WORKSHOP LIVE DISCUSSION: A Psychosomatic Framework for Considering the Long-term Sequelae of COVID-19 [INVITED SESSION]

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Millions of people have been infected with the SARS-CoV-2 virus in the United States and around the world. As the pandemic continues, it is becoming increasingly apparent that a significant portion of patients have not been able to return to their pre-infection health status. The large numbers of individuals with persistent (Long COVID) symptoms present important problems for public health officials, health care and disability payers, employers, communities, families, and patients themselves. They present an equally difficult conundrum for health care professionals across many specialties who are attempting to manage their COVID sequelae. Initial clinical observations and emerging epidemiologic research has identified several key challenges: (1) Myriad persistent symptoms have been reported in patients who have been infected with SARS-CoV-2, some linked to specific complications of acute infection, many not. (2) The time course of persistent symptoms is variable with some emerging during the acute stage of infection and continuing chronically whereas others appear later in the course of illness. (3) Relationships between the severity and recovery from acute illness, the nature and severity of persistent symptoms, and severity of long-term handicap are variable. These and other factors have made it difficult to conceptualize specific clinical phenotypes that may organize diagnostic evaluations, lead to specific therapeutic interventions, and inform research into potential pathogenic mechanisms. It is not yet clear if Long COVID arises from pathophysiologic processes uniquely triggered by SARS-CoV-2 or mechanisms of illness (structural, functional, and psychiatric) that have been observed as sequelae of other viral infections or other acute diseases more generally. This symposium will not attempt to answer all of these questions, but rather frame them in a psychosomatic context that will encourage C-L psychiatrists to use their skills and experience to treat patients with symptoms that persist after SARS-CoV-2 infection and contribute to research and education about the various manifestations of Long COVID.

Dr. Staab will set the stage for the symposium with an overview of mechanisms that are familiar to C-L psychiatrists (predisposing, precipitating, provoking, and perpetuating processes) and how they may be applicable to Long COVID (10 minutes). Dr. Hurt will review emerging epidemiologic, phenotypic, and pathophysiologic data that have begun to identify mechanisms of structural injury (e.g., cardiac and pulmonary lesions) and alterations in physiologic processes (immunologic, autonomic) that may underlie the presentations of specific groups of patients (20 minutes). Drs. Hamm and Coulter will describe psychiatric disorders (primary and secondary) in patients who have been infected with SARS-CoV-2 and those undergoing treatment for its complications (20 minutes). Dr. Bieber will discuss psychosocial consequences of the pandemic particularly for children of affected families (20 minutes). Then, all presenters will gather as a panel to engage the audience in discussion (20 minutes).