Sept. 2, 2022 – Many patients dealing with debilitating COVID long symptoms that interfere with their day-to-day lives might be tempted to go straight to a specialist – whether it’s a Pulmonologist for breathing difficulties or a physiatrist for muscle fatigue – to see if they have long COVID. But medical experts – including many specialists who treat the most complex long COVID cases – recommend starting in a different place: primary care.
“Their primary care physicians are often most knowledgeable about the patients’ complete medical history, and that context is important in the process of diagnosing someone with long COVID,” says Benjamin AbramoffMD, who is the leader of the long-running COVID collaborative at the American Academy of Physical Medicine and Rehabilitation.
Since the beginning of the year, primary care providers have been at the forefront of diagnosing COVID. pandemicWhen it was discovered that many patients suffered from lingering symptoms for several weeks after their COVID-19 infections had cleared up,
A guideline for diagnosing COVID in primary health care. Published in The BMJIt was estimated that one in 10 COVID patients died from long-term complications in August 2020. This estimate is now low. The CDC reported that 1 in 5 infected people have COVID symptoms as of July 2022.
Diagnosing long COVID has been a challenge because there’s no simple way to screen for the condition, and no single set of symptoms that definitively lead to the right diagnosis. Primary care providers, who often do detective work to sort out what conditions might explain patients’ health complaints, are well positioned to cast a wide net in exploring possible reasons for the complex mix of symptoms that is par for the course with long COVID.
Symptoms of long COVID Include fatigue, a cough that won’t go away, shortness of breath, lack of smell or taste, a hard time focusing, insomnia, sexual dysfunction, chest pain, and dizziness, among others, says Kristin EnglundDirector of the Cleveland Clinic reCOVer ClinicThe treatment of COVID patients for a long time.
Experts agree that primary care is the best option for diagnosing complex conditions.
Access to care is made easier by this. Primary care providers tend to be closer to the patient’s home, and many set aside time to see sick patients quickly. Long COVID clinics tend to be located in large cities, and can have long waits for patients. Patients should be seen as soon as possible to receive treatment for any symptoms that may affect their daily life.
The primary care doctor may be better equipped to distinguish the symptoms of COVID infection and old health conditions that may be resurfacing.
“Working with a primary care provider can avoid unwarranted and expensive diagnostic testing initially,” says Kathleen Bell, MD, a neuro-rehabilitation specialist at the University of Texas Southwestern O’Donnell Brain Institute who helped establish their COVID Recovery program. “Patients should always start exploring questions of health care with their primary care physicians.”
Although many experts agree that primary healthcare is the best place for long COVID diagnoses, they acknowledge that this process can be imperfect and not all doctors are capable of doing it. There aren’t yet evidence-based guidelines for diagnosing long COVID. And sometimes this diagnosis can get overlooked in primary care, especially when symptoms closely resemble those of other chronic health problems that have become more common during the pandemic – like DepressionChronic fatigue, burnout, or a combination thereof.
Primary care providers might refer patients to specialists if they see patients with unrelated symptoms. Alba Miranda AzolaJohns Hopkins University School of Medicine co-director of the Post-Acute COVID-19 team.
“What ends up happening in reality sometimes is patients see their primary care provider, they come in, they have 15 minutes, and they are ranting about all of these symptoms that are multisystemic,” she says. “The primary care provider doesn’t have time to deal with all of these symptoms – it’s gastroenterology and cardiology and neurology – and they refer to all of these different specialists.”
While referrals often help get patients diagnosed properly, it doesn’t always work because not all of these specialists are experienced with diagnosing long COVID, Azola says. “They see the cardiologist who says all of the tests are fine and I can’t help you, then it’s the same with all the different specialists.”
Patients who suspect long COVID, but don’t get this diagnosis despite persistent symptoms, may want to go to a specialized long COVID clinic for a Second opinion” Monica Verduzco-GutierrezDr. Judith A. Sullivan, MD, Chair of Rehabilitation Medicine and Director of the COVID-19 Recover Clinic at the University of Texas Health Science Center in San Antonio.
“If the primary care provider has limited knowledge on the topic or limited options for treatments, or in the case where patients may become more chronic and have multiple conditions and symptoms to manage, this is where a multi-disciplinary long COVID clinic would be an excellent option,” she says.
Patients with persistent symptoms after 4-4 weeks can diagnose long COVID, according to the CDC. Many specialized long COVID clinics focus on more severe, complex cases and won’t see patients unless their symptoms don’t clear up for at least 3 months.
This makes sense as many long COVID patients are easily diagnosed and treated in primary healthcare. Tochi Iroku MalizeDr., MD, is the founding chair and professor of family Medicine for Hofstra/Northwell’s Donald and Barbara Zucker School of Medicine. And primary care remains the best place for patients to go whenever they have concerning, unexplained symptoms – whether it’s long COVID or not.
“As the health care community continues to learn more about long COVID, it’s important to start with a health care professional you know and trust – your primary care physician,” she says.
