A 27-year-old man presents to urgent care with complaints of persistent fatigue, intermittent mild chest pain, and dyspnea on exertion. He had COVID-19 around 3 months ago, confirmed by multiple at-home tests. He has never been vaccinated for SARS-CoV-2. He says he was sick with COVID for about a week, with symptoms of sore throat, cough, headache, fatigue, and mild fever. Those symptoms resolved, but these new symptoms emerged a few weeks later and have persisted. He is not able to exercise and sometimes has trouble climbing the stairs to his third-floor apartment. He reports that he was previously healthy and exercised regularly. He says his girlfriend suggested he might have long COVID, and he asks you if this is possible. Which of the following statements about this patient is CORRECT?
- Long COVID is unlikely because he is young, healthy, and did not experience severe illness with COVID-19.
- Long COVID is a reasonable diagnosis if his physical examination, ECG, chest x-ray, and vital signs are normal at this visit.
- Long COVID is on the differential, but a definitive diagnosis of long COVID will not be made during this urgent care visit.
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Answer: C. Given this patient’s symptoms, history of COVID-19, and the risk factor of being unvaccinated, the possibility of long COVID should not be completely dismissed. However, long COVID is a diagnosis of exclusion. The goal of patient evaluation in the urgent care setting is not necessarily to establish the specific diagnosis of long COVID, but rather to exclude other syndromes that may pose a more serious and acute threat, regardless of the relationship to COVID.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
