Key Long COVID Symptoms Persist for Nearly 2 Years, But Many Return to Work

A new report suggests that two-thirds of people who have prolonged symptoms of COVID-19 are able to return to work by 22 months, though most continue to deal with effects of the disease.

The study adds new data to what has become one of the thorniest problems in the pandemic era—how to treat patients with what has become known as “long COVID.” The study was published in the Journal of Clinical Medicine.

Cases of long COVID are generally characterized by persistent post-infection symptoms that cannot be explained by any other diagnosis. To qualify as “long,” the symptoms must persist for 3 months after confirmed COVID-19 infection, or 2 months after the acute disease phase.

Corresponding author Bernard Geny, MD, PhD, of the University of Strasbourg, in France, and colleagues, said diagnosing long COVID can be challenging.

“Indeed, many patients suffering from post-COVID-19 condition might also demonstrate several and potentially serious comorbidities, making the link between symptoms and COVID infection difficult to discern,” he wrote, along with colleagues.

The prevalence of long COVID is not known, though the number of people with long-lasting symptoms could be as high as 1 in 10, the authors noted. Not all of those patients experience severe or disabling symptoms, however. Many patients with long-lasting symptoms have reported in previous research that they do not feel they have adequate support from the healthcare system. For its part, Geny and colleagues said healthcare providers do not yet have a clear model of optimal care for these patients.

In the new study, the investigators decided to track and interview patients with persistent COVID-19 symptoms to see what happened to their symptoms over time, and whether they could return to work. Between the study period of September 2021 and March 2022, the investigators contacted 45 people whose COVID-19 cases were referred to them. An advanced practice nurse with COVID-19 expertise called the patients, collected basic health parameters, and interviewed them using a structured set of questions. The interviews included questions about both physical and mental health, and the nurses proposed possible therapeutic interventions. The team then made a second phone call, months later, to see how the patients’ symptoms changed and to find out if they had been able to return to work. The phone calls were made at 15 and 22 months after infection, the authors said.

The investigators found that most people referred to their care coordination team were self-referrals (45%), with physician referrals comprising just 27% of cases. The rest came from the team’s own proactive contacts or from a regional support platform. The most common symptoms of long COVID—fatigue, neurocognitive disorders, and muscle and joint pain—generally did not resolve over the study period, the authors said, despite interventions such as exercise, therapy, and psychological support. However, patients did report significant improvement in dyspnea, anxiety, and chest pain. Overall, 53% of patients in the study reported symptom improvement, but only 9% said their symptoms resolved. Still, two-thirds of patients said they had sufficient improvement of symptoms to return to work, either part-time or full-time.

One difficulty understanding the pathology of long COVID is the fact that many patients had significant comorbidities, the authors said, meaning that the impact of COVID-19 infection needed to be measured in terms of worsening symptoms, rather than new symptoms.

“When talking about post-COVID-19 condition, there is a lack of data reporting reduced functions and activity in the participants compared to the previous ones, i.e., before SARS-CoV-2 infection, and further studies will be useful to investigate such issues,” they wrote.

The authors also said psychological factors might sometimes be at play, given that some of the longest-lasting symptoms are subjective (fatigue and pain, for instance). But they conceded that such ideas are controversial and the idea is poorly received by patients. Still, Geny and colleagues said clinicians should think about offering psychological and physical support in tandem, rather than seeing them as opposing strategies.

Finally, though their patient interventions were meant to collect data, the investigators found that patients appreciated the contact from the nurses.

“In such complex situations, besides early and adapted rehabilitations and psychological help allowing better symptom management, relatively simple actions such as a phone call might be very useful to reduce patients’ feelings of abandonment,” they concluded.