U.S. group NASEM develops a standard definition for long COVID

Survey data indicate that approximately 7% of U.S. adults and more than 1% of children (i.e., ~15–20 million Americans) have had a variety of chronic, systemic and often disabling conditions following an acute COVID infection, collectively known as “long COVID.” A variety of terms and definitions have been used or proposed for long COVID, although none have gained wide acceptance from patients, clinicians, researchers and government agencies. In view of the shortcomings of various existing definitions, the US Department of Health and Human Services requested that the National Academies of Sciences, Engineering, and Medicine (NASEM) develop a definition for long COVID that would take into account the needs of patients as well as the views and understanding of a range of experts.NASEM created a three-part definition of long COVID, which includes a core description, a list of characteristic symptoms and associated diagnosable conditions, and seven important features, as outlined below.2024 NASEM Long COVID DefinitionLong COVID is an infection-associated chronic condition that occurs after SARS-CoV-2 infection and is present for at least three months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems.Long COVID manifests in multiple ways. Any organ system can be involved, and patients can present with the following:Single or multiple symptoms, such as shortness of breath, cough, persistent fatigue, post-exertional malaise, difficulty concentrating, memory changes, recurring headache, lightheadedness, fast heart rate, sleep disturbance, problems with taste or smell, bloating, constipation and diarrhea.Single or multiple diagnosable conditions, such as interstitial lung disease and hypoxemia, cardiovascular disease and arrhythmias, cognitive impairment, mood disorders, anxiety, migraine, stroke, blood clots, chronic kidney disease, postural orthostatic tachycardia syndrome and other forms of dysautonomia, myalgic encephalomyelitis–chronic fatigue syndrome, mast-cell activation syndrome, fibromyalgia, connective-tissue diseases, hyperlipidemia, diabetes, and autoimmune disorders such as lupus, rheumatoid arthritis and Sjögren’s syndrome.Seven important features of long COVIDIt can follow asymptomatic, mild or severe SARS-CoV-2 infection. Previous infections may have been recognized or unrecognized.It can be continuous from the time of acute SARS-CoV-2 infection or have a delayed onset for weeks or months after what had appeared to be full recovery from acute infection.It can affect children and adults, regardless of health, disability or socioeconomic status, age, sex, sexual orientation, race, ethnic group or geographic location.It can exacerbate preexisting health conditions or present as new conditions.It can range from mild to severe and can resolve over a period of months or can persist for months or years.It can be diagnosed on clinical grounds; no biomarker that is currently available conclusively determines the presence of this condition.It can impair patients’ ability to work, attend school, take care of family and care for themselves, resulting in profound emotional and physical effects on patients, their families and caregivers.The authors hope that the 2024 NASEM definition of long COVID will facilitate communication among patients, family members and clinicians. The standard definition should enable better tracking of the burden of long COVID and facilitate the design and conduct of robust clinical trials that produce better treatments for this infection-associated chronic condition. The authors also hope that the new definition contributes to compassionate and effective care for all patients in whom long COVID is diagnosed.Reference:Ely EW, Brown LM, Fineberg HV; National Academies of Sciences. Long Covid defined. NEJM 2024 (accessed August 15, 2024).

U.S. group NASEM develops a standard definition for long COVID

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