September 2, 2022 – Many patients deal with debilitating COVID long Symptoms that interfere with their daily lives may be tempted to go straight to a specialist – be it Pulmonologist For breathing difficulties or a physiologist for muscle fatigue – to see if they have a prolonged COVID. But medical experts — including many specialists who treat more complex long-term COVID cases — recommend starting in a different place: primary care.
“Primary care physicians often have the most knowledge of the patients’ complete medical history, and this context is important in the process of diagnosing someone with long-term COVID,” Benjamin AbramovD., MD, who leads the long-running COVID collaboration for the American Academy of Physical Medicine and Rehabilitation.
Primary care providers have been on the front lines of COVID diagnosis since the early months of pandemicwhen it became apparent that a significant number of patients had long-term symptoms several weeks after the original COVID-19 infection had cleared.
One early guide to diagnosing long-term COVID in primary care, published in BMJ In August 2020, it was estimated that 1 in 10 patients experienced a prolonged illness after contracting COVID-19. This estimate now appears to be low. A July 2022 report from the CDC found that 1 in 5 people infected with the virus currently have prolonged COVID symptoms.
Diagnosing COVID has long been a challenge because there is no simple way to detect the condition, nor is there a single set of symptoms that conclusively leads to a correct diagnosis. Primary care providers, who often carry out investigative work to triage conditions that may explain patients’ health complaints, are well placed to find a broad net in exploring potential causes of the complex mix of symptoms that are on par with the long course of COVID.
Symptoms of prolonged COVID include fatigue, cough that does not go away, shortness of breath, lack of smell or taste, difficulty concentrating, insomnia, sexual weakness, chest pain, dizziness, among others, Kristen EnglundMD, Director reCOVer Clinic at Cleveland Clinicwho has been treating covid patients for a long time.
Experts say that given how complex this is, there are many good reasons to seek a diagnosis in primary care.
Ease of access to care is one of the main reasons. Primary care providers tend to be closer to the patient’s home, and many take the time to see sick patients quickly. Specialized clinics dedicated to long-term COVID care tend to be concentrated in academic medical centers in major cities and may wait for new patients for extended periods. The earlier patients are screened, the sooner they begin to receive care for symptoms that interfere with their daily lives.
A primary care physician who knows the patient well may be able to better distinguish the unique symptoms of COVID infection from old health problems that reappear.
“Working with a primary care provider can avoid unnecessary and costly diagnostic tests in the beginning,” he says. Kathleen BellMD, a neurorehabilitation specialist at the University of Texas Southwest O’Donnell Brain Institute who helped establish COVID Recovery a program. “Patients should always begin exploring health care questions with their primary care physicians.”
Even if many experts agree that primary care is the best place for a prolonged diagnosis of COVID, they also agree that the process is imperfect and that these doctors are not up to the task. There are no evidence-based guidelines yet for diagnosing long-term COVID. This diagnosis is sometimes overlooked in primary care, especially when symptoms are very similar to those of other chronic health problems that have become more common during an epidemic – such as depressionFatigue and chronic fatigue.
When patients present with too many unexplained symptoms, primary care providers may also choose to refer patients to local specialists who can troubleshoot each issue individually, he says. Alba Miranda AzollaMD, co-director of the Post-Covid-19 team at Johns Hopkins University School of Medicine.
“What actually happens sometimes is patients see their primary care provider, and they come in, and they have 15 minutes, and they’re talking about all these multi-system symptoms,” she says. “The primary care provider doesn’t have time to deal with all these symptoms – it’s gastroenterology, cardiology, neurology – and they refer to all these different specialists.”
While referrals often help diagnose patients correctly, they don’t always work because not all of these specialists have experience diagnosing COVID for that long, Azola says. “They see the cardiologist who said all the tests are fine and I can’t help you, and then it’s the same with all the different specialists.”
Patients who have been suspected of having had COVID for a long time, but who do not get that diagnosis despite persistent symptoms, may want to go to a specialist long-term COVID clinic for a diagnosis. second opinionSays Monica Verduzco GutierrezD., MD, chief of rehabilitation medicine and director of the COVID-19 Recovery Clinic at the University of Texas Health Science Center at San Antonio.
“If the primary care provider has limited subject knowledge or limited options for treatment, or in a situation where patients may become more chronic and have multiple conditions and symptoms to manage, this is where a long multidisciplinary COVID clinic would be an excellent option.”
Long-term COVID can be diagnosed when patients have persistent symptoms at 4 weeks after the infection began, according to Center for Disease Control. Many specialist long-running COVID clinics focus on the most serious and complex cases and will not see patients unless their symptoms clear up for at least 3 months.
This makes sense, as many long-term COVID patients can be diagnosed and effectively treated in primary care, he says, Tucci Iroko MalaysiaD., MD, founding chair and professor of family medicine at the Donald and Barbara Zucker College of Medicine in Hofstra/Northwell. Primary care remains the best place for patients to go when they have worrisome and unexplained symptoms – whether or not the coronavirus has lingered.
“With the health care community continuing to learn more about COVID for so long, it is important to start with a health care professional you know and trust — your primary care physician,” she says.