clinic, we can begin to coordinate a care plan.
- Speaking of care plans: Long COVID also shows the importance of a multidisciplinary approach. We have to get the team involved, and all of us on the team must work from the best, most current guidance and factor it into our care plans. That’s why the AAFP putting this information in one place is a big deal.
- Most important, we have our vigilance. We’re already well practiced when it comes to keeping up with research and clinical recommendations. (Here I’d like to put in a plug for my chapter because its journal, Florida Family Physician, centers on this topic in its fall issue.) Checking in with the AAFP’s updated long-COVID page is a natural extension of our learning habit.
Given the need for testing, pulmonologists and cardiologists are important in the long-COVID fight. Having well-vetted data and information centralized from a trusted source is going to make my conversations with other doctors easier and more specific. This is the other important benefit of the whole-team approach: We can educate one another about the latest guidance and what’s working for our patients.
In being proactive about this, we also validate our patients. We can tell them, Yes, what you’re experiencing is real, and we will help you work through it. (And I still counsel my patients to get vaccinated and boosted against COVID.)
What my patients want to know about long COVID
The No. 1 thing my patients ask me is: When are these symptoms going to go away? Then they ask how long it will take for them to feel 100% again. They want to know if there’s a treatment, a therapy, an answer.
Just as there isn’t a simple test for long COVID, though, we have no one-size-fits-all timetable for healing. I’m glad we have consensus that long COVID is real and it’s out there, but it’s also complex. Not everybody fits into one treatment plan. That’s understandably frustrating for patients to hear. Anyone would want a more definitive answer than long COVID allows. It can feel like trial and error.
Given how hard it is to diagnose long COVID or have a specific treatment plan for it, an up-to-date compendium such as this is important. Having the latest clinical information lets us tackle the symptoms. For instance, we can address fatigue with exercises, behavioral techniques, lifestyle modification.
What I’ve learned from my long-COVID patients
Keeping current on long COVID isn’t just about data and clinical guidance. I’m also attentive to what I hear in the exam room. The dominant complaints brought to me are fatigue and brain fog (cognitive impairment). Those are two of the seven main symptoms detailed on the AAFP’s updated long-COVID page:
- physical fatigue,
- breathing and respiratory issues,
- cardiovascular issues,
- neurologic issues,
- mental health,
- autonomic dysfunction and
- cognitive impairment.
I see how these symptoms, and the uncertainty of how long it will take to resolve them, have real effects on my patients’ mental health. We know that behavioral health care is in short supply, which means opportunities to talk about how long COVID makes our patients feel aren’t as plentiful as we’d like. This is another area where our leadership is needed: We can keep listening.
Amra Resic, MD, is a family physician practicing in Palm Harbor, Florida.
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