Considerations for Primary Care Providers in the Diagnosis of Long COVID

January 28, 2023

Perspectives in Primary Care (formally the Primary Care Review) features perspectives from practitioners and students representing organizations, practices, and institutions across the country and around the world. All opinions expressed in this article are owned by the author(s).

Data on long COVID is evolving, causing diagnosis and treatment to be complex. Primary care clinicians must consider not only the preexisting conditions of each patient, but their environment (work, home, financial security). There are special considerations when caring for vulnerable patient groups affected by long COVID, including patients with disabilities, substance use disorder, and those who are immunocompromised.

Who is at risk for long COVID?

Long COVID is significantly associated with age and in some reports, has been disproportionately affecting women. People with an elevated body mass index and those with asthma have been reported in observational studies as more likely to develop long COVID along with those who experienced more severe COVID-19 illness. People who had pre-existing respiratory, cardiovascular, or cerebrovascular disease prior to a COVID-19 infection are likely to require more specialized and prolonged rehabilitation (APJM). The condition spans socioeconomic groups; however, through existing health disparities, the most vulnerable in our communities may be impacted the most. In addition, the differentiation between long COVID vs persistent COVID infection among those who are immunocompromised is an important distinction for clinicians to make, manage and provide counseling to patients.

Diagnosing long COVID

Since symptoms of long COVID vary from fatigue to muscle pain and even rash, diagnosing the condition can be challenging (see a list of symptoms outlined by The Centers for Disease Control). As noted in a BMJ article titled, Management of post-acute covid-19 in primary care, “The effective management of long COVID requires, first and foremost, recognition of the condition and empathic validation of the patient's experience.”  A systematic clinical approach with broad differential diagnoses needs to be applied by clinicians as long COVID is a diagnosis of exclusion.

Preventing severe infection, long COVID

Ideally, patients wouldn’t have to suffer the consequences of long COVID, but its prevalence is only increasing. Vaccination and preventing severe COVID-19 illness as much as possible is the best way to prevent long COVID. A new study shows that exercise prior to illness can also have an effect.

An American Journal of Preventive Medicine study found that men and women who worked out at least 30 minutes most days prior to becoming ill with COVID had less severe outcomes. This study highlights a fact that we have known for some time, people who are healthier prior to a COVID infection tend to have fewer adverse effects. The study even noted the findings were consistent across demographic subgroups and chronic conditions.

Learn more from HMS faculty and your peers

Join the “Managing patients with long COVID” CME course presented by HMS faculty to learn more about caring for patients with long COVID. Participants will be encouraged to share their own experiences and partake in small-group case-based discussions during this interactive virtual course on April 28, 2023, from 9 a.m.-5 p.m. ET.

Learn more and register


About the author

David DuongDavid Duong, MD, MPH, is the Director of Primary Care Equity, Access, and Advocacy at Harvard Medical School Center for Primary Care and a primary care physician.


**Feature photo obtained with a standard license on Shutterstock.

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