Long COVID: Key Features and Current Trends in Management

Long COVID, or Post-Acute Sequelae of COVID-19 (PASC), has emerged as a major public health challenge, affecting a substantial minority of people months to years after the acute illness. Recent cohort studies and meta-analyses suggest that 10-30% of infected individuals report persistent symptoms, with some series indicating that ~45% still experience complaints four months after infection, and higher prevalence in lower- and middle-income settings. Clinically, Long COVID is heterogeneous, with cardinal manifestations including fatigue, exertional intolerance, dyspnea, chest pain, dysautonomia, sleep disturbance, cognitive impairment (“brain fog”), headache, myalgia, and a range of neuropsychiatric, cardiovascular and gastrointestinal symptoms. Reported risk factors include female sex, higher Body Mass Index (BMI), smoking, comorbidities such as diabetes and hypertension, severe acute COVID-19, prolonged hospitalization or ICU stay, and a high burden of symptoms during the acute phase. Pathogenesis is likely multifactorial, involving viral persistence, immune dysregulation, autoimmunity, endothelial dysfunction, dysautonomia, and mitochondrial and metabolic dysfunction affecting multiple organ systems. Management is therefore complex and symptom-directed, emphasizing careful phenotyping, rehabilitation, psychological support, and secondary prevention of complications. The Johns Hopkins Post-Acute COVID-19 Team (PACT) at the Bayview Medical Center in Baltimore provides a model of multidisciplinary care: a collaborative, ambulatory program led by pulmonary and critical care medicine and physical medicine and rehabilitation, and integrating neurology, psychiatry, pharmacy, primary care, and other subspecialties. Using a multi-pronged approach that combines standardized assessment, tailored pharmacologic and non-pharmacologic interventions, structured rehabilitation, and coordinated follow-up, PACT addresses clusters of respiratory, neurocognitive, mental health and functional impairments in a single care pathway. This model illustrates how interdisciplinary, post-acute clinics can respond to the complex needs of long COVID “long-haulers”, while simultaneously generating data to refine definitions, clarify mechanisms and improve evidence-based treatment.