COMMENTARY

Newly Released: Post-COVID Conditions Interim Guidance for Healthcare Professionals

Jennifer R. Chevinsky, MD, MPH; Robert A. Bonacci, MD, MPH; Brendan R. Jackson, MD, MPH; Alyson B. Goodman, MD, MPH; Jessica Brown, PhD, MPH; Valentine Wanga, PhD, MS; Jennifer R. Cope, MD, MPH

Disclosures

July 02, 2021

Editorial Collaboration

Medscape &

The persistence, severity, and disability associated with post-COVID conditions, often referred to as "long COVID," pose significant diagnostic and management challenges. Post-COVID conditions are associated with a spectrum of physical, social, and psychological consequences. Patients with post-COVID conditions often experience functional limitations that can present substantial challenges to their wellness and quality of life.

CDC recently released Interim Guidance for Healthcare Professionals Evaluating and Caring for Patients with Post-COVID Conditions. The information in this interim guidance is based on individual medical expert opinion and on the available data. With extensive research underway, evidence-based treatment practices will continue to evolve. A quick summary of the interim guidance on post-COVID conditions is provided below.

What are post-COVID conditions?

Post-COVID conditions are a wide range of new, recurring, or ongoing health problems people can experience 4 or more weeks after first being infected with the virus that causes COVID-19. (The time frame of 4 or more weeks provides a rough approximation of effects that occur beyond the acute period but might change as we learn more.)

Post-COVID conditions can occur in patients who had varying degrees of illness during acute infection, including those who had asymptomatic or mild infections. Some patients with post-COVID conditions might not have tested positive for SARS-CoV-2 because of a lack of testing, inaccurate testing during the acute period, waning antibody levels, or false negative antibody testing.

How common are post-COVID conditions?

At present, standardized case definitions are still being developed, and robust longitudinal surveillance data on post-COVID conditions are lacking; therefore, the prevalence is challenging to estimate. The frequency of long-term symptoms and conditions following SARS-CoV-2 infection varies widely in the literature, ranging from 5% to 80%, because studies differ on several key criteria:

  • Symptoms or conditions investigated

  • Temporal criteria used (ranging from three weeks up to many months following SARS-CoV-2 infection)

  • Study setting (outpatient vs. inpatient)

  • How symptoms and conditions are assessed (self-report vs. electronic health record database)

It is unknown whether there are biological risk factors for some post-COVID conditions, and demographic differences remain unclear. Evidence suggests that post-COVID conditions can occur in children and adolescents as well as adults, although the true frequency and severity are unknown. Patients with certain comorbidities could be at higher risk for post-COVID conditions, although prevalence by clinical characteristics is limited. Although older patients might have an increased risk for severe acute disease and related ongoing symptoms, younger patients, including those in good health before SARS-CoV-2 infection, have also reported debilitating post-COVID conditions months after acute illness.

What are the most common symptoms of post-COVID conditions?

People with post-COVID conditions report experiencing different combinations of the following symptoms:

  • Tiredness or fatigue

  • Difficulty thinking or concentrating (sometimes referred to as "brain fog")

  • Headache

  • Loss of smell or taste

  • Dizziness on standing

  • Heart palpitations (fast-beating or pounding heart)

  • Chest pain

  • Difficulty breathing or shortness of breath

  • Cough

  • Joint or muscle pain

  • Depression or anxiety

  • Fever

  • Post-exertional malaise (symptoms that get worse after physical or mental activities)

It can be difficult to distinguish symptoms caused by post-COVID conditions from symptoms that occur for other reasons. Patients experiencing the acute and post-acute effects of COVID-19, along with social isolation resulting from pandemic mitigation measures, frequently suffer from symptoms of depression, anxiety, or mood changes.

Alternative reasons for health problems could exist, such as other diagnoses, unmasking of preexisting health conditions, or even reinfection. For clinicians considering whether new symptoms could be explained by reinfection, please refer to the CDC guidance on investigating suspected reinfection.

Should people with post-COVID conditions be offered a COVID-19 vaccine?

COVID-19 vaccination should be offered to all eligible people, regardless of their history of SARS-CoV-2 infection, including people with post-COVID conditions.

Data from clinical trials indicate that the currently authorized COVID-19 vaccines can be given safely to people with evidence of a prior SARS-CoV-2 infection. Viral testing to assess for acute SARS-CoV-2 infection or serologic testing to assess for prior infection is not recommended for the purposes of vaccination decision-making. While there is no recommended minimum interval between infection and vaccination, evidence suggests that the risk of SARS-CoV-2 reinfection is low in the months after initial infection but might increase with time, owing to waning immunity.

Research is ongoing to evaluate effects of COVID-19 vaccination on improving post-COVID conditions.

People with post-COVID conditions should continue to follow CDC's recommended COVID-19 prevention measures, including wearing a face mask when and where indicated, maintaining the appropriate physical distance from people who are not from their household, avoiding crowds and poorly ventilated indoor spaces, and washing hands. Once fully vaccinated, they should follow CDC recommendations for fully vaccinated people.

How can healthcare professionals evaluate and treat post-COVID conditions?

On the basis of current information, many post-COVID conditions can be managed by primary-care physicians, incorporating patient-centered approaches to optimize function and quality of life.

Objective laboratory or imaging findings should not be used as the only measure or assessment of a patient's well-being. The lack of laboratory or imaging abnormalities does not invalidate the existence, severity, or importance of a patient's symptoms or conditions.

Healthcare professionals and patients are encouraged to set achievable goals through shared decision-making and to approach treatment by focusing on specific symptoms (eg, headache) or conditions (eg, dysautonomia). Additionally, a comprehensive management plan that focuses on improving physical, mental, and social well-being may be helpful for some patients.

Our understanding of post-COVID conditions remains incomplete, and guidance for healthcare professionals will likely change over time as the evidence evolves. Healthcare professionals can advise patients that the best way to prevent post-COVID conditions is by getting vaccinated against COVID-19, which is recommended for all people aged 12 years and older. For more information about evaluating and caring for patients with post-COVID conditions, please refer to the CDC interim guidance for healthcare professionals.

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