The Executive Suite: 3 Things physicians should consider when treating long Covid

A full two-plus years into the pandemic, many individuals who contracted COVID-19 are experiencing new or lingering symptoms that have been dubbed long COVID. While many of them are turning to their physicians or other health care providers in search of answers, so much remains unknown about the underlying causes and prognosis of long COVID. One significant challenge facing physicians is that the most prominent symptoms of long COVID have been traditionally among the most challenging to treat, even pre-pandemic: fatigue, poor concentration, lightheadedness, among others. Seeing such “reasons for visit” on a clinic schedule would incite discomfort and angst in a physician long before SARS-CoV-2 came along. And, they are no easier to effectively manage now in the context of post-COVID-19.

As clinicians navigate the many unknowns of long COVID and try to effectively manage their patients’ symptoms, keeping the following three things in mind can help them achieve more satisfying outcomes for both patients and providers.

1. Validate your patients’ symptoms, concerns, and fears

As physicians, our goal is to provide the best care possible for our patients, and this encompasses showing them compassion. Patients who are living with long COVID are undoubtedly feeling worried and stressed, along with a myriad of other emotions, in addition to the physical or mental symptoms for which they’re seeking care. Even if clinicians don’t have all the answers when it comes to long COVID, we need to ensure that we validate our patients’ symptoms, concerns, and fears every time they step into the exam room or log on to a telehealth visit. According to CDC’s interim guidance on long COVID, objective lab results and imaging findings should not be used as the only measure of a patient’s well-being. Furthermore, the agency notes that a lack of lab or imaging abnormalities doesn’t invalidate the severity or existence of a patient’s symptoms. For clinicians who are accustomed to relying on objective test findings to support their diagnoses, this may mean that evaluating and treating patients with long COVID symptoms may well be outside their comfort zone.

2.Be forthcoming with realistic goals to manage patient expectations

Unfortunately, there is currently no magic bullet that will effectively treat every symptom of long COVID. Given our experience with other post-viral syndromes and the nature of the symptoms themselves, we may never have such a magic bullet. Thus, when treating a patient with long COVID, it’s especially important to communicate clearly and effectively to manage their expectations and set achievable goals.

For example, when managing fatigue, consider establishing a more realistic goal of incremental improvements over time, rather than complete symptom resolution. This will help patients avoid disappointment and frustration if their symptoms linger longer than expected. In fact, there is little clarity on how long various symptoms of long COVID are expected to last. Being open and honest with patients about the evolving knowledge of symptom duration and general characteristics of long COVID will strengthen the clinician-physician relationship as you traverse the journey toward recovery together.

Patients will invariably ask, “How long am I going to feel tired (or breathless, or foggy, or whatever the symptom may be)?” While these kinds of questions will be difficult, and in some cases impossible, to answer, a response with equal parts of optimism and realism will serve the patient best. For example: “Many patients report that their fatigue improves after a few months, but some with post-COVID fatigue may experience a slower return to baseline.”

3. Be comfortable not having all the answers and be open to new information, evidence, and guidance

The understanding of post-COVID conditions and clinical guidance will be fluid and everchanging as evidence evolves – and that’s ok. Additionally, as new evidence and consensus guidance becomes available, it’s natural to expect that it will get easier to treat patients with long COVID. However, that isn’t guaranteed because so many of the symptoms are by nature challenging for clinicians to treat definitively. What matters is being open to learning and adapting to the newest information, evidence, and guidelines as they become available. Clinical decision support tools will be pivotal in helping clinicians stay informed on the latest guidance in the era of long COVID.

While post-viral syndrome isn’t unique to COVID-19, it may seem daunting because of the sheer number of individuals being impacted in such a short period of time. Instead of a clinician seeing just one or two patients each year who might present with lingering symptoms following infections like influenza, Epstein-Barr, or even the common cold, clinicians today may see a far greater number of patients with complex symptoms related to COVID-19 infection. Even though answers may be scarce at the moment, remaining compassionate, realistic, and informed will ensure that patients with long COVID get the best care possible.