29. Long COVID Roundtable

This week on Pulm PEEPs, Dave and Kristina are joined by Jason Maley and Ann Parker, two pulmonary and critical care physicians who are leaders in treating patients with Long COVID, or Post-Acute Sequelae of SARS-CoV-2. Both of them help run the Long COVID clinics at their respective institutions and are part of broader consortiums dedicated to patient care. They also both participate in research to improve outcomes for patients with Long COVID and Post-Intensive Care Syndrome. In this conversation, we cover the diagnosis of Long COVID, common symptoms, abnormal test findings, possible mechanisms of disease, the impacts of variants and vaccines, treatments, and the natural history of this condition. We hope this will be helpful for providers, patients, and family members. Meet Our Guests Jason Maley is an Assistant Professor of Medicine at Beth Israel Deaconess Medical Center and Harvard Medical School. He is the Director of the BIDMC Critical Illness and COVID-19 Survivorship Program, and the Co-Chair of the American Academy of Physical Medicine and Rehabilitation Postacute Sequeleae of SARS-CoV-2 infection (PASC) initiative. He is NIH funded to study post-COVID patients. Ann Parker is an Assistant Professor of Medicine at Johns Hopkins and is the Co-Director of the Johns Hopkins Post-Acute COVID-19 team. She is NIH funded with her research focusing on survivors of respiratory failure and critical illness. Key Learning Points Long COVID or Post-Acute Sequelae of SARS-CoV-2 or Post-COVID condition * Long COVID was first described this way by patients so this is the common nomenclature that is used. It is also referred to as Post-Acute Sequelae of SARS-CoV-2 or Post-COVID condition* Defined by patients that have not returned to their baseline health 3 months after their acute episode of COVID-19* Major organizations in describing this disease and doing research are:* World Health Organization* Multiple patient-led organizations* CDC – INSPIRE* NIH – RECOVER Post-COVID Clinic * Seeing patients across the spectrum of illness. Not all patients had to be critically ill or hospitalized* The standard patient has changed over time and now the vast majority had a mild initial illness, but afterward had unusual and persistent symptoms* Patients are generally referred by their PCP or self-referred* The criteria for being seen in clinic are very loose to make sure patients are not excluded* Many patients do not have a confirmed case of COVID since patients early in the pandemic often did not have a positive test available, and now many people are testing positive at home* Initial records review to make sure that can help patients* Standardized questionnaires* Screening for physical impairment, mental health impairment, and cognitive impairment* Rehabilitation and multi-disciplinary based approach* It is extremely important to be aware of the bias in patient populations in Post-COVID clinics* The population that can make it to clinic may not, and does not, represent all patients who have had COVID or have Long COVID. Patients may be limited in their ability to get to clinic based on their physical condition, financial resources, location, support, and language barriers. Overlap of Long COVID and PICS * These conditions are very similar and certainly have a lot of overlap* For patients coming out of the ICU,