Today a new report from the National Academies of Sciences, Engineering, and Medicine presents a number of conclusions about long-COVID diagnosis, symptoms, and impact on daily function, including that the condition can cause more than 200 symptoms, and that a positive COVID-19 test is not necessary to make a long-COVID diagnosis.
The findings are meant to guide the Social Security Administration (SSA) and are published one week before the National Academies of Sciences, Engineering, and Medicine is set to offer a new single definition of long COVID that can be used across US governmental groups as a way to streamline treating the condition in the years to come.
"This report offers a comprehensive review of the evidence base for how Long COVID may impact a patient's ability to engage in normal activities, such as going to work, attending school, or taking care of their families," said Victor J. Dzau, MD, president of the National Academy of Medicine, in a National Academies press release. "Its findings will be useful to anyone attempting to understand how Long COVID may affect the millions of people in the U.S. who have reported symptoms."
Hospitalization increases risk
According to the Centers for Disease Control and Prevention, 5.3% of Americans currently have long COVID, with a significant proportion of those experiencing disability from the condition.
In today's report, more than 200 symptoms are formally listed as possible signs of long COVID, affecting every organ system. Women are twice as likely to men to experience long COVID, but people who have never received a diagnosis or even a positive COVID-19 test may be experiencing symptoms of the condition.
Though people with mild or even asymptomatic cases of acute COVID can develop long COVID, the report recognizes that people whose infection required hospitalization are two to three times more likely to experience long COVID than are those who were not hospitalized.
Similarities to other chronic conditions
Emphasized throughout the report is the similarity long COVID has to other chronic conditions, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia, and postural orthostatic tachycardia syndrome (POTS).
Like those conditions there is no current way to treat long COVID, though long COVID does have a better prognosis than does ME/CFS.
While there is evidence that many people with Long COVID symptoms have improved by 12 months, data beyond that time frame is limited but suggestive that recovery might plateau.
"While there is evidence that many people with Long COVID symptoms have improved by 12 months, data beyond that time frame is limited but suggestive that recovery might plateau or progress at a slower rate," the authors wrote.
Children and teens with long COVID are also more likely than adults are to make a full recovery.
Some symptoms might not qualify as impairments
Long COVID can impair a person's ability to work or attend school for 6 months to 2 years or more after COVID-19 infection, the authors said.
Disability from long COVID is associated with acute disease severity, female sex, and baseline comorbidities, the authors said. Though some people with long COVID applying for disability with the SSA will qualify under the SSA's current listing of impairments, many will not.
"Three frequently reported health effects that can significantly interfere with the ability to perform work or school activities and may not be captured in the SSA Listings are chronic fatigue and post-exertional malaise, post-COVID-19 cognitive impairment, and autonomic dysfunction, all of which can be difficult to assess clinically in terms of their severity and effects on a person’s functioning," the authors said.
