America’s National Academies of Sciences, Engineering, and Medicine (NASEM) has proposed a new definition of long Covid – one requiring no lab confirmation or other proof of initial infection – in an effort to streamline diagnosis and treatment.
In a detailed report, the authoring committee said long Covid has serious medical, social, and economic consequences for patients, and should now be defined as an infection-related chronic condition occurring after Covid-19, remaining present for at least three months “as a continuous, relapsing and remitting, or progressive disease state affecting one or more organ systems”.
The report was compiled with input from more than 1 300 participants from a range of interdisciplinary specialties, as well as patients, and initiated at the request of the Administration for Strategic Preparedness and Response and the Office of the Assistant Secretary for Health (OASH).
“Despite there having been many efforts to characterise this condition … no common definition has yet been widely agreed upon,” said Committee Chair Harvey Fineberg, MD, PhD.
“This hampers patients’ ability to get the care they need, and impedes research, surveillance, and the availability of support for them.”
He said the committee wants the new definition to be urgently adopted by all federal, state, and local government authorities, as well as clinicians, medical societies and organisations, public health practitioners, employers and educators, reports Medpage Today.
The report said the condition can manifest in many ways, and involve any organ system. For example, patients can experience one or more of the following symptoms: shortness of breath, coughing, persistent fatigue, post-exercise malaise, difficulty concentrating, memory changes, recurring headache, light-headedness, fast heart rate, sleep disturbances, problems with taste or smell, bloating, constipation, and diarrhoea.
However, the definition does not list any specific symptoms as being associated with long Covid, as “studies estimate the prevalence of more than 200 symptoms in multiple organ systems”.
Patients can present with one or multiple diagnosed conditions, including hypoxemia, cardiovascular disease, cognitive impairment, mood disorders, postural orthostatic tachycardia syndrome (POTS), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and autoimmune disorders like lupus, rheumatoid arthritis, or Sjögren’s syndrome.
Committee members pointed out, though, that including these conditions in the overall definition is not a suggestion that there is a causal association between any specific diagnosis and long Covid.
In addition to other conditions that might signal long Covid, the report noted several important features that clinicians can use to make a diagnosis.
First, the condition can follow asymptomatic, mild, or severe SARS-CoV-2 infection, so previous infections may be unknown to patients and their healthcare providers. It is also possible for symptoms to be continuous from the initial infection, or delayed for several weeks or months.
Long Covid can affect any individual regardless of age or other demographics, and be exacerbated by pre-existing conditions. The committee said it can be diagnosed on clinical grounds and that no biomarkers currently exist.
Ultimately, the report emphasised that it is a condition that can have a profound impact on a person’s life, including limiting their involvement in everyday work, educational, family, or personal activities.
long covid definition
Medpage Today article – New Long COVID Definition Proposed by National Academies (Open access)
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Impaired lung function in 25% of long Covid patients – Dutch study