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CDC offers guidance for evaluating patients with post-COVID conditions

June 16, 2021

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The Centers for Disease Control and Prevention (CDC) has developed interim guidance to assist health care providers in evaluating patients with post-COVID conditions, including new, returning and ongoing health problems occurring more than four weeks after infection with SARS-CoV-2.

The guidance refers to “post-COVID conditions” as the umbrella term for physical and mental health consequences experienced by individuals after SARS-CoV-2 infection, including patients who initially had mild or asymptomatic acute infection. The frequency and severity of post-COVID conditions in children and adolescents are unknown, according to the CDC.

According to CDC, there are multiple possible onset patterns for post-COVID conditions including, but not limited to: “(A) persistent symptoms and conditions that begin at the time of acute COVID-19 illness; (B) new-onset late sequelae following asymptomatic disease or a period of acute symptom relief or remission; or (C) an evolution of symptoms and conditions that include some persistent symptoms (e.g., shortness of breath) with the addition of new symptoms or conditions over time (e.g., cognitive difficulties).”

Some post-COVID conditions share similarities with other post-viral syndromes like myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), dysautonomia (e.g., postural orthostatic tachycardia syndrome) or mast cell activation syndrome, according to the guidance. “Understanding of post-COVID conditions remains incomplete and guidance for health care professionals will likely change over time as the evidence evolves.”

Primary care providers will play a key role in managing many patients with post-COVID conditions, also called “long COVID,” according to the CDC. Providers are encouraged to use patient-centered approaches to optimize quality of life and function. This approach will allow health care providers and patients to use shared decision-making and focus on treating specific symptoms or conditions, within the medical home model. A comprehensive management plan to improve physical, mental and social well-being also may be helpful.

Evidence suggests that post-COVID conditions occur in children and adolescents but the true frequency and severity are unknown at his time. Peter C. Rowe, M.D., FAAP, an expert on post-COVID conditions who contributed to the CDC interim guidance, said pediatricians are in an ideal position to identify and care for children with impairments following COVID-19.

Role of pediatricians

The guidance includes a suggested evaluation of patients that involves obtaining a thorough history, including COVID-19 disease course, severity of illness, treatment received and a timeline of the emergence of acute- and post-illness symptoms. It includes a list of symptoms commonly reported by people with post-COVID conditions (see table) and system-based conditions reported following SARS-CoV-2 infection.

Health care providers should:

  • use patient history, examination and clinical findings to guide laboratory testing,
  • be judicious about use of imaging in children and
  • listen to patients’ experiences and avoid dismissing patients whose diagnostic testing results are within normal ranges.

“One of the most important things we can do is to validate their experience and believe what they are telling us, as the post-COVID symptoms are not random complaints but often are monotonously consistent from one child to the next,” said Dr. Rowe.

To lessen the burden on patients with limited energy from post-COVID conditions, the guidance supports use of telehealth for follow-up. “Although an in-person initial assessment might be ideal, under some circumstances it may not be possible. Evaluation and care should not be delayed if only telemedicine options are available.”

Table. Common symptoms among people with post-COVID conditions
  • dyspnea or increased respiratory effort
  • fatigue
  • post-exertional malaise* and/or poor endurance
  • “brain fog,” cognitive impairment
  • cough
  • chest pain
  • headache
  • palpitations and/or tachycardia
  • arthralgia
  • myalgia
  • paresthesia
  • abdominal pain
  • diarrhea
  • insomnia and other sleep difficulties
  • fever
  • lightheadedness
  • impaired daily function and mobility
  • pain
  • rash (e.g., urticaria)
  • mood changes
  • anosmia or dysgeusia
  • menstrual cycle irregularities
*Post-exertional malaise is the worsening of symptoms following even minor physical or mental exertion, with symptoms typically worsening 12 to 48 hours after activity and lasting for days or even weeks.
Source: Centers for Disease Control and Prevention
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