Dear Editor
In a systematic review of interventions for managing long COVID (post-COVID condition), Zeraatkar et al. reported that interventions such as cognitive behavioral therapy (CBT) and physical rehabilitation help alleviate fatigue and cognitive impairments. [1] As a clinical researcher who has witnessed a large number of long COVID patients, I believe that long COVID is a multifactorial, heterogeneous condition that requires personalized and multidimensional interventions.
First, in clinical practice, patients should undergo comprehensive health assessments to thoroughly analyze the biological mechanisms underlying long COVID symptoms, such as immune dysfunction, microvascular damage, and autonomic nervous system dysfunction. Therapeutic strategies targeting these mechanisms may fundamentally improve the condition, rather than solely relying on CBT and physical rehabilitation to alleviate symptoms.
Second, given the significant heterogeneity of long COVID, it is crucial to develop personalized care plans. For example, for patients with prominent respiratory sequelae, pulmonary rehabilitation may be the first choice; for those with immune dysfunction, immunomodulatory treatments could be considered; [2] for patients experiencing microvascular damage, anticoagulation therapy and interventions to improve microcirculation might be effective; while autonomic nervous system dysfunction can typically be treated with regular aerobic exercise, progressive muscle relaxation, and psychological interventions, including CBT. [1]
Third, long COVID patients may experience a range of symptoms, such as fatigue, cognitive impairments, and pain. [3] Social factors such as healthcare access, socioeconomic status, and mental health may significantly affect individuals’ experience and recovery from long COVID. [4] Patients from low-income or resource-poor regions may struggle to access the personalized treatments they need for recovery. Integrating community health workers or social workers into the care process can improve healthcare accessibility by linking patients to medical and social resources, providing health education, offering psychological counseling, emotional support, and assisting with the comprehensive management of long-term conditions.[5]
References
1. Zeraatkar D, Ling M, Kirsh S, et al. Interventions for the management of long covid (post-covid condition): living systematic review. bmj 2024;387. doi：https ://doi.org/10.1136/bmj-2024-081318
2. Velikova T, Valkov H, Aleksandrova A, et al. Harnessing immunity: Immunomodulatory therapies in COVID-19. World Journal of Virology 2024;13(2):92521. doi: 10.5501/wjv.v13.i2.92521
3. Faghy MA, Maden-Wilkinson T, Arena R, et al. COVID-19 patients require multi-disciplinary rehabilitation approaches to address persisting symptom profiles and restore pre-COVID quality of life. Expert Review of Respiratory Medicine 2022;16(5):595-600. https://doi.org/10.1080/17476348.2022.2063843
4. Zhang AY, Koroukian S, Owusu C, et al. Socioeconomic correlates of health outcomes and mental health disparity in a sample of cancer patients during the COVID‐19 pandemic. Journal of Clinical Nursing 2023;32(7-8):1173-85. https://doi.org/10.1111/jocn.16266
5. Knowles M, Crowley AP, Vasan A, et al. Community health worker integration with and effectiveness in health care and public health in the United States. Annual review of public health 2023;44(1):363-81. https://doi.org/10.1146/annurev-publhealth-071521-031648
The heterogeneity of long COVID (post-covid condition) and the need for personalized, multidimensional interventions