Infectious Disease

WHO publishes clinical case definition for long COVID

October 06, 2021

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The WHO released a clinical case definition of long-term COVID on Wednesday that includes 12 domains and 88 words.

Using the Delphi methodology – “a structured communication technique originally developed as a systematic, interactive forecasting method based on a panel of experts,” explains the WHO document, a group of hundreds of patients, researchers, external experts, WHO- Staff and others with a working case definition they said can be used to identify long-term COVID in all clinical situations.

Doctor holds test tube that says COVID-19

The WHO has published a definition of long-term COVID. Source: Adobe Stock.

The authors defined long-term COVID as a condition that “occurs in people with a history of likely or confirmed SARS-CoV-2 infection, usually 3 months after the onset of COVID-19, with symptoms that last at least 2 months and are unexplained can”. through an alternative diagnosis. “

“Common symptoms are fatigue, shortness of breath, cognitive dysfunction, but also others and generally have an impact on everyday functions,” they wrote. “Symptoms can recur after initial recovery from an acute COVID-19 episode or persist after the original illness. Symptoms can also fluctuate or relapse over time. “

Research has shown that COVID-19 survivors can be exposed to “significant exposure to health impairment” that affects almost every organ and regulatory system in the body. An international study identified more than 200 long-term COVID symptoms.

By consensus, the WHO project participants identified 12 areas and variables that should be included in the clinical case definition:

  • History of SARS-CoV-2 infection;
  • laboratory-confirmed SARS-CoV-2 infection;
  • Minimum period from the onset of symptoms (or from a positive test for asymptomatics) of 3 months;
  • Minimum duration of symptoms of at least 2 months;
  • Symptoms including cognitive dysfunction, fatigue, shortness of breath;
  • minimal number of symptoms;
  • Accumulation of symptoms;
  • temporal course of symptoms;
  • Consequences of well-described complications of COVID-19;
  • Symptoms cannot be explained by alternative diagnosis;
  • Applying the definition to different population groups; and
  • Effects on everyday functions.

“This standardized clinical case definition will help clinicians more easily identify patients and provide them with the appropriate treatment, and is critical in driving recognition and research,” WHO told Healio. “WHO encourages all national authorities, policy makers and clinicians to adopt this definition. With a uniform definition, we hope to promote the recognition of the disease. “

With the definition “[we] will be able to better measure the burden of this disease and give us a better understanding of its global prevalence, ”said the WHO. “We hope that it will support and promote research on this topic. With a single definition, we can bring global research together and promote a globally relevant understanding of the disease. The definition is the first and as we learn more the definition will evolve. “

The WHO’s clinical definition differs from the CDC published in July, which states that people with long-term COVID may show symptoms 4 or more weeks after being infected with SARS-CoV-2.

The WHO noted that a separate definition of long-term COVID may apply to children.

References:

CDC. COVID-19. Conditions according to COVID. https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html. Accessed October 6, 2021.

WHO. A clinical case definition of conditions after COVID-19 by a Delphi consensus, October 6, 2021. https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1. Accessed October 6, 2021.

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Ziyad Al-Aly, MD

Ziyad Al-Aly

This is disappointing and ignores much of the science on long-term COVID. The report is very thin in detail and the definition is far from the everyday suffering of the millions of people with long-term COVID.

For example, we know that COVID can affect the kidneys and heart over a long period of time and lead to the onset of new diabetes. However, we do not find any of this in this new “case definition”.

This is very disappointing. The definition does not recognize the complexities of the disease and I do not see how this serves patients and communities. We are asking more of the WHO. You better do it. I am very disappointed.

Ziyad Al-Aly, MD

Director, Center for Clinical Epidemiology

Chief, Research and Development Service

Veterans Affairs St. Louis Health System

Disclosure: Al-Aly does not report any relevant financial information.

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