Narrative Review Outlines Primary Care Evaluation and Management of Long COVID

A focused narrative review in the Journal of General Internal Medicine presents a primary care approach to Long COVID, defined as new or worsened symptoms lasting at least 3 months after acute SARS-CoV-2 infection. Using patient-centered vignettes, the review describes common presentations and suspected pathophysiological mechanisms. Symptoms include fatigue, post-exertional malaise, cognitive impairment, and orthostatic intolerance, often despite normal routine diagnostic test results.

The proposed approach includes evaluating competing or coexisting diagnoses and providing validation and supportive care. Management strategies include activity pacing, multidisciplinary rehabilitation, and consideration of symptom-based medication trials. To accommodate brief consultations, the authors suggest prioritizing the most bothersome or addressable symptoms, focusing on one or two symptoms per visit, and using longitudinal follow-up. Prevention counseling covers infection prevention and early outpatient treatment during acute infection.

The review addresses diagnostic uncertainty, time constraints, and limited specialty access that can complicate primary care management. It offers a practical framework rather than new trial evidence; the supplied text reports no patient sample, comparative outcomes, or treatment effect estimates. Reliable diagnostic biomarkers and curative treatments remain unmet needs, making the proposed approach primarily supportive and symptom-focused.