The Public Health Approach to Long COVID

Overview

Long COVID affects millions of people across the United States and increases healthcare needs. 12 Health departments play a crucial role in surveillance, communication, and education to increase awareness, reduce stigma, and improve care.

CDC and its partners are conducting research on Long COVID 3in a variety of populations and settings and are actively working to:

• Disseminate clinical guidance and share epidemiologic and surveillance data to inform public health policy and action.

• Create and increase access to Long COVID educational and communication resources.

• Support clinical capacity by connecting clinicians and public health professionals to Long COVID clinical guidance, resources and educational opportunities.

Public health approach to Long COVID

Key themes for U.S. public health agencies in addressing Long COVID.

Collaboration between federal agencies and public health partners is important to address the serious nature of Long COVID. CDC has identified key areas where clinicians and public health professionals need support in order to empower their efforts to address Long COVID. 4

Surveillance and epidemiology

Using a variety of data sources to better inform public health actions to address the economic, social, and clinical burden of Long COVID.

Prevention and mitigation

Emphasizing COVID-19 vaccination as the best available tool to prevent Long COVID and promoting additional measures to prevent acute COVID-19 and reduce the severity of COVID-19 illness.

Combat stigma

Helping to address the stigma that many patients with Long COVID encounter by promoting awareness of Long COVID as a real condition.

Communication and public education

Creating and increasing access to practical educational and communication resources to inform support clinicians and public health professionals.

Clinical capacity building

Improving and standardizing clinical tools and resources to better support clinician efforts to effectively diagnose and manage Long COVID.

Health equity

Continuing to understand how health inequities disproportionately affect different groups of people and how they experience Long COVID.

What CDC is doing

CDC continues to collaborate with clinicians, public health partners, and other federal agencies to better understand and address the impacts of Long COVID. CDC supports these goals by:

• Monitoring the burden and impact of Long COVID on various populations through TrackPCC, a project tracking Post-COVID Condition 5

• Sharing data and research aimed at better understanding COVID-19 and Long COVID

• Connecting clinicians and people experiencing Long COVID to important resources

Resources

Reports

• A Long COVID Definition: A Chronic, Systemic Disease State with Profound Consequences | The National Academies Press

• Long-Term Health Effects of COVID-19: Disability and Function Following SARS-CoV-2 Infection | The National Academies Press
• Whole-Health-System-Approach-to-Long-COVID_080122_FINAL.pdf
• CSTE-STLT-Long-COVID-Surveillance-August-2023.pdf

Toolkits and additional resources

• Education and Practice-Based Resources | AAFP

• The AHC Health-Related Social Needs Screening Tool

• Long Covid (ca.gov)

• Long COVID (PASC) Resources

Continuing education and webinars

• Long-COVID webinars – Institute for Learning, Education and Development

• Education and Practice-Based Resources | AAFP

• The EveryONE Project™: COVID-19 and Health Equity

• Continuing Education|Clinician Outreach and Communication Activity (COCA)

Echo program

• Public Program | iECHO

• Long-COVID ECHO | College of Health Solutions

• Exploring Clinical Practice and Research

Select CDC publications

Prospective cohort studies

• Gottlieb M, Wang RC, Yu H, Spatz ES, Montoy JCC, Rodriguez RM, Chang AM, Elmore JG, Hannikainen PA, Hill M, Huebinger RM, Idris AH, Lin Z, Koo K, McDonald S, O'Laughlin KN, Plumb ID, Santangelo M, Saydah S, Willis M, Wisk LE, Venkatesh A, Stephens KA, Weinstein RA; Innovative Support for Patients with SARS-CoV-2 Infections Registry (INSPIRE) Group. Severe Fatigue and Persistent Symptoms at 3 Months Following Severe Acute Respiratory Syndrome Coronavirus 2 Infections During the Pre-Delta, Delta, and Omicron Time Periods: A Multicenter Prospective Cohort Study. Clin Infect Dis. 2023 Jun 8;76(11):1930-1941. doi: 1093/cid/ciad045. PMID: 36705268; PMCID: PMC10249989.
• Han JH, Womack KN, Tenforde MW, Files DC, Gibbs KW, Shapiro NI, Prekker ME, Erickson HL, Steingrub JS, Qadir N, Khan A, Hough CL, Johnson NJ, Ely EW, Rice TW, Casey JD, Lindsell CJ, Gong MN, Srinivasan V, Lewis NM, Patel MM, Self WH; Influenza and Other Viruses in the Acutely Ill (IVY) Network. doi: 10.1111/irv.12980.
• O'Laughlin KN, Thompson M, Hota B, Gottlieb M, Plumb ID, Chang AM, Wisk LE, Hall AJ, Wang RC, Spatz ES, Stephens KA, Huebinger RM, McDonald SA, Venkatesh A, Gentile N, Slovis BH, Hill M, Saydah S, Idris AH, Rodriguez R, Krumholz HM, Elmore JG, Weinstein RA, Nichol G; INSPIRE Investigators. Study protocol for the Innovative Support for Patients with SARS-COV-2 Infections Registry (INSPIRE): 2022 Mar 3;17(3). doi: 10.1371.
• Vu QM, Fitzpatrick AL, Cope JR, et al. Estimates of Incidence and Predictors of Fatiguing Illness after SARS-CoV-2 Infection. Emerging Infectious Diseases. 2024;30(3):539-547. doi:3201/eid3003.231194.

Analysis of electronic healthcare data

• Barrett CE, Koyama AK, Alvarez P, Chow W, Lundeen EA, Perrine CG, Pavkov ME, Rolka DB, Wiltz JL, Bull-Otterson L, Gray S, Boehmer TK, Gundlapalli AV, Siegel DA, Kompaniyets L, Goodman AB, Mahon BE, Tauxe RV, Remley K, Saydah S. Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 Years – United States, March 1, 2020-June 28, 2021. MMWR Morb Mortal Wkly Rep. 2022 Jan 14;71(2):59-65.
• Hernandez-Romieu AC, Carton TW, Saydah S, Azziz-Baumgartner E, Boehmer TK, Garret NY, Bailey LC, Cowell LG, Draper C, Mayer KH, Nagavedu K, Puro JE, Rasmussen SA, Trick WE, Wanga V, Chevinsky JR, Jackson BR, Goodman AB, Cope JR, Gundlapalli AV, Block JP. Prevalence of Select New Symptoms and Conditions Among Persons Aged Younger Than 20 Years and 20 Years or Older at 31 to 150 Days After Testing Positive or Negative for SARS-CoV-2. JAMA Netw Open. 2022;5(2):e2147053. doi:10.1001/jamanetworkopen.2021.47053.
• Kompaniyets L, Bull-Otterson L, Boehmer TK, et al. Post–COVID-19 Symptoms and Conditions Among Children and Adolescents — United States, March 1, 2020–January 31, 2022. MMWR Morb Mortal Wkly Rep 2022;71:993–999. https://www.cdc.gov/mmwr/volumes/71/wr/mm7131a3.htm?s_cid=mm7131a3_w.
• Malden, D.E., Liu, IL.A., Qian, L. et al.Post-COVID conditions following COVID-19 vaccination: a retrospective matched cohort study of patients with SARS-CoV-2 infection. Nat Commun 15, 4101 (2024). DOI: https://www.nature.com/articles/s41467-024-48022-9.

Health surveys

• Feldstein LR, Edwards D, Cope JR, Hagen MB, Saydah S. Differences in Report of Post-COVID Conditions Among Adults Tested for SARS-CoV-2 by Race and Ethnicity: 2022 Porter Novelli SummerStyles Survey, U.S. AJPM Focus. 2023 Dec 27;3(2):100181. doi: 1016/j.focus.2023.100181. PMID: 38371340; PMCID: PMC10869300.
• Nicole D. Ford, PhD; Douglas Slaughter, MPH; Deja Edwards, MPH; Alexandra Dalton, PhD; Cria Perrine, PhD; Anjel Vahratian, PhD; Sharon Saydah, PhD. CDC Morbidity and Mortality Weekly (MMWR), Aug. 11, 2023. Long COVID and Significant Activity Limitation Among Adults, by Age — United States, June 1–13, 2022, to June 7–19, 2023. MMWR Morb Mortal Wkly Rep. 2023 Aug 11;72(32):866-870. doi: 15585/mmwr.mm7232a3. PMID: 37561665; PMCID: PMC10415000.

Commentary

• Saydah SH, Brooks JT, Jackson BR. Surveillance for Post-COVID Conditions Is Necessary: Addressing the Challenges with Multiple Approaches. J Gen Intern Med. 2022 Feb 15:1–3.

Models of care

• Godino JG, Samaniego JC, Sharp SP, Taren D, Zuber A, Armistad AJ, Dezan AM, Leyba AJ, Friedly JL, Bunnell AE, Matthews E, Miller MJ, Unger ER, Bertolli J, Hinckley A, Lin JS, Scott JD, Struminger BB, Ramers C. A technology-enabled multi-disciplinary team-based care model for the management of Long COVID and other fatiguing illnesses within a federally qualified health center: protocol for a two-arm, single-blind, pragmatic, quality improvement professional cluster randomized controlled trial. Trials. 2023 Aug 12;24(1):524. doi: 1186/s13063-023-07550-3. PMID: 37573421; PMCID: PMC10423413.