Unraveling the enigma of long COVID: What we know so far

The enigma of long COVID continues to baffle researchers, more than three years since COVID-19 was declared a pandemic. And while the federally declared public health emergency has ended, the reason behind why certain patients may be ensnared by the syndrome's collection of incapacitating symptoms long after recovering from their SARS-CoV-2 infection—even as others return to their normal lives uneventfully—remains elusive.

Like other infection-associated chronic illnesses, the link between infection and long-term symptoms remains poorly understood. For long COVID, fatigue and brain fog take center stage for some patients, while others grapple with heart and respiratory issues. Some endure recurring headaches, sleep disturbances, loss of taste, abdominal discomfort, rashes, muscle pains or alterations in their menstrual cycles. But it can also be a combination of these symptoms.

The AMA House of Delegates has adopted policy to support “the development of an ICD-10 code or family of codes to recognize Post-Acute Sequelae of SARS-CoV-2 infection (‘PASC’ or ‘long COVID’) and other novel post-viral syndromes as a distinct diagnosis.”

As researchers and physicians work to decode its mechanisms and develop effective interventions, the mystery of long COVID reminds us of the virus' capacity to leave a lasting imprint, prompting a paradigm shift in how we perceive and manage the aftermath of COVID-19.

Here are some AMA news articles and videos that set out to help decode what we know so far about long COVID.

1. There are 12 key symptoms of long COVID

   1. There are more than 200 lingering symptoms associated with long COVID. But a study narrowed down that list and identified 12 key symptoms that best define the condition. In the long term, these findings can influence how long COVID is diagnosed, treated and studied. This episode of “AMA Update” dives in deeper.

1. Look out for psychiatric sequelae

   1. Physicians may be grappling in the dark when trying to diagnose psychiatric symptoms in patients with long COVID. Symptoms aren’t clear-cut, and studies addressing psychiatric problems and prolonged viral symptoms have yielded inconsistent results. But physicians can do their part by actively looking for psychiatric comorbidities in long COVID patients.

2. Long COVID increases health care visits and costs

   1. COVID-19 leads to a rise in use of health care services for a variety of conditions long after the acute stage of infection. This is especially true with virtual and emergency care. Evaluating more than 250,000 patients from eight large health care organizations across the U.S., researchers found an association between the virus and a 4% boost in services six months post-infection. A study from researchers at The Permanente Medical Group—a member of the AMA Health System Program—uncovers more.

3. Neurological symptoms may persist

   1. Neurological effects of PASC pose a conundrum for physicians. How it manifests is unclear and finding effective treatments may be an exercise of trial and error. This AMA news article takes a closer look.

4. Long COVID’s cardiac symptoms can be managed

   1. It has now become clear that in addition to widely known symptoms with long COVID, cardiac symptoms may occur as well. These include chest pain, shortness of breath, syncope and palpitations. For some patients with COVID-19, cardiac symptoms may persist, lasting for months after their initial illness. Physicians should keep these tips in mind when caring for patients with long COVID and cardiovascular symptoms.

5. A person’s ability to work is affected

   1. Research has shown how long COVID can affect a person’s ability to work, leading to higher rates of unemployment and financial hardship. Knowing how to help patients who are unemployed and struggling with long COVID symptoms is key.

6. Treating long COVID requires a patient-centered approach

   1. While many patients with long COVID feel as though they have to suffer alone, the Atlantic COVID Recovery Center offers a way for patients to easily get help and find relief from their ongoing symptoms. Three physicians from the Atlantic Health System in New Jersey—another member of the AMA Health System Program—took time to discuss their recovery center, their goals and what they are seeing in patients presenting for care. 

7. More awareness is needed on treatment options

   1. At the University of Iowa (UI) Hospitals & Clinics—also an AMA Health System Program member—physicians in the UI Health Care Post-COVID-19 Clinic are fighting long COVID on several fronts. They’re studying long COVID and post-acute sequelae of SARS-CoV-2 infection, looking for its manifestations and potential treatments. They’re trying to get the word out to primary care physicians about how best to treat long COVID patients and when to refer to specialist clinics like theirs in Iowa City.

Stay informed and updated with the AMA COVID-19 resource center for physicians, which features news updates, information on the end of the public health emergency, COVID-19 guidance, and AMA research, online learning and CME. 

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