Long COVID clinical evaluation, research and impact on society: a global expert consensus, 2025, Ewing et al

Abstract:
Background
Long COVID is a complex, heterogeneous syndrome affecting over four hundred million people globally. There are few recommendations, and no formal training exists for medical professionals to assist with clinical evaluation and management of patients with Long COVID. More research into the pathology, cellular, and molecular mechanisms of Long COVID, and treatments is needed. The goal of this work is to disseminate essential information about Long COVID and recommendations about definition, diagnosis, treatment, research and social issues to physicians, researchers, and policy makers to address this escalating global health crisis.

Methods
A 3-round modified Delphi consensus methodology was distributed internationally to 179 healthcare professionals, researchers, and persons with lived experience of Long COVID in 28 countries. Statements were combined into specific areas: definition, diagnosis, treatment, research, and society.

Results
The survey resulted in 187 comprehensive statements reaching consensus with the strongest areas being diagnosis and clinical assessment, and general research. We establish conditions for diagnosis of different subgroups within the Long COVID umbrella. Clear consensus was reached that the impacts of COVID-19 infection on children should be a research priority, and additionally on the need to determine the effects of Long COVID on societies and economies. The consensus on COVID and Long COVID is that it affects the nervous system and other organs and is not likely to be observed with initial symptoms. We note, biomarkers are critically needed to address these issues.

Conclusions
This work forms initial guidance to address the spectrum of Long COVID as a disease and reinforces the need for translational research and large-scale treatment trials for treatment protocols.

Link | PDF (Ann Clin Microbiol Antimicrob 24:27, April 2025, open access)

 

Some of the statements:

Definitions:
Consensus level A statements:

«Effort tolerance» is a very unfortunate description.

I don’t understand the purpose of the second half of this statement. If you get ME/CFS from covid, you have ME/CFS. I understand why it’s useful to be able to say that you have LC because it signifies the cause of your illness, but it doesn’t add any clinical value at this moment.

I’m not sure why this statement includes young people specifically.

I guess they wanted to mention all the buzzwords? And as per above, LC is not an umbrella term in the clinical sense. It just says what initially caused your illness.

Diagnosis and clinical assessment
Consensus level U statements

100 % agree.

Consensus level A statements (not all of them)

This seems to be mostly about PEF.

Are the equating PEM and PESE here?

This seems like a decent list for me personally, although it isn’t exhaustive.

In light of the critique of the concept of POTS, they could probably have left that out and just focused on OI. Dysautonomia also doesn’t tell us much.

Important point!

Important point!

We’ll never get an LC biomarker. But we might get biomarkers for certain aspects of the issues that covid can cause.

Technically yes, but many of those evaluations will give false positives for anyone with a chronic illness. So they can’t be used as explanations for the symptoms.

 

Treatment
Consensus level A statements (some of them)

Based on what?

What’s the alternative? MDTs?

I disagree. Psychosocial support can be useful. Treatment not so much unless for specific problems.

Evaluation of treatment
Consensus level B statements

That’s this, and I’m not sure how this can be used to monitor the effect of treatments.

This section really just says X can be useful for monitoring the effect of treatments. But it seems to me like that would depend on what you’re trying to treat in the first place?