Response.

To the Editor:

We read the letter to the editor from Drs Yu and Kelly regarding our published review with great interest. We agree that successful long COVID/post-COVID care structures require primary care involvement, either by way of direct incorporation or close collaboration, depending on local resources. In both cases, post-acute sequelae of COVID-19 (PASC) clinics can serve as hubs for dissemination of rapidly evolving PASC knowledge via events such as continuing medical education conferences and one-on-one consultations. We appreciate the e-consult and tumor board framework that you have implemented and welcome such creativity in leveraging institutional strengths to customize a multidisciplinary approach to the care of patients recovering from COVID-19.

We also wish to emphasize the importance of concentrated clinical and research efforts to recognize patterns in PASC. A benefit of dedicated PASC clinics is an opportunity to define, test, and operationalize effective care strategies. Such evidence-based care can then be disseminated broadly to all physicians who encounter patients with PASC to advance the care of this growing population. For example, it is important for clinical and research leaders to remain up to date with evolving PASC guidelines and the development of core outcome measures. Local resources and capacity will determine whether these clinical structures derive leadership from primary care, pulmonary medicine, physical medicine and rehabilitation, or other specialties as is the case in PASC clinics across the United States. We advocate strongly for a concentrated leadership model, regardless of the primary discipline, while the knowledge base is being developed. This provides a central resource to coordinate the care of often complex presentations. The pre-COVID-19 literature in recovery from acute care that requires hospitalization, including in the ICU, has jumpstarted comprehensive care of survivors of COVID in these populations and provided a substantive framework for the care of those who did not require hospitalization. Importantly, PASC clinics provide a structure for the identification of similarities and differences between patients with initial mild vs moderate-to-severe COVID-19 illness to further tailor management approaches.

Ultimately, necessary and sufficient care will require cooperation across multiple disciplines, especially primary care, to advocate for essential resources; together, we can overcome this challenge. We applaud your novel approach and look forward to learning about more innovative methods from our national and international colleagues as we collectively join our patients in confronting PASC/long COVID.