Long COVID: Why and How Physiatrists Are Essential to Managing Its Challenges

As long COVID looms large in the ongoing battle against COVID-19, physiatrists and other physical medicine and rehabilitation (PM&R) caregivers are emerging as key members of healthcare teams meeting the needs of affected patients.

Specifically, the American Academy of Physical Medicine and Rehabilitation (AAPM&R) has launched a multispecialty collaborative to develop clinical guidance and formal education for the medical community around improving quality of care for people with long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC). The organization has also issued a national call to action for a comprehensive federal plan to address this new challenge.

“Long COVID/PASC is affecting 3 to 10 million people in the United States, including those who were asymptomatic during the acute stage of COVID-19,” says Cleveland Clinic physiatrist Deborah Venesy, MD, who helped oversee creation of the collaborative in her role as AAPM&R President-Elect. “Studies to date indicate that 10% to 30% of individuals who had COVID-19 reported at least one persistent symptom up to six months after the SARS-CoV-2 virus left their bodies. The need for long COVID care is growing, and the AAPM&R Board of Governors decided to prioritize addressing this need in a cooperative fashion.”

The QI collaborative at a glance

The group is doing so through its multispecialty Long COVID/PASC Quality Improvement Collaborative, which it formed in March 2021 with the following objectives:

• Establishing best practices and protocols, including assessment and treatment principles
• Disseminating learnings and developing resources for the medical community, including efforts to ensure inclusion of primary care providers and those attempting to develop a long COVID/PASC clinic
• Engaging patient and caregiver partners to develop and disseminate resources for patients
• Promoting patient-centeredness and health equity in long COVID care

Guidance is developed using a consensus-building process among collaborative participants, which include clinicians in multiple specialties from more than two dozen long COVID/PASC clinics across the country (including at Cleveland Clinic) as well as federal representatives and patient organizations.

The collaborative expects to roll out its guidance to the medical community on a monthly basis through the AAPM&R website and multiple other avenues. “There are many unknowns about long COVID at this time,” notes Dr. Venesy. “Practicing physiatrists can expect to gain knowledge on best practices from long COVID/PASC clinics in this rapidly evolving field.”

A national call to action

Around the time it launched the collaborative, AAPM&R also issued a call to action to the Biden administration and Congress to develop a comprehensive crisis management plan to address the critical needs of people with long COVID and help these patients regain quality of life. Specifically, AAPM&R advocated for resources to build needed care infrastructure, equitable access to care for patients and research to advance medical understanding of long COVID.

The call to action identified addressing inequities in long COVID care as a priority, along with strengthening disability evaluation and benefits and other forms of safety-net care. “Too often access to sustained, quality care is diminished because of racial, ethnic or socioeconomic factors,” Dr. Venesy explains.

At the same time, AAPM&R applauded Congress for funding research and current efforts of the National Institutes of Health, World Health Organization and Centers for Disease Control and Prevention to advance understanding of long COVID/PASC-related issues.

A singular role for PM&R

When it comes to research related to long COVID, Dr. Venesy identifies some leading unanswered questions as how best to find, assess and treat patients and how best to improve their quality of life.

“PM&R physicians are uniquely qualified to help guide the multidisciplinary effort needed to develop a plan for the long COVID crisis,” Dr. Venesy says. “As a specialty, we are investigators, team leaders and problem solvers. We see the whole patient and the whole picture of the rehabilitation ecosystem. We are exactly what this crisis demands.”

In direct clinical terms, she adds, the symptoms of long COVID that physiatrists are most often addressing are:

• Breathing discomfort and exercise limitation
• Cognitive impairment (brain fog or problems with short-term memory, concentration and focus)
• Cardiac/autonomic impairment, including tachycardia, palpitations and orthostasis
• Headaches and/or vertigo
• Fatigue and malaise
• Neuropsychiatric symptoms

“Physiatrists are experts in the comprehensive management of individuals living with sequelae of viruses that require multidisciplinary rehabilitative treatment,” Dr. Venesy observes. “In the aftermath of the polio pandemic, physiatrists proved that an appropriate combination of medical rehabilitation and therapies helped preserve function and minimize pain and deconditioning in polio survivors. The same can be true for COVID-19 survivors.”