CDC Case Challenge: A Woman With Fatigue, Palpitations, and Headache

Jennifer R. Chevinsky, MD, MPH; Sallyann M. Coleman King, MD, MSc; Robert A. Bonacci, MD, MPH; Brendan R. Jackson, MD, MPH; Alyson B. Goodman, MD, MPH; Jessica Rogers-Brown, PhD, MPH; Valentine Wanga, PhD, MS; Jennifer R. Cope, MD, MPH; Stacey Konkle, PhD, MPH; Miriam Nji, MD, MPH; Melissa Briggs-Hagen, MD, MPH; Elizabeth R. Unger, PhD, MD; Brook Belay, MD, MPH; Sharon Saydah, PhD


September 02, 2021

Editorial Collaboration

Medscape &

Choosing the Appropriate Treatment

For most patients, the goal of medical management of post-COVID conditions is to optimize function and quality of life. Setting achievable goals through shared decision-making can be beneficial. Transparency is important for the process of goal setting; healthcare professionals should advise patients that post-COVID conditions are not yet well understood and assure them that support will continue to be provided as new information emerges. Healthcare professionals and patients should continue to discuss progress and challenges and reassess goals as needed. Symptoms not explained by, or out of proportion to, objective findings are not uncommon after COVID-19 and should not be dismissed even if there is not yet a full understanding of their etiology or their expected duration.

Many post-COVID conditions can be improved through already established symptom management approaches (eg, breathing exercises to improve symptoms of dyspnea). Creating a comprehensive rehabilitation plan may be helpful for some patients and might include physical and occupational therapy, speech and language therapy, vocational therapy, as well as neurologic rehabilitation for cognitive symptoms. A conservative physical rehabilitation plan might be indicated for some patients (eg, persons with postexertional malaise); consultation with physiatry for cautious initiation of exercise and recommendations about pacing may be useful. Gradual return to activity as tolerated could be helpful for most patients. Optimizing management of underlying medical conditions might include counseling on lifestyle components such as nutrition, sleep, and stress reduction (eg, meditation).

Patients with post-COVID conditions may share some of the symptoms that occur in patients who experience myalgic encephalomyelitis/chronic fatigue syndrome, fibromyalgia, post-treatment Lyme disease syndrome, dysautonomia, and mast cell activation syndrome. Symptom management approaches that have been helpful for these disorders may also benefit some patients with post-COVID conditions (eg, activity management [pacing] for postexertional malaise).

FDA-approved or over-the-counter medications as well as vitamin or electrolyte supplements may be helpful for indicated illnesses (eg, headache, anxiety) or documented deficiencies (eg, vitamin deficiency) after carefully weighing the benefits and risks of pharmaceutical interventions.

Healthcare professionals may also consider referral to multidisciplinary post-COVID care centers, where available, for additional care considerations. Multidisciplinary post-COVID care centers based in a single physical location can provide a comprehensive and coordinated treatment approach to COVID-19 aftercare. On the basis of clinical evaluation and response to treatment, healthcare professionals might consider using a stepwise approach to other specialist referrals. Healthcare professionals should be mindful of the additional burden (eg, financial, time, and psychological) that multiple specialist visits may place on patients and the possibility of fragmented care that can increase the risk for contradictory medical advice.

Recognizing and validating the impact of illness on quality of life should be part of the ongoing healthcare professional and patient interaction. Healthcare professionals can provide information on peer support resources (eg, patient support groups, online forums). Support groups are connecting individuals and sharing resources for persons affected by COVID-19. When material, employment, or other social support needs are identified, healthcare professionals should consider referral themselves (if they are knowledgeable and able) and engage a social worker, case worker, community health worker, or similarly trained professional to assist.

For more information about management of post-COVID conditions, see the management section of the CDC interim guidance.