Multidisciplinary collaborative guidance on the assessment and treatment of patients with Long COVID: A compendium statement 2025 Cheng et al

Abstract

Background: In 2021, the American Academy of Physical Medicine and Rehabilitation established the Multi-Disciplinary Post-Acute Sequelae of SARS-CoV-2 Infection Collaborative to provide guidance from established Long COVID clinics for the evaluation and management of Long COVID. The collaborative previously published eight Long COVID consensus guidance statements using a primarily symptom-based approach. However, Long COVID symptoms most often do not occur in isolation.

Aims: This compendium aims to equip clinicians with an efficient, up-to-date clinical resource for evaluating and managing adults experiencing Long COVID symptoms. The primary intended audience includes physiatrists, primary care physicians, and other clinicians who provide first-line assessment and management of Long COVID symptoms, especially in settings where subspecialty care is not readily available. This compendium provides a holistic framework for assessment and management, symptom-specific considerations, and updates on prevalence, health equity, disability considerations, pathophysiology, and emerging evidence regarding treatments under investigation. Because Long COVID closely resembles other infection-associated chronic conditions (IACCs) such as myalgic encephalomyelitis/chronic fatigue syndrome, the guidance in this compendium may also be helpful for clinicians managing these related conditions.

Methods: Guidance in this compendium was developed by the collaborative's established modified Delphi approach. The collaborative is a multidisciplinary group whose members include physiatrists, primary care physicians, pulmonologists, cardiologists, psychiatrists, neuropsychologists, neurologists, occupational therapists, physical therapists, speech and language pathologists, patients, and government representatives. Over 40 Long COVID centers are represented in the collaborative.

Results: Long COVID is defined by the National Academies of Sciences, Engineering, and Medicine as "an 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." The current global prevalence of Long COVID is estimated to be 6%. Higher prevalence has been identified among female gender, certain racial and ethnic groups, and individuals who live in nonurban areas. However, anyone can develop Long COVID after being infected with the SARS-CoV-2 virus.

Long COVID can present as a wide variety of symptom clusters. The most common symptoms include exaggerated fatigue and diminished energy windows, postexertional malaise (PEM)/postexertional symptom exacerbation (PESE), cognitive impairment (brain fog), dysautonomia, pain/myalgias, and smell and taste alterations. Holistic assessment should include a traditional history, physical examination, and additional diagnostic testing, as indicated. A positive COVID-19 test during acute SARS-CoV-2 infection is not required to diagnose Long COVID, and currently, there is no single laboratory finding that is definitively diagnostic for confirming or ruling out the diagnosis of Long COVID. A basic laboratory assessment is recommended for all patients with possible Long COVID, and consideration for additional labs and diagnostic procedures is guided by the patient's specific symptoms.

Current management strategies focus on symptom-based supportive care. Critical considerations include energy conservation strategies and addressing comorbidities and modifiable risk factors. Additionally, (1) it is essential to validate the patient's experience and provide reassurance that their symptoms are being taken seriously because many patients have had their symptoms dismissed by loved ones and clinicians; (2) physical activity recommendations must be carefully tailored to the patient's current activity tolerance because overly intense activity can trigger PEM/PESE and worsened muscle damage; and (3) treatment recommendations should be delivered with humility because there are many persistent unknowns related to Long COVID.

To date, there are limited data to guide medication management specifically in the context of Long COVID. As such, medication use generally follows standard practice regarding indications and dosing, with extra attention to prioritize (1) patient preference via shared decision-making and (2) cautious use of medications that may improve some symptoms (eg, cognitive/attention impairment) but may worsen other symptoms (eg, PEM/PESE). Numerous clinical trials are investigating additional treatments. The return-to-work process for individuals with Long COVID can be challenging because symptoms can fluctuate, vary in nature, affect multiple functional areas (eg, physical and cognitive), and often manifest as an "invisible disability" that may not be readily acknowledged by employers or coworkers.

Clinicians can help patients return to work by identifying suitable workplace accommodations and resources, providing necessary documentation, and recommending occupational or vocational therapy when needed. If these efforts are unsuccessful and work significantly worsens Long COVID symptoms or impedes recovery, applying for disability may be warranted. Long COVID is recognized as a potential disability under the Americans with Disabilities Act.

Conclusion: To contribute to the overall health and well-being for all patients, Long COVID care should be delivered in a holistic manner that acknowledges challenges faced by the patient and uncertainties in the field. For more detailed information on assessment and management of specific Long COVID symptoms, readers can reference the collaborative's symptom-specific consensus guidance statements.

Open access

 

I've seen better. I've seen far worse. All things we knew and have been telling them for decades, things we literally warned them from early 2020. For which we have been vilified, discriminated and profusely lied about. This is not something that can be swept under the rug. It's just not serious to pretend like this didn't happen. Being right is supposed to matter, even when it's widely unpopular.

I don't have the energy to look further, but the abstract looks adequate. It also looks roughly like what we have been telling them the whole time. Which is good, but also terrible if it goes unacknowledged. Intentional mistakes destroying millions of lives can't just be overlooked like this. A huge number of amateurs out-predicting an entire profession is a huge freaking deal, something that almost never happens. And happens in medicine far more than any other profession. Always for the same reasons, which mostly boil down to hubris.

We could have been at this point 30 years ago. We knew all of this back then, in fact it was somewhat accepted. Then things happened. People happened. Bad people. Those people will need to face accountability, investigations, consequences, punishment. We will need to be apologized to, the fact that we have been right all along needs to be front and center of everything, or all of this will just fall back in the shadows.

Because what's most notable is the wide range of opinions still at this point. There is this, which looks competent and reasonable, but the psychosomatic ideologues are still pushing their BS, and still dominate in many countries and in many areas. This incompetence won't just cede to reason. The truth of what happened has to be acknowledged. Now. Not 40 years from now, when everyone involved has retired.

And more than anything, we need real treatments. This isn't it, it's just acknowledging the problem as it mostly is. A starting point.

 

They seem to be saying that we don't actually have anything useful to say about assessment and management of Long Covid but whatever you decide to do you should talk nicely to the patients.

They might score a point for being careful about 'physical activity recommendations' but they spoil it by implying that you might offer some 'tailored to the patient'.

 

The missed the accumulative aspect of PEM.

I don’t like the work-first sentiment. That should not be the focus of healthcare providers. They should prioritise long term health. Somehow, we’ve ended up in a situation where the healthcare system runs the errands of the politicians.