Important update: Healthcare facilities
CDC has updated select ways to operate healthcare systems effectively in response to COVID-19 vaccination. Learn more
To maximize protection from the Delta variant and prevent possibly spreading it to others, get vaccinated as soon as you can and wear a mask indoors in public if you are in an area of substantial or high transmission.
UPDATE
Given new evidence on the B.1.617.2 (Delta) variant, CDC has updated the guidance for fully vaccinated people. CDC recommends universal indoor masking for all teachers, staff, students, and visitors to K-12 schools, regardless of vaccination status. Children should return to full-time in-person learning in the fall with layered prevention strategies in place.
UPDATE
The White House announced that vaccines will be required for international travelers coming into the United States, with an effective date of November 8, 2021. For purposes of entry into the United States, vaccines accepted will include FDA approved or authorized and WHO Emergency Use Listing vaccines. More information is available here.
UPDATE
Travel requirements to enter the United States are changing, starting November 8, 2021. More information is available here.

Management of Post-COVID Conditions

Management of Post-COVID Conditions

Evaluating and Caring for Patients with Post-COVID Conditions: Interim Guidance

Updated June 14, 2021
PAGE 6 of 8

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Medical Management

For most patients, the goal of medical management of post-COVID conditions is to optimize function and quality of life. Ideally, healthcare professionals, in consultation with the appropriate specialists, should develop a comprehensive management plan based on their patients’ presenting symptoms, underlying medical and psychiatric conditions, personal and social situations, and their treatment goals. Setting achievable goals through shared decision-makingexternal icon can be beneficial. Transparency is important for the process of goal setting; healthcare professionals should advise patients that post-COVID conditions are not yet well understood, and assure them that support will continue to be provided as new information emerges. Healthcare professionals and patients should continue to discuss progress and challenges and reassess goals as needed. Symptoms not explained by, or out of proportion to, objective findings are not uncommon after COVID-19 and should not be dismissed even if there is not yet a full understanding of their etiology or their expected duration.

Many post-COVID conditions can be improved through already established symptom management approaches (e.g., breathing exercises to improve symptoms of dyspnea). Creating a comprehensive rehabilitation plan(48, 49) may be helpful for some patients and might include physical and occupational therapy, speech and language therapy, vocational therapy, as well as neurologic rehabilitation for cognitive symptoms. A conservative physical rehabilitation plan might be indicated for some patients (e.g., persons with post-exertional malaise); consultation with physiatry for cautious initiation of exercise and recommendations about pacing may be useful. Gradual return to exercise as tolerated could be helpful for most patients.(50) Optimizing management of underlying medical conditions might include counseling on lifestyle components such as nutrition, sleep, and stress reduction (e.g., meditation).

Patient diaries and calendars might be useful to document changes in health conditions and symptom severity, especially in relation to potential triggers such as exertion (physical and cognitive), foods, menstruation, and treatments or medications. Such diaries and calendars can provide greater insight into patients’ symptoms and lived experience for healthcare professionals. Healthcare professionals should encourage patients to report any new or changing symptoms and to discuss any changes in activities or routines.

Patients with post-COVID conditions may share some of the symptoms that occur in patients who experience myalgic encephalomyelitis/chronic fatigue syndrome, fibromyalgia, post-treatment Lyme disease syndrome, dysautonomiaexternal icon, and mast cell activation syndromeexternal icon. Symptom management approaches that have been helpful for these disorders may also benefit some patients with post-COVID conditions (e.g., activity management (pacing) for post-exertional malaise).

FDA-approved or over the counter medications as well as vitamin or electrolyte supplements may be helpful for indicated illnesses (e.g., headache, anxiety) or documented deficiencies (e.g., vitamin deficiency) after carefully weighing the benefits and risks of pharmaceutical interventions. Some treatments have been offered that lack evidence of efficacy or effectiveness, and could be harmful to patients. Healthcare professionals should inquire about any unprescribed medications, herbal remedies, supplements, or other treatments that patients may be taking for their post-COVID conditions.

Follow-up visits with a healthcare professional might be considered every 2–3 months, with frequency adjusted up or down depending on the patient’s condition and illness progression.

Holistic Support for Patients with Post-COVID Conditions

Evidence indicates that holistic support for the patient throughout their illness course can be beneficial.(32-38) Recognizing and validating the impact of illness on quality of life should be part of the ongoing healthcare professional and patient interaction. Healthcare professionals can provide information on peer support resources (e.g., patient support groups, online forums). Support groups are connecting individuals, providing support, and sharing resources for persons affected by COVID-19 (see Resources). When material, employment or other social support needs are identified, healthcare professionals should consider referral themselves (if they are knowledgeable and able) and engaging a social worker, case worker, community health worker, or similarly trained professional to assist.

Patient Groups with Special Considerations

Persons who belong to racial and ethnic minority populations have experienced a higher burden of COVID-19 in part because of structural racism and longstanding disparities in social determinants of health, which could reasonably lead to a higher incidence of post-COVID conditions in these same populations.(51) COVID-19-related health disparities have also been reported for racial and ethnic minority employees of certain occupations (e.g., working in meat processing facilities).(52) Deploying resources to these communities can help ensure disproptionally affected residents are aware of post-COVID conditions and have access to needed services that may be lacking there.

People with disabilities may require close follow-up related to functional limitations. People experiencing homelessness or housing instability as well as people in correctional facilities may experience challenges accessing healthcare and other support services. People with pre-existing substance use disorder may be at risk for relapse.

Tools for cross-cultural communication and language access, including translated materials on post-COVID conditions and interpreter services, could help address health literacy and improve communication effectiveness.

People with barriers to accessing health care due to lack of health insurance, access to healthcare professionals who accept their health insurance, or lack of transportation, childcare, or paid sick leave may face additional challenges accessing healthcare. Telemedicine visits may be helpful for such patients who live in rural areas with access to broadband.

Lastly, patient advocacy groups have raised concerns that some post-COVID conditions have been either misdiagnosed as or misattributed to psychiatric causes, particularly among persons who belong to marginalized or vulnerable groups. Sensitivity to and awareness of stigma, completing a full clinical evaluation, and maintaining an attitude of empathy and understanding can help address these concerns.

References