Multidisciplinary Center Care for Long COVID Syndrome – a Retrospective Cohort Study



Specialty Utilization Specialty utilization by a total of 1802 patients evaluated at the Comprehensive COVID Center (CCC) during the first 21 months in a total of 2361 initial visits in 12 specialty clinics. The mean number of specialty clinics visited by CCC patients was 1.3 (range 1-6) and multiple clinic consultations accounted for 405 visits.



Persistent multi-organ symptoms after COVID-19 have been termed “long COVID” or “post-acute sequelae of SARS-CoV-2 infection” (PASC). The complexity of these clinical manifestations posed challenges early in the pandemic as different ambulatory models formed out of necessity to manage the influx of patients. Little is known about the characteristics and outcomes of patients seeking care at multidisciplinary post-COVID centers.


We performed a retrospective cohort study of patients evaluated at our multidisciplinary Comprehensive COVID-19 Center (CCC) in Chicago, IL, between May 2020 and February 2022. We analyzed specialty clinic utilization and clinical test results according to severity of acute COVID-19.


We evaluated 1802 patients a median of 8 months from acute COVID-19 onset, including 350 post-hospitalization and 1452 non-hospitalized patients. Patients were seen in 2361 initial visits in 12 specialty clinics, with 1151 (48.8%) in neurology, 591 (25%) in pulmonology, and 284 (12%) in cardiology. Among patients tested, 742/878(85%) reported decreased quality of life, 284/553(51%) had cognitive impairment, 195/434(44.9%) had alteration of lung function, 249/299(83.3%) had abnormal CT chest scans, and 14/116(12.1%) had elevated heart rate on rhythm monitoring. Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19. Non-hospitalized patients with positive SARS-CoV-2 testing had similar findings than those with negative or no test results.


The CCC experience shows common utilization of multiple specialists by long COVID patients, who harbor frequent neurologic, pulmonary, and cardiologic abnormalities. Differences in post-hospitalization and non-hospitalized groups suggest distinct pathogenic mechanisms of long COVID in these populations.

Keywords: Long COVID, Post-Acute Sequelae of SARS-CoV-2 Infection, PASC, Multidisciplinary Care, Health Service Delivery

doi: 10.1016/j.amjmed.2023.05.002 [Epub ahead of print]

Author(s): Joseph Bailey, M.D.,a,⁎ Bianca Lavelle, M.D.,b Janet Miller, B.S.,a Millenia Jimenez, B.S.,c Patrick H. Lim, M.S.,c Zachary S. Orban, B.S.,c Jeffrey R. Clark, B.A.,c Ria Tomar, B.S.,a Amy Ludwig, M.D.,a Sareen T. Ali, B.S.,c Grace K. Lank, B.S.,c Allison Zielinski, M.D.,d Ruben Mylvaganam, M.D.,a Ravi Kalhan, M.D.,a Malek El Muayed, M.D.,e R. Kannan Mutharasan, M.D.,d Eric M. Liotta, M.D. M.S.,c Jacob I Sznajder, M.D.,a Charles Davidson, M.D.,d Igor J. Koralnik, M.D.,c,1 and Marc A. Sala, M.D.a,1, for the Northwestern Medicine Comprehensive COVID Center Investigators

Publication Date: 2023 May 22

Publication Site: National Library of Medicine

Northwestern Medicine shares new findings from the Comprehensive COVID-19 Center as significant demand remains for patient appointments




Long COVID occurs in approximately a third of COVID survivors and is now the third leading neurologic disorder in the United States. In May 2020, during the height of the pandemic, Northwestern Medicine physicians noticed this growing trend and established one of the first Comprehensive COVID-19 Centers in the United States to treat patients suffering from lingering impacts of the virus such as brain fog, shortness of breath and chest pain. Three years later, a new study published in the American Journal of Medicine reports key findings from more than 1,800 patients who were evaluated during the first 21 months at the Northwestern Medicine Comprehensive COVID-19 Center (CCC) with neurology, pulmonology and cardiology being the most commonly accessed specialties and still in high-demand today.  


The team evaluated 1,802 patients (350 post-hospitalization and 1,452 non-hospitalized) via telehealth or in-person at the CCC between May 2020 and February 2022. Patients were seen in 2,361 initial visits in 12 specialty clinics including neurology, pulmonology, cardiology, otolaryngology, gastroenterology, infectious diseases, endocrinology, nephrology, hematology, dermatology, psychiatry and rheumatology. Patients most commonly sought treatment from neurology (49%), pulmonology (25%) and cardiology (12%) specialists.

Among patients tested:

–        85% of patients reported decreased quality of life

–        51% had cognitive impairment

–        45% had altered lung function

–        83% had abnormal CT chest scans

–        12% had elevated heart rate on rhythm monitoring

–        Frequency of cognitive impairment and pulmonary dysfunction was associated with severity of acute COVID-19

–        Non-hospitalized patients with positive COVID-19 testing had similar findings than those with negative or no test results


–        65% of patients identified as female

–        Average age at first clinic visit was 47 years old

–        72% were White, 10% were Black, 4% were Asian and 13% were Hispanic

Publication Date: 13 Jul 2023

Publication Site: Northwestern Medical

Guidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID-19)




Certifying deaths due to post-acute sequelae of
In the acute phase, clinical manifestations and complications
of COVID-19 of varying degrees have been documented,
including death. However, patients who recover from the acute
phase of the infection can still suffer long-term effects (8).
Post-acute sequelae of COVID-19 (PASC), commonly referred
to as “long COVID,” refers to the long-term symptoms, signs,
and complications experienced by some patients who have
recovered from the acute phase of COVID-19 (8–10). Emerging
evidence suggests that severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19,
can have lasting effects on nearly every organ and organ system
of the body weeks, months, and potentially years after infection
(11,12). Documented serious post-COVID-19 conditions include
cardiovascular, pulmonary, neurological, renal, endocrine,
hematological, and gastrointestinal complications (8), as well as
death (13).

Consequently, when completing the death certificate, certifiers
should carefully review and consider the decedent’s medical
history and records, laboratory test results, and autopsy report,
if one is available. For decedents who had a previous SARSCoV-2 infection and were diagnosed with a post-COVID-19
condition, the certifier may consider the possibility that the death
was due to long-term complications of COVID-19, even if the
original infection occurred months or years before death. If it is
determined that PASC was the UCOD, it should be reported on
the lowest line used in Part I with the condition(s) it led to on the
line(s) above in a logical sequence in terms of time and etiology.
If it is determined that PASC was not the UCOD but was still a
significant condition that contributed to death, then it should be
reported in Part II. Certifiers should use standard terminology,
that is, “Post-acute sequelae of COVID-19.” See Scenario IV in
the Appendix for an example certification. In accordance with
all death certification guidance, if the certifier determines that
PASC did not cause or contribute to death, then they should not
report it anywhere on the death certificate.

Author(s): National Vital Statistics System, National Center for Health Statistics

Publication Date: updated 27 Feb 2023

Publication Site: CDC

One-Year Adverse Outcomes Among US Adults With Post–COVID-19 Condition vs Those Without COVID-19 in a Large Commercial Insurance Database


JAMA Health Forum. 2023;4(3):e230010. doi:10.1001/jamahealthforum.2023.0010



Key Points

Question  Do postacute sequelae of SARS-CoV-2 increase risks of 1-year adverse outcomes?

Findings  In this case-control study of 13 435 US adults with post–COVID-19 condition (PCC) and 26 870 matched adults without COVID-19, the adults with PCC experienced increased risks for a number of cardiovascular outcomes, such as ischemic stroke. During the 12-month follow-up period, 2.8% of the individuals with PCC vs 1.2% of the individuals without COVID-19 died, implying an excess death rate of 16.4 per 1000 individuals.

Meaning  Individuals with PCC may be at increased risk for adverse outcomes in the year following initial infection.

Author(s): Andrea DeVries, PhD1; Sonali Shambhu, BDS, MPH1; Sue Sloop, PhD1; et al

Publication Date:

Publication Site: JAMA Health Forum

Long COVID Correlates With High Mortality: Health Insurer



A giant health insurer says health plan enrollees who suffered from long COVID-19 symptoms were more than twice as likely as other enrollees to die during a 12-month follow-up period.

Andrea DeVries, a researcher at Elevance Health, and three colleagues found that, during the year studied, 2.8% of the 13,435 enrollees classified as having “post-COVID-19 condition” died, according to a study published in the JAMA Health Forum, which is affiliated with the Journal of the American Medical Association.

That compares with a death rate of just 1.2% for similar enrollees without COVID-19 during the same period.


Elevance Health is the company formerly known as Anthem. The company provides or administers major medical coverage for about 48 million people.

The DeVries looked at claim records for 249,013 Elevance plan enrollees ages and older who were diagnosed with COVID-19 from April 1, 2020, through July 31, 2020 — before regulators had adopted a long COVID diagnosis code.

The team began by identifying enrollees with COVID-19 who had been enrolled in an Elevance plan for at least five months before being diagnosed with COVID-19 and who had survived for at least two months after the diagnosis date.

Because of the lack of a long COVID-19 diagnosis code, the team used claims for other conditions, such as loss of the sense of smell, brain fog, anxiety and heart rate problems, to come up with a list of enrollees with long COVID.

Author(s): Allison Bell

Publication Date: 3 March 2023

Publication Site: Think Advisor

Long COVID Is Keeping Significant Numbers of People Out of Work, Study Finds


Source of study:

Link to study (will download):



Long COVID is having a significant effect on America’s workforce, preventing substantial numbers of people from going back to work while others continue needing medical care long after returning to their jobs, according to a new analysis of workers’ compensation claims in New York state.

The study, published Tuesday by New York’s largest workers’ compensation insurer, found that during the first two years of the pandemic, about 71% of people the fund classified as experiencing long COVID either required continuing medical treatment or were unable to work for six months or more. More than a year after contracting the coronavirus, 18% of long COVID patients had still not returned to work, more than three-fourths of them younger than 60, the analysis found.

“Long Covid has harmed the work force,” said the report, by the New York State Insurance Fund, a state agency financed by employer-paid premiums. The findings, it added, “highlight long Covid as an underappreciated yet important reason for the many unfilled jobs and declining labor participation rate in the economy, and they presage a possible reduction in productivity as employers feel the strains of an increasingly sick work force.”

Author(s): Pam Belluck

Publication Date: 24 Jan 2023

Publication Site: Yahoo (originally published at NYT)

Covid’s Drag on the Workforce Proves Persistent. ‘It Sets Us Back.’




Two-and-a-half years after Covid-19 emerged, reported infections are way down, pandemic restrictions are practically gone and life in many respects is approaching normal. The labor force, however, is not.

Researchers say the virus is having a persistent effect, keeping millions out of work and reducing the productivity and hours of millions more, disrupting business operations and raising costs.

In the average month this year, nearly 630,000 more workers missed at least a week of work because of illness than in the years before the pandemic, according to Labor Department data. That is a reduction in workers equal to about 0.4 percent of the labor force, a significant amount in a tight labor market. That share is up about 0.1 percentage point from the same period last year, the data show.


Another half a million workers have dropped out of the labor force due to lingering effects from previous Covid infections, according to research by economists Gopi Shah Goda of Stanford University and Evan J. Soltas at the Massachusetts Institute of Technology. In a Census Bureau survey in October, 1.1 million people said they hadn’t worked the week before because they were concerned about contracting or spreading the virus.

The resulting labor shortages are contributing to upward pressure on wages and inflation, one reason the Fed delivered its fourth consecutive 0.75 percentage point interest rate increase last Wednesday. On Friday, the Labor Department reported brisk job growth in October, but health-related absences remained elevated and the labor force contracted slightly.

Author(s): Gwynn Guilford and Lauren Weber

Publication Date: 7 Nov 2022

Publication Site: WSJ

What are the Implications of Long COVID for Employment and Health Coverage?




Preliminary evidence suggests there may be significant implications for employment: Surveys show that among adults with long COVID who worked prior to infection, over half are out of work or working fewer hours (Figure 2). Many conditions associated with long COVID—such as malaise, fatigue, or the inability to concentrate—limit people’s ability to work, even if they have jobs that allow for remote work and other accommodations. Two surveys of people with long COVID who had worked prior to infection showed that between 22% and 27% of those workers were out of work after getting long COVID. In comparison, among all working-age adults in 2019, only 7% were out of work. Given the sheer number of working age adults with long COVID, the employment implications may be profound and are likely to affect more people over time. One study estimates that long COVID already accounts for 15 percent of unfilled jobs.

Author(s): Alice Burns

Publication Date: 1 Aug 2022

Publication Site: KFF

The Relation Between COVID-19 and Depression



A number of studies have looked at the incidence of Long COVID, including a recently published state-of-the-art review of post-acute sequelae of severe disease.1 This indicates that 33% to 98% of survivors have symptoms or complications for at least a month. The most common of these are fatigue (28.3%‑98%), headache (91.2%), dyspnoea (13.5%‑88%), cough (10%‑13%), chest pain (5%‑42.7%), anxiety or depression (14.6%‑23%) and deficits in smell or taste (13.1%‑67%). The importance of understanding the long-term effects of COVID‑19 is vital in planning future care and management strategies. The National Institutes of Health (NIH) in the U. S. has recently allocated $470 million to build a national study population including diverse research volunteers and, to support large-scale studies on the long-term effects of COVID‑19. This is known as the NIH Researching COVID to Enhance Recovery (RECOVER) study.2


A recent study of the effects of the pandemic on anxiety and major depression has estimated a significant increase in the prevalence of both major depressive disorder, with an estimated additional 53.2 million cases worldwide, and anxiety disorders with an additional 76.2 million cases. These findings are particularly concerning because depression and anxiety were already leading causes of disability worldwide. By using the global burden of disease study model, the study gives estimates of additional disability-adjusted life-years (DALYS). Major depressive disorder caused 49.4 million DALYs, and anxiety disorders caused 44.5 million DALYS in 2020.9

Whether the increase in depression and anxiety can be solely ascribed to the effects of the pandemic or whether the disease itself can induce these conditions remains uncertain. Soon after the start of the pandemic, a UK‑wide surveillance study trying to identify neurological and neuropsychiatric complications identified patients with altered mental status, which fulfilled the clinical case definition for psychiatric diagnoses:10

21 of the 23 cases were new diagnoses.

10 had new onset psychosis.

6 had a neurocognitive syndrome.

4 had an affective disorder.

Author(s): Dr. John O’Brien, Life/Health Chief Medical Officer, London

Publication Date: Feb 2022

Publication Site: GenRe

The four most urgent questions about long COVID




But most people with COVID-19 are never ill enough to be hospitalized. The best way to assess the prevalence of long COVID is to follow a representative group of people who have tested positive for the virus. The UK Office of National Statistics (ONS) has done just that, by following more than 20,000 people who have tested positive since April 2020 (see ‘Uncertain endpoint’). In its most recent analyses, published on 1 April, the ONS found that 13.7% still reported symptoms after at least 12 weeks (there is no widely agreed definition of long COVID, but the ONS considers it to be COVID-19 symptoms that last more than 4 weeks).


In other words, more than one in 10 people who became infected with SARS-CoV-2 have gone on to get long COVID. If the UK prevalence is applicable elsewhere, that’s more than 16 million people worldwide.

The condition seems to be more common in women than in men. In another ONS analysis, 23% of women and 19% of men still had symptoms 5 weeks after infection. That is “striking”, says Rachael Evans, a clinician scientist at the University of Leicester, UK, and a member of the Post-Hospitalisation COVID-19 study (PHOSP-COVID). “If you’re male and get COVID, you’re more likely to go to hospital and you’re more likely to die. Yet if you survive, actually it’s females that are much more likely to get the ongoing symptoms.”

Author(s): Michael Marshall

Publication Date: 9 June 2021

Publication Site: Nature