Long COVID: Experts Weigh in on Increasingly Common Syndrome

Dr. Calabrese notes that her clinic takes an integrative approach with patients, addressing medical comor­bidities of long COVID when appropriate, as well as sleep issues, depression and autonomic dysfunction, if present. They also advise pacing strategies in patients with chronic fatigue, finding that over-exertion is often counterproductive for patients in the long term. 

Health practitioners have experimented with many different therapies for such patients, although many in the absence of data. Prospective studies are currently underway for many different types of agents, including anti-virals, glucocorticoids, immuno­modulating agents, such as infliximab, intravenous immunoglobulin (IVIG), hyperbaric oxygen and dietary supplements.⁴ It remains to be seen whether any of these treatments can be used to successfully treat patients with long COVID or specific long-COVID endotypes. 

Even without intervention, many patients with long COVID appear to improve over time, and only a small percentage appear to be profoundly affected two to three years later.⁴ Dr. Sparks notes that post-COVID symptoms eventually resolve in the majority of rheumatology patients, even in those who still had symptoms 90 days after infection.

Rheumatologists’ Role

The public health implications of long COVID are substantial. “It’s easy to want to just go back to the status quo,” says Dr. Sparks, “but I think you have to recognize that this is probably a growing problem. It is a call to action to try to understand how to better treat these patients.”

Dr. Calabrese notes that rheuma­tologists are well versed in dealing with patients with long-term pain and fatigue. 

“Until we have better understanding of long COVID that can drive more specific therapeutic decisions, empathy is going to be the most important medicine we can deliver patients right now,” says Dr. Kim. “The worst thing that a provider can do for any chronic con­dition is to discount those experiences.” 

Ruth Jessen Hickman, MD, is a graduate of the Indiana University School of Medicine. She is a freelance medical and science writer living in Bloomington, Ind.

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