For Health Care Providers: Post-COVID Conditions

On this page
Definitions
Provider education and resources
Interim guidance
Resources for patients
Post-COVID conditions in children and adolescents
Documentation for return to work and disability
Guiding Council

The following resources are for health care providers. Information for the general public can be found at Long COVID: A Post-COVID Condition.

Long Covid and post-COVID conditions are not well understood, and their true frequency and severity remain unknown. Guidance will continue to change over time. We will update this page as more information and resources become available. Refer to CDC: Clinical Overview of Long COVID for the latest updates from the Centers for Disease Control and Prevention (CDC).

Definitions

The CDC and the National Academies of Sciences, Engineering, and Medicine describe long COVID as “an infection-associated chronic condition that can occur after SARS-CoV-2 infection, the virus that causes COVID-19, and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems..” However, there is not yet widespread consensus around standard clinical case definitions for most post-COVID conditions. This is in part because studies of post-COVID conditions and “long COVID” have varied widely by symptoms investigated, temporal criteria, study settings (inpatient vs. outpatient), and data sources (self-reporting versus electronic health records).

The World Health Organization (WHO) has also published a version for consideration (WHO: A Clinical Case Definition of Post COVID-19 Condition by a Delphi Consensus, 6 October 2021), which varies somewhat from the CDC description: "Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, and cognitive dysfunction among others, and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time."

We may include standard clinical and case definitions here as they become available.

Provider education and resources

• U.S. Department of Health and Human Services (HHS): Health+ Long COVID: Human-Centered Design Report (PDF)
  Framework and recommendations, including a map of the "ideal" versus "actual" treatment journey and patient-identified pain points. Published November 2022.
• University of California Health: Long COVID/PASC Education
  Free CME credits available (AMA PRA Category 1). Short videos for providers. Topics include evaluation in primary care settings, pediatrics, health disparities, post-ICU complications, psychiatry/behavioral health, emergency medicine, and more.
• Mayo Clinic Proceedings: Diagnosis and Management of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (PDF)
  Free CME credits available (AMA PRA Category 1). Concise review for clinicians that describes a generalist approach to ME/CFS (common in long COVID), including diagnosis, evaluation, and management strategies.
• Project ECHO: Long COVID and Fatiguing Illness Recovery Program
  Monthly learning series, resource library, and quarterly short course for providers who care for patients with post-COVID conditions.
• National Institutes of Health: Dietary Supplements in the Time of COVID-19
  Fact sheet for health professionals. 
• HHS: Services and Supports for Longer-Term Impacts of COVID-19 (PDF)
  An overview of federal programs and recommendations with patient input throughout. Includes "Chapter 3: Enabling Health Care Personnel to Improve Treatment of People Experiencing Long COVID." Published August 2022.
• MEAction: For Clinicians: Pacing and Management Guide for ME/CFS and Long COVID (PDF)
  A brief guide from ME/CFS patient-advocates and the Patient-Led Research Collaborative.

Interim guidance

Guidance is for informational purposes only. This is not an all-inclusive list, nor is MDH endorsing specific guidance over others.

• CDC: Clinical Overview of Long COVID
  Information on assessment and testing, management and follow-up care, documentation, public health recommendations, and more. Includes an extensive list of references.
• American Academy of Physical Medicine and Rehabilitation: PASC Consensus Guidance
  Links to guidance statements for assessing and managing fatigue, breathing discomfort, cognitive symptoms, autonomic dysfunction, and more related to long COVID.
• U.S. Department of Veterans Affairs: Whole Health System Approach to Long COVID (PDF)
  A comprehensive guide from the Patient-Aligned Care Team. Includes quick guides. Published August 2022.
• National Institute for Health and Care Excellence: COVID-19 Rapid Guideline: Managing the Long-Term Effects of COVID-19
  Includes a baseline assessment tool, guidelines for assessing and managing long-term effects of COVID-19, advice for coordinating services, and more. Updated March 2022.
• International Journal of Environmental Research and Public Health: Long COVID-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management (PDF)
  Recommendations for structured primary care visits, longitudinal follow up, multidisciplinary rehabilitation services, and empowering patients. Published April 2021.
• American Academy of Pediatrics: Post-COVID Conditions in Children and Adolescents
  Interim guidance for pediatricians and primary care providers.
• CDC: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Resources for Healthcare Providers
  Guidance on presentation, diagnosis, clinical care, and more. Long COVID may present as ME/CFS and benefit from similar management.
• Substance Abuse and Mental Health Services Administration (SAMHSA): Identification and Management of Mental Health Symptoms and Conditions Associated with Long COVID (PDF)
  Includes recommendations for assessments and therapeutic intervention strategies.

Resources for patients

• World Health Organization: Support for rehabilitation: Self-management after COVID-19-related illness
  Advice for adults who are recovering from COVID-19. Written by rehabilitation professionals in consultation with people recovering from long COVID. Includes tips for pacing and monitoring for post-exertional malaise.
• Directory of Centers for Independent Living (CILs) and Associations
  CILs serve people of all ages with all types of disabilities, and also those who may not identify as having a disability but struggle with daily tasks. A local CIL may be able to coordinate services, arrange accessible transportation, locate and/or provide mobility equipment, and more.
• Administration for Community Living: Resources for People with Long COVID
  Roundup of guidance and resources.
• CDC: Patient Tips: Healthcare Provider Appointments for Post-COVID Conditions
  Tips and checklists to help prepare for health care encounters.
• MEAction: Pacing and management guide for ME/CFS (PDF)
  Tips for recognizing post-exertional malaise, monitoring symptoms, and prioritizing rest and activities.
• Long COVID Kids: Supporting Children Living with Long COVID to Manage Their Energy with Pacing Penguins
  Information to help kids and parents understand and describe fatigue, plus a poster with graphics to help support recovery.

More can be found at Long COVID Resources and Support, including resources related to employment, school, and mental health.

Post-COVID conditions in children and adolescents

Interim guidance for pediatricians and primary care providers is available at American Academy of Pediatrics: Post-COVID Conditions in Children and Adolescents.

Children with post-COVID conditions may experience challenges related to concentration, memory, or physical activity. Health care providers can work with schools and families on accommodations for classes, homework, and other activities. For more information, visit the U.S. Department of Education’s Office for Civil Rights (OCR) and the Office of Special Education and Rehabilitative Services (OSERS)’s Long COVID under Section 504 and the IDEA, Resource to Support Children, Students, Educators, Schools, Service Providers, and Families (PDF) and MDH: Long COVID Resources and Support: Resources for caregivers, schools, and more.

Documentation for return to work and disability

• Job Accommodation Network (JAN): Practical Guidance for Medical Professionals
  Guidance and templates for providing sufficient medical documentation in support of a patient's workplace accommodation request. From the U.S. Department of Labor's Office of Disability Employment Policy. Patients can also receive free, one-on-one consultation from JAN at 800-526-7234 or JAN: Contact Us.
• JAN: Accommodation and Compliance: Long COVID Key Accommodations
  Includes common workplace accommodations organized by long COVID symptom/limitation.
• U.S. Social Security Administration (SSA): Long COVID: A Guide for Health Professionals on Providing Medical Evidence for Social Security Disability Claims (PDF)
  Brief overview and tip sheet for providers.
• SAMHSA: Developing SSI/SSDI Applications for Individuals with Long COVID
• CDC Clinician Outreach and Communication Activity Calls/Webinars: Evaluating and Supporting Patients with Long COVID in Returning to Work
  Review of some of the complex symptoms specific to Long COVID, medical considerations for recommending return to work, and accommodations to support patients returning to the workplace. Featuring Dr. Greg Vanichkachorn, formerly of Mayo Clinic.

Guiding Council

MDH, in partnership with Stratis Health, is convening a Guiding Council of Minnesota clinicians who care for long COVID patients in primary and specialty care settings across the state. We are also gathering input from people with long COVID, caregivers, support services, community leaders, and other health care practitioners.

Long COVID Guiding Council: Project Accomplishments to Date and Plan for Future Work (PDF)

More from MDH

• Health Care: COVID-19
• Clinical Recommendations for Patients with Underlying Medical Conditions: COVID-19
• Coronavirus Disease 2019 (COVID-19)