AOCPMR 2024 Mid-Year Meeting-Long COVID: A Major Public Health Condition

Video Transcription

Video Summary

The term "long COVID" originated from a patient on Twitter and describes persistent symptoms following acute COVID-19 infection. Though similar post-viral syndromes like ME/CFS exist, long COVID’s large scale has made it a public health concern, notably affecting working-age adults (36-50), contributing to labor shortages. Two distinct populations exist: those hospitalized with multi-organ involvement and those with mild or asymptomatic acute infections; their long COVID manifestations and treatments differ.<br /><br />Long COVID presents heterogeneously with symptoms like severe fatigue, brain fog, dizziness, palpitations, and autonomic dysfunction (e.g. POTS). Diagnosing is challenging due to lack of definitive tests; inflammatory markers like interleukins and CRP can be elevated but inconsistently. Viral RNA persistence and immune dysregulation involving monocytes/macrophages contribute to ongoing inflammation. Risk factors include diabetes, female gender, vaccination reduces risk by about 50%.<br /><br />Management is multidisciplinary and symptom-based, incorporating physical therapy, cognitive rehabilitation, mental health support, nutrition counseling (anti-inflammatory diets), pacing activity to avoid post-exertional malaise, and sometimes medications like amantadine or low-dose naltrexone. Research includes trials on ultrasound vagus nerve stimulation, metformin, Paxlovid, and studies on diaphragm muscle dysfunction. Return to work is slow and individualized; some improve within 6-9 months, others remain symptomatic for years. Long COVID continues to pose complex clinical and research challenges.

Keywords

Physical Medicine and Rehabilitation

PM&R billing

outpatient billing

inpatient billing

telemedicine

CPT codes

billing modifiers

Relative Value Units

documentation practices

COVID-19 impact on billing

long COVID

post-viral syndrome

ME/CFS

persistent symptoms

multisystem involvement

autonomic dysfunction

immune dysregulation

multidisciplinary management

return to work