• Long COVID: The Next Fight in an Ongoing Battle

    May 26, 2022, 9:30 a.m. — If there’s one thing we have figured out about COVID-19 after two-plus years, it’s this: It really doesn’t care. Whether you’re conservative or liberal, whether you live in an urban area or a rural area, or whether your vehicle of choice is a pickup or a Prius, it doesn’t matter. All COVID-19 sees is a body where it can replicate.

    long covid concept

    We’re still learning new things about SARS-CoV-2 and its variants and subvariants every day. What has become abundantly clear, though, is that for many people, this isn’t a virus that you get, recover from, and go back to life as usual. Sometimes, the symptoms of COVID-19 can persist for weeks or even months. The CDC generally refers to this cluster of symptoms as “long COVID” (with an ICD-10 code of U09.9, Post COVID-19 condition, unspecified), although I’ve also heard terms like “post-acute sequelae of SARS-CoV-2 infection,” “chronic COVID” and “COVID-19 long hauler” used.

    Exactly how many people have long COVID? We don’t know for sure, but the best estimates are that between 10% and 40% of people — or up to about 23 million Americans — who become infected go on to develop long COVID symptoms.

    As family physicians, we have been on the front lines of this pandemic since the start. Over the last couple of years, our members have shared their stories in dealing with COVID-19 from a variety of angles, from handling surges of cases at a large hospital in Chicago to caring for patients in upstate New York to meeting the challenges that come with treating older patients. We’ve seen that COVID-19 can throw a lot at us, and we’re still here, doing the best we can with what we’ve got.

    I am currently treating several patients with varying symptoms of long COVID in my practice. Their chagrin with the persistent fatigue, cough or brain fog, and mine with the inability to counsel them with exact certainty on the long-term prognosis of their condition, has been frustrating.

    So what about those who have long COVID? Who are they, and who is taking care of them?

    Research from the Journal of Women’s Health may help answer the first question. A new study from researchers in Italy analyzed the case records of 223 men and women who were infected with SARS-CoV-2 during the first waves of the pandemic, and reviewed their symptoms at two points: during the acute phase of infection and a mean follow-up of five months. While a higher percentage of men were hospitalized with severe COVID-19 at the acute phase, women were significantly more symptomatic than men at the five-month follow-up.

    Let’s be honest: None of us are experts on long COVID at this point. That said, while this is a small sample size and more long-term studies are definitely needed, the findings here tell me that at least some of the symptoms of long COVID may be more likely to present in women, so it’s something we should certainly be aware of.

    We also know that patients with more severe disease are more likely to develop long COVID, but those with mild or even asymptomatic disease can develop the condition as well, sometimes months after testing positive.

    This all means we’ll need to be diligent in our initial evaluations, ask a lot of questions, and consider tailored, personalized treatment strategies for our long COVID patients.

    Now, for the second question. Last month, Morning Consult released the results of an analysis of the medical records of about 78,000 people with long COVID who had private health insurance. The analysis showed that about two-thirds of these people were being treated in a primary care setting. More specifically,

    • 25.5% were being seen by a family physician,
    • 25% were being cared for by an internal medicine physician,
    • 9.9% were being seen by a nurse practitioner and
    • 4.2% were being seen by a physician assistant.

    These numbers tell me a few things. First, that we (family physicians) are the ones seeing more patients with long COVID than any other specialty. Second, that we know — as well as, if not better than, anyone else — what long COVID patients need and where we can best help them. And third, that we are in an excellent position to advocate for our patients and move our work forward on their behalf.

    Several of the long COVID patients I have seen have ended up in a tertiary care center’s long COVID clinic, only to have been shuttled from one specialty clinic to another based on their predominant symptom. There has been a lack of continuous, coordinated care that these patients desperately need. The best place for care for a majority of these patients is in their medical home with their trusted family physician.

    Our Academy is taking steps to make sure each of you have the information you need to provide quality care for patients with long COVID:

    • CME programming: We recently debuted a comprehensive long COVID CME course that features not only a recorded webinar, but also modules and activities you’ll be able to complete on your own schedule.
    • Pandemic survey: The AAFP National Research Network and the Robert Graham Center are partnering on a survey that will help us better understand and gauge the response to (and capacity of) family physicians, staff and practices during the pandemic. The survey is active and will remain open until 11:59 p.m. PT June 6; please take a few minutes to submit your responses.
    • FMX sessions: We’re also offering CME sessions on long COVID at this year’s FMX. In fact, we’re providing an entire CME track titled “Living With COVID-19” that will include several interactive sessions for attendees. You can learn more about FMX and register to attend at aafp.org/fmx.

    These are just two of the ways we’re working for you and helping you provide your patients with the best care possible. I’m confident there will be plenty of other long COVID resources available from the AAFP to you in the weeks and months to come.

    COVID-19 rates may be down in many places for the time being, but the disease is definitely not out. Stay strong, keep your eyes and ears open, protect yourself, and take care of one another. That’s how we turn the corner on this pandemic and make long COVID not something that people just have to live with, but something that they’ll one day read about in a history book.

    Sterling Ransone, M.D., is the president of the AAFP.



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    The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.