Without ‘uniform definition’ for long COVID, prevention of infection may be best strategy
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DESTIN, Fla. — The long COVID epidemic continues to raise more questions than answers for rheumatologists, and while there are no definite solutions, data regarding prevention is painting a clear picture, according to a speaker here.
“We think that the pandemic is over, and it really is not over,” Leonard Calabrese, DO, of the Cleveland Clinic and chief medical editor of Healio Rheumatology, told attendees at the 2023 Congress of Clinical Rheumatology-East. “Infection is going to be prevalent in the world; there will be the healthy and the vaccinated and the unvaccinated and the immunocompromised.”
The way forward is unclear for long COVID and the physicians who care for afflicted patients, Calabrese said. There is no uniform definition of the disease, which is one major source of consternation.
“There is a challenge, because as I have outlined for you, there is no uniform definition,” Calabrese said. “We do not have ACR classification criteria for long COVID like we do for lupus or rheumatoid arthritis or any of the other diseases we are so familiar with.”
In addition to a lack of clear, specific criteria, the challenges to long COVID identification include variable evidence of infection, existing reporting bias and quality diagnostic biomarkers, Calabrese said.
While work is being done to more fully investigate its epidemiology and potential therapies, Calabrese pointed to prevention as a way for patients to reduce their risks of developing long COVID.
“I do tell people in my clinic that there is data on how to prevent this, you know, primary prevention, secondary prevention of COVID,” Calabrese said. “Even if the COVID is milder, you still do not want to get COVID-19, as it carries some risk, even if that is diminished.”
Additionally, Calabrese looks toward vaccination and early antiviral therapies to stem the risks of developing long COVID.
“I think that most of the data shows that there is at least a 30% to 50% reduction in the incidence of this,” Calabrese said. “Early antiviral therapy, there is some very interesting data, I still recommend early antiviral therapy for people at increased risk.”
It is difficult to predict where the answers may lie for physicians treating patients with long COVID, but Calabrese emphasized that long COVID will be around for the foreseeable future.
“This is the real deal, and it is going to be around for a long time,” Calabrese said. “People at the more severe end really need our help, while most of the people with mild to moderate long COVID, like I experienced, will ultimately work out of this.”
Calabrese added, “This is going to take a lot of work, but I think rheumatology has a lot to offer.”
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Calabrese L. The epidemic long COVID: Questions implications for rheumatology. Presented at The Congress of Clinical Rheumatology East; May. 4-7, 2023; Destin, Florida (hybrid meeting).
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