Multidisciplinary care needed for COVID-19 long-haulers, study finds

A new review published in the journal Nature Medicine offers an initial glimpse of the multi-organ effects of long-term novel coronavirus (COVID-19) and suggests a framework for the care of COVID-19 long-haulers through dedicated, multidisciplinary clinics.

Physicians across the country have analyzed the emerging scientific data about the long-term effects of COVID-19, creating an initial knowledge base about the clinical experiences of so-called "long-haulers,” patients with COVID-19 who experience prolonged symptoms or the emergence of new ones well after the initial viral infection has resolved.

In the study, researchers found that the most common symptoms of long-term COVID-19 include fatigue, shortness of breath, brain fog, loss of sense of smell or taste, anxiety, depression, and post-traumatic stress disorder (PTSD). Based on the limited number of studies published to date, at least one-third of patients who required hospitalization for COVID-19 have experienced one of these long-term side effects. While there is much more work yet to be done, this finding is consistent with what has been found in the few studies of survivors of the SARS epidemic in 2003 as well as the MERS outbreak in 2012, which involved viruses that are closely related to SARS-CoV-2, the researchers said.

Since the symptoms of long COVID are not typically restricted to just one organ system, the researchers stress the importance of multidisciplinary care, such as a dedicated COVID-19 clinic that includes specialists with expertise in diverse areas of clinical medicine. Some academic medical centers have already established such an effort. In response to the clinical need and the emerging research findings, the Brigham Lung Center has recently established a COVID Recovery Center to coordinate and deliver multi-disciplinary care for patients with long-term symptoms after infection.

Moving forward, the researchers said they believe it will also be essential to develop mechanisms for appropriately sharing and pooling patient data across organizations and institutions, including from patient advocacy groups, which played a major role in highlighting the health struggles of long-haulers.

"The medical needs of patients with COVID-19 don't stop at the time of hospital discharge and they also don't necessarily stop after three to four weeks, even for those who didn't require hospitalization," said Kartik Sehgal, MD, lead author of the study and a medical oncologist at Dana-Farber Cancer Institute and Brigham and Women's Hospital, and instructor in medicine at Harvard Medical School, in a statement. "It is important for physicians to be aware of these possible symptoms and complications and to have resources available for early recognition to provide the best possible care."

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