Long Covid Has an Inclusivity Problem

If everyone has long Covid, no one does.

I want to help people suffering from long covid as much as anyone. But we have a real problem. In brief, we are being too inclusive. The first thing you learn, when you start studying the epidemiology of diseases, is that you need a good case definition. And our case definition for long covid sucks. Just last week, the National Academies of Sciences, Engineering, and Medicine (NASEM) issued a definition of long covid with the aim of “improving consistency, documentation and treatment”. Good news, right? Here’s the definition.

“Long COVID is an infection-associated chronic condition that occurs after SARS-CoV-2 infection and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems.”

This is not helpful. The symptoms can be in any organ system, can be continuous or relapsing and remitting. Basically, if you had COVID — and essentially all of us have by now — and you have any symptom, even one that comes and goes, for three months after that — it’s long covid. They don’t even specify that the symptom has to be new.

I’m not saying that long covid doesn’t exist. I’m not saying it isn’t weird or that it can’t present in diverse ways. But a case definition…