How prepared are we to treat patients with Long COVID?

Most people who have been treated for coronavirus disease (COVID-19) recover completely within a few weeks. But for some people, symptoms can persist, requiring treatment for what is known as long COVID. The goal is to find better treatment options and implement them in rehabilitation centers.

At last year's MEDICA, Dr. Frommhold delivered a keynote titled "How prepared are we to treat patients with long COVID?" as part of the MEDICA ECON FORUM. In this post-MEDICA 2021 review, she reveals the measures we still must take to facilitate better long COVID treatment options.

Dr. Frommhold, what are the guidelines for long COVID treatment?

Dr. Jördis Frommhold: First, it is important that general practitioners and medical specialists take patients and their symptoms seriously because it is difficult to diagnose "long COVID". Unfortunately, there is not one key marker that can pinpoint long COVID. The syndrome is usually diagnosed by using a continued process of elimination. Once you made the diagnosis, the next step is to classify the patient’s main symptoms. Does he/she have serious neurological and neurocognitive impairments? Or does he/she suffer from adrenal insufficiency? Once the diagnosis has been firmly established and recovery at home proves unsatisfactory, an application for rehabilitation should be submitted as quickly as possible. A concurrent outpatient treatment can be an alternative. We know that the corresponding structures are still somewhat underdeveloped, which is why we are working diligently to create digital options for post-COVID outpatient aftercare and rehabilitation recovery.

Where is there still room for improvement in terms of the treatment?

Frommhold: On December 20th, 2021, twelve doctors from various medical disciplines formed the interdisciplinary "Long COVID Medical Association". Our goal is to drive advancements in the research, treatment, and care for patients with long COVID. We are already off to a good start when it comes to continuing education and training, but we must still transcend sectoral boundaries. Given that we are all concerned with the same disease pattern, we should take a pan-sector approach to be successful. From this perspective, I see long COVID as an opportunity to strengthen the healthcare sector. Digitization options also play a major role in this setting. The idea is to make it possible for patients to use virtual appointments with general practitioners and hospital physicians to get an expert opinion and recommendation. It makes the process so much easier since patients no longer must be physically taken to different locations to meet with specialists.

Are we well prepared to treat patients with long COVID?

Frommhold: That’s still unclear since we have not yet decoded the long-term effects of the COVID-19 Omicron variant. We must take a wait and see approach yet ensure sufficient capacities in rehabilitation facilities to treat all affected patients. That’s because those patients who are typically in need of rehabilitation services will likewise still need our care whether there is a pandemic or not. The problem is that we often see younger people affected by long COVID, even though they were previously relatively healthy and did not need rehabilitation services.

What are the treatment options?

Frommhold: Long COVID is a chronic condition. Affected patients benefit from a wide range of rehabilitation measures. The clinical guidelines do not yet contain a causal therapy pertaining to rehabilitation. It’s pointless to merely distribute the patients among rehabilitation facilities and the latter carry out their typical programs. Long COVID patients must be already differentiated when their medical history is taken. To identify the right therapy option, you must first establish the key symptoms you plan to target. For example, it makes little sense if a long COVID patient suffering from chronic fatigue syndrome embarks on strength and endurance training. Instead, the patient must be taught how to cope with the disease and learn ways to relax and restructure his/her daily routine. It is essential to have access to a recommended rehabilitation program to know which therapy is the right one for which constellation of symptoms. It’s the only way to ensure staff is trained and instructed correctly.

How did you like the MEDICA 2021 trade fair?

Frommhold: I was glad the trade fair was arranged as a hybrid in-person event that was complemented by virtual concepts. It shows flexibility and means we are breaking new ground. Connecting with others and agreeing that we need more digital progress, also as it pertains to our patients, is important to me. Needless to say, I am also thrilled that MEDICA highlighted "long COVID" in this setting.