2022

Treatment of 'long COVID' hampered by limited research data, UCLA-led report says


In a new report, Dr. Joann Elmore says research into 'long COVID' is hampered by research data of varying quality and consistency.

Close-up of COVID-19 virus

In a new report, researchers say the challenges of treating long COVID are amplified by a critical issue: we do not know what constitutes long COVID or how to formally diagnose it, an issue that is further exacerbated by limited research data of varying quality and consistency.

Early reports foretell a difficult challenge with long COVID, which researchers call Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Some patients with prior acute COVID-19 cases have continued to report new or persistent health issues affecting nearly every organ system.

“We need high-quality data and information that supports an accurate diagnosis before patients can receive appropriate supportive care and effective, disease-specific therapy,” said Dr. Joann Elmore, UCLA Fielding School of Public Health professor of health policy and management, and professor at the David Geffen School of Medicine at UCLA. “The scientific research community will need to be able to provide data that helps the medical community to distinguish long COVID symptoms from those of other illnesses.”

Writing in the March edition of the Annals of Internal Medicine, Elmore and her co-authors point out that while PASC has been approved for inclusion and protections within the Americans with Disabilities Act, which has strict medical and legal paperwork requirements, there is limited study data or medical consensus on what constitutes long COVID.

“The first challenge when studying any disease is knowing how to diagnose it, and although we have seen serious medical consequences stemming from COVID-19, we do not yet have definitive diagnostic criteria,” said Dr. Lauren E. Wisk, a researcher with the UCLA Fielding School of Public Health's UCLA Kaiser Permanente Center for Health Equity and the Division of Internal Medicine and Health Services Research in the David Geffen School of Medicine at UCLA, the article’s first author. “We believe that as more high-quality data emerges, the current list of symptoms will become better refined, and the timing and duration of symptoms will become clearer. So far, however, these have remained elusive.”

Although multiple studies are in progress, the authors say making useful comparisons across studies are nearly impossible without uniformly applied criteria. They also point out that researchers must contend with confounding issues in study design that can skew results, such as biases that can result from patient’s own recollection and clinicians’ interpretation of symptoms.

“Due to the dynamic nature of the virus itself and the technology available to test, monitor, and treat infection, substantial variation may exist in apparent clinical presentation of PASC,” the authors write. “Now more than ever, we must implement robust, standardized, longitudinal assessments of health and well-being across systems and settings, including premorbid evaluation, to facilitate real-time monitoring of trends.”

In addition to recall and surveillance bias, study selection bias and health care access could produce misleading results, according to the article.

“People who were already vulnerable to socioeconomic and racial or ethnic disparities – people who often have limited access to health care – have disproportionately borne the burden of the COVID-19 pandemic," Wisk said. "Now, inequities in the development, presentation and documentation of long COVID-19 may also be accentuated.” 

The authors offer potential solutions to ensure equity in future study and treatment, first urging the medical community to come together on a case definition that can be consistently applied. They further recommend that researchers implement robust and standardized measures of potential risk factors and outcomes; consider risk of bias when designing studies; take steps to facilitate cross-study comparisons; and to “be judicious in application of this evolving evidence as we all strive to provide effective and efficient care that reduces prior inequities.”

Funding: Financial support was provided under contract 75D30120C08008 from the National Center for Immunization and Respiratory Diseases of the Centers for Disease Control and Prevention

Citation: Toward Unbiased Evaluation of Postacute Sequelae of SARS-CoV-2 Infection: Challenges and Solutions for the Long Haul Ahead, Ann Internal Medicine 2022, DOI: 10.7326/M21-4664

by David Sampson


The UCLA Fielding School of Public Health, founded in 1961, is dedicated to enhancing the public's health by conducting innovative research, training future leaders and health professionals from diverse backgrounds, translating research into policy and practice, and serving our local communities and the communities of the nation and the world. The school has 761 students from 26 nations engaged in carrying out the vision of building healthy futures in greater Los Angeles, California, the nation and the world.

Faculty Referenced by this Article

Dr. Joann Elmore
Joann G. Elmore
Health Policy and Management
Read Faculty Profile
silhoette
Ty Robbins
Health Policy and Management
Read Faculty Profile
Rosenstock
Linda Rosenstock
Environmental Health Sciences Health Policy and Management
Read Faculty Profile
Diana Hilberman
Diana Hilberman
Health Policy and Management
Read Faculty Profile
Freund, Deborah
Deborah Anne Freund
Health Policy and Management
Read Faculty Profile
Dr. Kristen Choi
Kristen Choi
Health Policy and Management
Read Faculty Profile
Patricia Ganz
Patricia Ganz
Health Policy and Management
Read Faculty Profile
Kadiyala, Srikanth
Srikanth Kadiyala
Health Policy and Management
Read Faculty Profile
Dr. Kenneth Wells
Kenneth Wells
Health Policy and Management
Read Faculty Profile
Image of Dr. Susan Ettner
Susan Ettner
Health Policy and Management
Read Faculty Profile
Dr. Stephanie Taylor
Stephanie L. Taylor

Nationally recognized health services researcher and sociomedical scientist with 25+ years' experience in effectiveness and implementation research.

Health Policy and Management
Read Faculty Profile
Yusuke Tsugawa
Yusuke Tsugawa
Health Policy and Management
Read Faculty Profile
Dr. Elizabeth (Becky) Yano
Elizabeth (Becky) Yano
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Brennan Spiegel
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Thomas Priselac
Health Policy and Management
Read Faculty Profile
Dr. Arturo Vargas Bustamante
Arturo Vargas Bustamante
Health Policy and Management
Read Faculty Profile
Dr. Anthony Schiff
Anthony Hunter Schiff
Health Policy and Management
Read Faculty Profile
Dr. Beth Glenn
Beth Glenn
Health Policy and Management
Read Faculty Profile
Dr. Jonathan Fielding
Jonathan Fielding
Health Policy and Management
Read Faculty Profile
Dr. Dylan Roby
Dylan Roby
Health Policy and Management
Read Faculty Profile
Dr. Xi Zhu
Xi Zhu
Health Policy and Management
Read Faculty Profile
James Macinko
James Macinko

Professor of Community Health Sciences & Health Policy and Management, and Associate Dean for Research

Community Health Sciences Health Policy and Management
Read Faculty Profile
Michelle Keller
Michelle S. Keller

Dr. Michelle S. Keller is a health services researcher whose research focuses on the use and prescribing of high-risk medications.

Health Policy and Management
Read Faculty Profile
Dr. Felicia Hodge
Felicia Hodge
Health Policy and Management
Read Faculty Profile
Vickie Mays
Vickie Mays
Health Policy and Management
Read Faculty Profile
Moira Inkelas
Moira Inkelas
Health Policy and Management
Read Faculty Profile
Jody Heymann
Jody Heymann
Epidemiology Health Policy and Management
Read Faculty Profile
Paul Chung
Paul Chung
Health Policy and Management
Read Faculty Profile
Mangione, C
Carol Mangione
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Barbara Berman
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Annette Maxwell
Health Policy and Management
Read Faculty Profile
Isomi Miake-Lye
Isomi Miake-Lye
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Steven Teutsch
Health Policy and Management
Read Faculty Profile
Dr. Lillian Gelberg
Lillian Gelberg
Health Policy and Management
Read Faculty Profile
Dr. Ninez Ponce
Ninez Ponce
Health Policy and Management
Read Faculty Profile
Robert Kaplan
Robert Kaplan
Health Policy and Management
Read Faculty Profile
Dr. Thomas Rice
Thomas Rice
Health Policy and Management
Read Faculty Profile
Dr. Yvonne Flores
Yvonne Flores
Health Policy and Management
Read Faculty Profile
Olivia Jung
Olivia Jung
Health Policy and Management
Read Faculty Profile
Avram Kaplan
Avram Kaplan
Health Policy and Management
Read Faculty Profile
Nadereh Pourat
Nadereh Pourat
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Alan Tomines
Health Policy and Management
Read Faculty Profile
Davidson - headshop
Pamela Davidson
Health Policy and Management
Read Faculty Profile
Dr. Paul Fu, Jr.
Paul Fu, Jr.
Health Policy and Management
Read Faculty Profile
Dr. John Lu
Z. John Lu
Health Policy and Management
Read Faculty Profile
Dr. Jennifer Wortham
Jennifer Wortham
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Robert Brook
Health Policy and Management
Read Faculty Profile
Comanor, Bill
William Comanor
Health Policy and Management
Read Faculty Profile
Clifford Ko
Clifford Ko
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Arlene Fink
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Emmeline Chuang
Health Policy and Management
Read Faculty Profile
Balgrosky headshot
Jean Balgrosky
Health Policy and Management
Read Faculty Profile
Warren Scott Comulada
Warren Scott Comulada
Health Policy and Management
Read Faculty Profile
Gordon headshot
Thomas D. Gordon
Health Policy and Management
Read Faculty Profile
Dr. Aria Fallah
Aria Fallah
Health Policy and Management
Read Faculty Profile
Laura Erskine
Laura Erskine
Health Policy and Management
Read Faculty Profile
Michael Ong
Michael Ong
Health Policy and Management
Read Faculty Profile
Sangeeta Ahluwalia
Sangeeta Ahluwalia
Health Policy and Management
Read Faculty Profile
Roshan Bastani Headshot
Roshan Bastani
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Julie A. Elginer

EMPH Academic Program Director with expertise in healthcare marketing, finance, and reproductive health policy, teaching in the EMPH, MPH, MHA program

Health Policy and Management
Read Faculty Profile
Leah Vriesman
Leah Vriesman
Health Policy and Management
Read Faculty Profile
Gerald Kominski
Gerald Kominski
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Jose J. Escarce
Health Policy and Management
Read Faculty Profile
Galper, Michael
Michael Galper
Health Policy and Management
Read Faculty Profile
Jeanne Miranda
Jeanne Miranda
Health Policy and Management
Read Faculty Profile
Dr. Frederick Zimmerman
Frederick Zimmerman
Health Policy and Management
Read Faculty Profile
Dr. Risha Gidwani
Risha Gidwani
Health Policy and Management
Read Faculty Profile
Ron D. Hays
Ron D. Hays

@UCLA since 1997

Health Policy and Management
Read Faculty Profile
Dr. Samuel Sessions
Samuel Sessions
Health Policy and Management
Read Faculty Profile
Jack Needleman
Jack Needleman
Health Policy and Management
Read Faculty Profile
Dr. William McCarthy
William J. McCarthy
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Lori Pelliccioni
Health Policy and Management
Read Faculty Profile
Burt Cowgill
Burt Cowgill
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Neal Halfon
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
David Hayes-Bautista
Health Policy and Management
Read Faculty Profile
Dr. Naomi Zewde
Naomi Zewde
Health Policy and Management
Read Faculty Profile
Dr. Daniel Eisenberg
Daniel Eisenberg
Health Policy and Management
Read Faculty Profile
Aronberg, Sandra
Sandra Aronberg
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Ron Andersen

Dr. Ron Andersen is the Wasserman Professor Emeritus in the UCLA Departments of Health Policy and Management.

Health Policy and Management
Read Faculty Profile
Dr. Alice Kuo
Alice Kuo
Health Policy and Management
Read Faculty Profile
Emily Abel
Emily Abel
Health Policy and Management
Read Faculty Profile
Faculty/staff profile placeholder image
Mark Litwin
Health Policy and Management
Read Faculty Profile
Corrina Moucheraud
Corrina Moucheraud
Health Policy and Management
Read Faculty Profile

Related Content

2023.12.18_anxious-woman-rubbing-her-hands.jpg
December 18, 2023
Recent immigrants saw biggest spike in mental distress as anti-immigrant sentiment increased

UCLA study shows rate of serious psychological distress more than doubled for those in U.S. fewer than five years

Source: UCLA FSPH CHPR Read Full Article
2023.10.04_CHPR_CHIS_NewsRelease_visual
October 4, 2023
California Health Interview Survey reveals alarming rates of food insecurity, hate incidents, mental health concerns, and challenges in accessing needed care

Comprehensive data from the 2022 California Health Interview Survey highlights persistent health inequities impacting Californians.

Read Full Article