June 20, 2024

Establishing a Consensus on Long COVID: Definitions and Challenges

A new consensus definition of long COVID has been established by the National Academies of Sciences, Engineering, and Medicine (NASEM), as requested by the U.S. government. The definition describes long COVID as an "infection-associated chronic condition (IACC) that occurs after SARS-CoV-2 infection and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems." Despite this effort, some medical professionals predict ongoing disputes about the disease due to its varied symptoms.


The CDC reports that the most common symptoms of long COVID include fatigue, shortness of breath, cough, joint pain, chest pain, brain fog, depression, muscle pain, headache, fever, and heart palpitations. According to a U.S. Census Bureau and National Center for Health Statistics Household Pulse Survey, nearly 18% of U.S. adults have experienced long COVID, with almost 7% currently affected.


Although the CDC has accepted the NASEM definition, confusion about testing, diagnosis, and treatment is likely to persist. Dr. David Cutler, a board-certified family medicine physician, notes that while the new definition clarifies some aspects, the lack of a simple diagnostic test means controversies will continue. Dr. Steve Allder, a consultant neurologist, expressed concern that the umbrella definition may lead to frustration due to the complex and multi-system nature of long COVID.


Long COVID patients often face skepticism from doctors, and the most important treatment remains reassurance. Patients need thorough evaluations to exclude other conditions, an endorsement of the long COVID diagnosis, information on the generally favorable prognosis, and adequate follow-up.


The new definition may not simplify care due to the disease's complexity and the varied symptoms reported by patients. Disagreements about diagnosis, management, and when the condition is resolved are expected to continue. Additionally, debates over the impact of vaccines and treatments like Paxlovid and metformin on long COVID incidence persist, highlighting the challenges in providing personalized care amidst conflicting information.

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