UVM pulmonologist outlines long COVID symptoms, diagnostic challenges and limited treatment evidence

Dr. Catherine Minson, assistant professor of pulmonology and critical care at the University of Vermont, told the Senate Health and Welfare committee that long COVID can follow mild or moderate acute infections and is defined differently by public-health bodies.

“The CDC recognizes long COVID as being after greater than 4 weeks after acute illness,” Minson said, while other organizations use longer timelines. She emphasized that symptoms “can be regardless of how acute the initial infection was” and that a key feature for many patients is post-exertional malaise (PEM), a condition in which activity — physical or cognitive — precipitates hours-to-days of symptom worsening.

Minson summarized common symptom clusters observed in research: patients with primarily gastrointestinal or ENT complaints; those with cardiac and neuropsychiatric problems; and a third group with extra-pulmonary manifestations. She described several hypothesized mechanisms, including immune dysregulation, persistent inflammation, viral remnants and reactivation of viruses such as Epstein-Barr.

On diagnosis and care, Minson said the approach used at UVM emphasizes identifying cases in the medical home, ruling out alternative causes, and referring to rehabilitation specialists when appropriate. She listed practical management strategies for fatigue and PEM — planning, pacing, prioritizing and positioning — and noted that cognitive behavioral therapy has shown benefit for some fatigue symptoms.

Minson reviewed the research landscape: the NIH RECOVER initiative aims to identify treatments for different patient cohorts, but evidence remains mixed. She said one RECOVER neuro trial found three cognitive training programs were not helpful and that smaller trials of interventions such as hyperbaric oxygen have had limited sample sizes and mixed results. “We don't yet have the data” to recommend hyperbaric therapy broadly, she said.

Minson also described UVM’s recovery program model, which was developed with family medicine and internal medicine leads to make diagnoses in primary care and then route patients to appropriate rehabilitation. She said UVM and partners have pursued clinician education through AHEC and Grand Rounds to spread protocols statewide.

Committee members thanked Minson for the overview; the panel said the information will inform discussions with state health partners about education, clinic capacity and referral pathways.