Long COVID Remains a Complex Challenge, Experts Say at Infectious Disease Week 2025
Meta Description: Experts at Infectious Disease Week 2025 highlighted the ongoing complexities of long COVID, emphasizing the need for multidisciplinary care and increased research into treatments and support.
Five years after the start of the COVID-19 pandemic, long COVID – formally known as post-COVID-19 sequelae – continues to be a growing concern, with a fragmented landscape of research, treatment options, and patient support. At the Infectious Disease Week 2025 annual meeting held October 20th in Atlanta, Georgia, leading experts stressed that long COVID remains a complex, heterogeneous syndrome requiring collaborative, multidisciplinary approaches to provide effective frontline support and address the myriad challenges faced by patients.
The expert panel featured moderators Zanthia Wiley, MD, associate professor of medicine at Emory University School of Medicine, and Michael Peluso, MD, assistant professor at University of California San Francisco. Featured panelists included Marta Cerda, Juris Doctor, CEO of ASI Home Care; Melissa Stockwell, MD, MPH, from the department of pediatrics at Columbia University Irving Medical Center; and Igho Ofotokun, MD, MSc, FIDSA, Grady distinguished professor of medicine at Emory University School of Medicine.
The Varied Lived Experience of Long COVID
Presentations centered on the lived experiences of patients, alongside updates on potential therapeutics, ongoing research, and the unique challenges of managing long COVID in pediatric, adolescent, and adult populations. Cerda, sharing her personal journey with the condition, described a constellation of symptoms impacting multiple systems, including cardiovascular (heart palpitations), digestive (nausea), musculoskeletal (leg inflammation), respiratory (scarred lungs, shortness of breath), nervous (headache, brain fog, dizziness), and integumentary (rashes).
Cerda powerfully urged the audience to empathize with those living with these often-debilitating symptoms, particularly those that are frequently dismissed or disbelieved by others. “Imagine going to work knowing that your brain does not function the way it used to. Imagine people not believing that all of this is happening to you. Please do not let millions of us suffer with long COVID,” Cerda pleaded. “We do not want to lose hope for our future.”
Addressing Roadblocks in Pediatric and Adolescent Long COVID Research
A significant focus of the discussion was the persistent misconceptions surrounding long COVID, particularly in children and adolescents. Stockwell directly addressed the prevalent belief that children are not susceptible to developing long COVID. “We know that long COVID is a significant pediatric public health problem,” she stated, citing estimates suggesting that between 2% and 10% of children infected with COVID-19 experience long COVID symptoms. This translates to a potential 1.3 to 6.5 million children affected – a number exceeding the prevalence of childhood asthma, epilepsy, or cancer. In Stockwell’s assessment, “Long COVID is not rare.”
Stockwell outlined the difficulties in advancing research, including inconsistent symptom presentation in children, particularly younger ones who struggle to articulate their experiences, and a lack of standardized definitions for childhood long COVID across studies. However, through the Researching COVID to Enhance Recovery (RECOVER) initiative, and specifically the RECOVER-Pediatrics observational study, researchers are working to characterize long COVID in children and adolescents and develop an age-specific Long COVID research index to aid in diagnosis. Despite these efforts, Stockwell emphasized the current “dearth of specifically dedicated pediatric long COVID trials,” stressing the urgent need for further research to understand symptom relief and underlying mechanisms. “We need to protect children through research and not from research,” she concluded. “It’s really important we continue our pediatric trials.”
Navigating Therapeutic Challenges
Ofotokun highlighted the significant hurdles in research and development, stemming from the incomplete understanding of long COVID’s underlying pathology. Echoing Stockwell’s concerns, he noted that the lack of a universal definition and the wide variability in disease trajectory complicate clinical trial interpretation.
Current therapeutic approaches are being evaluated across three main categories: antivirals, immune modulators, and symptomatic relief. Trials evaluating nirmatrelvir-ritonavir (Paxlovid; Pfizer) – FDA-approved for acute COVID-19 – have generally shown limited efficacy in treating long COVID. Recent studies, including research published in The Lancet Infectious Disease by Sawano et al, found that a 15-day course of nirmatrelvir-ritonavir did not significantly improve health outcomes compared to placebo-ritonavir. Similarly, a trial published in JAMA Internal Medicine by Geng et al, while demonstrating safety, showed no significant benefit for improving specific long COVID symptoms.
However, potential avenues are being explored. Low-dose naltrexone (Vivitrol; Alkermes, Inc), originally approved for opioid use disorder, is being investigated for its potential anti-inflammatory properties. Additionally, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as tirzepatide (Monjouro, Zepbound; Eli Lilly and Company), are being considered for symptom relief, even at microdoses that do not induce weight loss. For symptomatic relief, Ofotokun mentioned stellate ganglion blocks as a potential method for improving neurovascular, neurocardiac, and neuroinflammatory presentations.
The Crucial Role of Pharmacists
Ofotokun acknowledged that “there is a lot of work to be done to come to the state where we have an effective treatment for long COVID.” In the interim, pharmacists are emerging as critical players in patient care. Stockwell agreed, suggesting pharmacists could serve as “first-line responders,” referring patients to specialists and encouraging parents to seek evaluation for their children. Pharmacists can “really try to get the message as much as possible to anybody that long COVID exists, that it can look different than in adults, and that you should talk to your pediatrician” to consider evaluation.
Ofotokun emphasized the importance of patient validation, noting that patients often feel dismissed by healthcare providers. Pharmacists can play a vital role in acknowledging patients’ experiences and recognizing underlying biological abnormalities. Furthermore, while direct long COVID treatments are still under development, pharmacists can prescribe medications to manage individual symptoms. Peluso added that pharmacists, “are a really critical and often underappreciated member of the team,” particularly in clinics, where they can assess potential drug-drug interactions with patient-experimented combinations or supplements. “Having a pharmacist on the team to really be on the lookout for those potential issues and help navigate them is really important,” Peluso explained.
