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Think You Have Long COVID? See MOST OF YOUR Care Doc First

Sept. 2, 2022 Many patients coping with debilitating long COVID symptoms that hinder their day-to-day lives may be tempted to go right to an expert whether its a pulmonologist for breathing difficulties or perhaps a physiatrist for muscle fatigue to see should they have long COVID. But doctors including many specialists who treat probably the most complex long COVID cases recommend starting in another place: primary care.

Their primary care physicians tend to be most proficient in the patients complete health background, and that context is essential along the way of diagnosing someone with long COVID, says Benjamin Abramoff, MD, who leads the long COVID collaborative for the American Academy of Physical Medicine and Rehabilitation.

Primary care providers have already been on leading lines of diagnosing long COVID because the early months of the pandemic, when it became clear a large numbers of patients had lingering symptoms weeks after their original COVID-19 infections solved.

One early guide for diagnosing long COVID in primary care, published in The BMJ in August 2020, estimated that 1 in 10 patients had an extended illness after COVID infections. That estimate now looks low. A July 2022 report from the CDC found 1 in 5 people infected by the herpes virus now have long COVID symptoms.

Diagnosing long COVID is a challenge because theres no simple solution to screen for the problem, no single group of symptoms that definitively result in the proper diagnosis. Primary care providers, who often do detective work to straighten out what conditions might explain patients health complaints, are well positioned to cast a broad net in exploring possible known reasons for the complex mixture of symptoms that’s par for the course with long COVID.

Outward indications of long COVID Include fatigue, a cough that wont disappear completely, shortness of breath, insufficient smell or taste, trouble focusing, insomnia, sexual dysfunction, chest pain, and dizziness, amongst others, says Kristin Englund, MD, director of the Cleveland Clinic reCOVer Clinic, which treats long COVID patients.

Given how complex that is, there are various good reasons to get an analysis in primary care, experts say.

Easier usage of care is one big reason. Primary care providers are usually nearer to the patients home, and several set aside time and energy to see sick patients quickly. Specialty clinics focused on long COVID care are generally concentrated at academic medical centers in major cities and could have long waits for new patients. The earlier patients have emerged, the sooner they could start getting look after symptoms which are interfering making use of their daily lives.

A primary care doctor who knows the individual well might be able to better distinguish symptoms unique to the COVID infection from old health issues which are resurfacing.

Dealing with a primary care provider can avoid unwarranted and expensive diagnostic testing initially, says Kathleen Bell, MD, a neuro-rehabilitation specialist at the University of Texas Southwestern ODonnell Brain Institute who helped establish their COVID Recover program. Patients should start exploring questions of healthcare making use of their primary care physicians.

Even though many industry experts agree that primary care is the greatest place to get a long COVID diagnosis, in addition they agree that the procedure is imperfect and that not absolutely all of the doctors are around the duty. There arent yet evidence-based guidelines for diagnosing long COVID. And sometimes this diagnosis will get overlooked in primary care, particularly when symptoms closely resemble those of other chronic health issues that have are more common through the pandemic like depression, burnout, and chronic fatigue.

When patients arrive with way too many unexplained symptoms, primary care providers could also choose to refer patients to local specialists who is able to explore each issue separately, says Alba Miranda Azola, MD, co-director of the Post-Acute COVID-19 Team at Johns Hopkins University School of Medicine.

What eventually ends up happening the truth is sometimes is patients see their primary care provider, they can be found in, they will have 15 minutes, plus they are ranting about most of these symptoms which are multisystemic, she says. The principal care provider doesnt have time and energy to deal with most of these symptoms its gastroenterology and cardiology and neurology plus they refer to most of these different specialists.

While referrals often help get patients diagnosed properly, it doesnt always work because not absolutely all of the specialists are familiar with diagnosing long COVID, Azola says. They start to see the cardiologist who says all the tests are fine and I cant assist you to, then its exactly the same with the different specialists.

Patients who suspect long COVID, but dont understand this diagnosis despite persistent symptoms, may choose to visit a specialized long COVID clinic for a second opinion, says Monica Verduzco-Gutierrez, MD, chair of rehabilitation medicine and director of the COVID-19 Recovery Clinic at the University of Texas Health Science Center at San Antonio.

If the principal care provider has limited knowledge on this issue or limited choices for treatments, or in the event where patients could become more chronic and also have multiple conditions and symptoms to control, that’s where a multi-disciplinary long COVID clinic will be a fantastic option, she says.

Long COVID could be diagnosed when patients have persistent symptoms at 4 a month after infections start, based on the CDC. Many specialized long COVID clinics concentrate on more serious, complex cases and wont see patients unless their symptoms dont get rid of for at the very least a few months.

This is practical, because so many long COVID patients could be effectively diagnosed and treated in primary care, says, Tochi Iroku-Malize, MD, founding chair and professor of family medicine for the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. And primary care remains where for patients to go every time they have concerning, unexplained symptoms whether its long COVID or not.

Because the healthcare community continues to find out more about long COVID, its vital that you focus on a healthcare professional you understand and trust most of your care physician, she says.

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