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Long COVID, also known as Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), is a complex, multisystem illness with a poorly understood pathophysiology, absence of specific diagnostic tests or criteria, or evidence-based treatments. With over 200 identified symptoms and approximately 10% of COVID-19 cases resulting in PASC, it is a challenge to provide comprehensive treatment at a scale commensurate with the illness burden. The diverse manifestations of PASC, encompassing numerous medical specialties, typically place primary care providers (PCPs) at the forefront of management, navigating an evolving landscape of research and lack of evidence-based guidelines. This paper presents a pragmatic, structured framework for PASC management in primary care, integrating current knowledge and best practices. The approach is individualized, addressing PASC's broad symptomatology through a four-step framework. The first step focuses on energy management strategies, emphasizing the prevention of post-exertional malaise, a cardinal feature of PASC. The second step, intentional rehabilitation, employs carefully titrated multidisciplinary modalities to address physical, cognitive, and emotional domains. The third step utilizes symptomatic management through both pharmacological and non-pharmacological interventions, targeting debilitating symptoms like fatigue, insomnia, and chronic pain. The fourth step outlines an approach to trialing experimental, targeted therapies that may impact PASC's underlying pathophysiology. These treatments, while experimental and lacking quality evidence in PASC, may be available off-label on an individual basis following a thorough risk-benefit discussion. This stepwise framework can equip PCPs to effectively address the most common and disabling symptoms of PASC, individualize care, and remain attuned to the evolving scientific understanding of the condition.
Brode et al. (Mon,) studied this question.