As the COVID pandemic rages, sadly, many survivors do not fully recover.

“Long COVID” describes those with lingering symptoms including brain fog; breathing difficulties; chronic fatigue; weakness; pain; heart, kidney and liver problems; and emotional difficulties. Such symptoms might last weeks to months and in many cases result in permanent disability. Long COVID survivors require testing and team-based rehabilitation.

About 82% of patients suffer from nervous system problems during active COVID, and those with brain swelling and confusion had a sevenfold increased risk of dying within 30 days of leaving the hospital, according to the Journal of Translational Neurology. More than half of patients complained of lasting fatigue 2-1/2 months after their illness, according to a Harvard study. The Mayo Clinic says the most common lingering symptoms are fatigue, cough, shortness of breath, headache and joint pain.

Many Long COVID survivors will require multidisciplinary rehabilitation designed to minimize suffering, optimize quality of life and help restore normal function at home, in school and at work. For the past 20 years, Manakai o Malama has offered team-based integrative services for primary care patients and injured workers. Special programs have been developed for those with chronic pain, obesity and diabetes, sleep apnea and traumatic brain injury. Those with Long COVID are quickly emerging as another growing group of patients who now require a specialized, customized approach to rehabilitation. We have been asked to treat Long COVID survivors and have begun the challenge.

Depending on the symptomatology, Long COVID survivors might require not only primary care, including naturopathic medicine and specialty medical services, but also physical and/or occupational therapy and psychological services. Fortunately, Medicare has just approved acupuncture under a physician for neurological symptoms and pain associated with the back. There are also a growing number of Long COVID-related cases of new-onset sleep apnea.

In addition to treatment, protocols also must be established for testing to ensure a safe return to work, especially when duties require careful judgment, the ability to make quick decisions and engage in multitasking, and the dexterity to operate heavy equipment. Care also must be taken to understand readiness to return to school and other educational or training environments.

Long COVID is so far underreported. For most of 2020, Hawaii has reported only the daily number of new COVID cases and related deaths in an effort to “flatten the curve” and to prevent overwhelming our health care system. We have worked to ramp up testing, and contact tracing of those found to be positive. Hawaii’s leadership has carried the burden of fighting the pandemic while also working to minimize the devastating economic fallout. We are now at grave risk of facing a third surge into the holidays as Long COVID cases continue to grow.

While we may be successful in slowing COVID’s rate of spread, enough to avoid overwhelming our hospital system and its ICU beds and ventilators, Hawaii also must turn its attention to flattening this newly discovered curve, that of Long COVID.

Many already have begun to complain that they feel isolated and abandoned by their providers once they have made it through the infectious period.

Amid the pandemic, a compromised visitor industry, a struggling economy and the need to address climate change, it feels overwhelming to consider one more pressing need among the people of Hawaii, but it cannot be ignored. Long COVID is an issue of critical and mounting importance. We can do this.

Ira Zunin is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center. His column appears the first Saturday of every month. Please submit your questions to info@manakaiomalama.com.