Answering Our Call to Care: Introduction to the Special Issue on Long Covid

The novel coronavirus 2019 (COVID-19) pandemic largely has faded from the daily news, but it still plays a prominent role in our daily reality. In 2023, COVID-19 was the cause of death for 76,000 people—still averaging over 200 people per day—and remained among the Top 10 leading causes of mortality in the United States.1 COVID-19 infections seem almost ubiquitous now, as community-based mitigation efforts have waned and vaccine uptake in the population has remained low. Testing and reporting for SARS-CoV-2, the virus that causes COVID-19, have become greatly diminished. Identifying cases, changes in clinical presentation based on variants, and potentially associated heath conditions is now much more difficult, because acute infections are substantially under-reported. But beyond the direct consequences of acute infections, COVID-19 has led to the emergence of a quieter yet deeply impactful medical and public health challenge of our times—Long Covid. Perego,2 a social scientist, coined Long Covid in May 2020 based on her daily experience of wrestling with its deleterious effects. Early in the COVID-19 pandemic, people living with Long Covid used this term on social media to share about their disabling signs and symptoms that were either a prolongation of the acute phase of illness or reappeared after short period of apparent recovery.3 Many of the earliest researchers in Long Covid were the patients themselves. By turning a scholarly lens on their own experiences, patients created the first empirical descriptions of Long Covid. These included profound and disabling fatigue, cognitive dysfunction, shortness of breath, loss of taste and smell, poor digestion, new-onset allergies and chemical sensitivities, and a whole host of other debilitating signs and symptoms.4 Their early work challenged the easy narrative that outcomes of COVID-19 fit into a neat binary of “surviving” versus “not surviving.” Indeed, early scholarship by people living with Long Covid influenced the medical and scientific communities, which were largely focused on treating acute infections and mortality, to also consider the emergence of this new form of chronic disease. It is an important recent example of how patient-led movements can help shape the trajectory of medicine and public health if we choose to listen. The term Long Covid is an important banner under which millions of people have now organized to demand acknowledgement and action—our call to care. It is also now well-established as a biological disease process. The exact cause of Long Covid is still not yet clear, but much is known about the disease. Long Covid is now understood as a chronic multisystem disease with over 200 signs and symptoms potentially caused by numerous pathophysiological processes.4 These include impairments in bioenergetic, cardiovascular, immune, neurological, gastrointestinal, and reproductive functioning. There are no approved biomarkers or tests for Long Covid and treatment is still mainly supportive in scope. Long Covid continues to challenge our traditional siloing of medical and scientific expertise, because it requires a multisystemic approach that centers lived experience. No area of our clinical practice excludes Long Covid signs, symptoms, and disablement. We all must be ready to answer the call to care. Long Covid is the newest member of a whole family of existing chronic complex diseases frequently preceded by an infection. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a multisystemic chronic complex disease that may present following an illness.5,6 Like Long Covid, there are no approved tests or cures for ME/CFS, and ME/CFS is identified using case definition criteria.7 Many people with Long Covid demonstrate postexertional malaise,8-10 the clinical hallmark of ME/CFS.7 The ME/CFS phenotype of Long Covid tends to be more prevalent among individuals with more prolonged disability.11 The overlaps between Long Covid and ME/CFS invite us to learn from an established history that continues on to the present day. Experiences of people with ME/CFS and other infection-associated chronic conditions highlight systemic issues in health care, including dismissal and bias from members of the medical and scientific communities.12 Arguably, under-investment in research into ME/CFS13 has put us behind in developing the basic and clinical science necessary to develop tests and treatments for Long Covid. We are still working to catch up. Long Covid has shined a bright light on chronic complex conditions preceded by an infection, but related and comorbid conditions must not be relegated to its shadows. In addressing Long Covid, we now must answer related calls to care that we previously ignored. A century ago, at the dawn of physical therapy in the United States, our forebears answered the call to care of their time to alleviate the suffering of poliomyelitis. They used the best available techniques of the day and helped to develop new strategies. Similarly, Long Covid has become our generation's call to improve understanding, health-related quality of life, and equity for a new of group people who are disabled, suffering, and require our care after illness related to an infection. I am pleased to present this Special Issue on Long Covid of the Cardiopulmonary Physical Therapy Journal to help answer our call to care. It includes a blend of primary research data, documentation of clinical reasoning, and descriptions of lived experience from an international roster of authors. 1. Laswell14 shares an essay relating her lived experience with Long Covid from her perspectives as patient and clinician, 2. Clancy and Dekerlegand15 present the results of a Long Covid practice survey from a multidisciplinary sample of rehabilitation providers in the United States, 3. Peirce et al16 provide a clinical model for safe physical therapy assessment and intervention approaches for individuals with Long Covid, 4. Rozanski et al17 contribute a cross-sectional study relating cognitive functioning and clinical outcomes in a sample of people living with Long Covid, 5. Skiffington and Breen share clinical approaches to addressing cognitive dysfunction related to Long Covid,18 6. Cheng et al19 describe a model of care using shared medical appointments to address financial barriers and equity while providing high-quality information and peer support for people living with Long Covid, 7. Steere20 provides a clinical perspective on the use of heart rate variability for biometric monitoring in various health conditions including Long Covid, 8. Wright et al21 share a case study involving the use of enoxaparin to address symptoms and functioning in a person living with Long Covid, 9. Pereira et al22 contribute a study of health-related quality of life and functional status in a cohort of people with Long Covid, 10. Bates and Gustavson23 describe a case study involving a manual therapy approach for a person living with Long Covid, and 11. Anderson and Bauer24 present the rationale and clinical recommendations for providing virtual physical therapy care for people living with Long Covid. There were so many high-quality submissions that we could not include them all in this issue. Please continue to watch for additional Long Covid scholarship in upcoming issues of the Journal and on the Journal's website (https://journals.lww.com/cptj). Thank you to all the authors both for their work and for choosing this Special Issue as a home for it. I am also grateful to the Journal's Editorial Board and its Editor-In-Chief Dr. A. Gurovich for entrusting and partnering with me to assemble this Special Issue. This collective effort is another step forward toward more understanding, more effective treatments, and more compassion for people with Long Covid. Together, let us continue to answer our call to care.