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Common manifestations include fatigue, post-exertional malaise, cognitive impairment, and orthostatic intolerance. Primary care clinicians are uniquely positioned to identify and manage Long COVID due to their longitudinal relationships with patients and holistic understanding of their patients\u2019 health. However, diagnostic uncertainty, time constraints, and limited access to specialty care present significant challenges, and sometimes hesitation, to addressing Long COVID in the primary care setting. This focused narrative review provides a pragmatic, primary care\u2013focused approach for the evaluation and management of Long COVID. Using patient-centered vignettes, we first describe common clinical presentations. Next, we provide a framework for the pathophysiological mechanisms suspected to contribute to persistent symptoms after SARS-CoV-2 infection. We then present a simple approach to Long COVID diagnosis and management that leverages primary care clinicians\u2019 skillset and highlights unique aspects of Long COVID care (e.g., diagnostic workup to evaluate for competing or coexisting diagnoses; management strategies focused on validation and supportive care, including activity pacing, multidisciplinary rehabilitation, and consideration of symptom-based medication trials). We offer practical strategies to effectively, yet efficiently, address a possible Long COVID diagnosis within the context of brief primary care visits (e.g., prioritize the most bothersome or addressable symptom(s) first, focus on one or two symptoms each visit, leverage longitudinal follow-up). We conclude with evidence-based strategies for prevention counseling, including infection prevention and early outpatient treatment during acute infection. While we remain optimistic that reliable diagnostic biomarkers and curative treatments will one day be available, until then, this primer supports primary care clinicians in recognizing Long COVID and supporting their patients who are living with it, despite the constraints of our current healthcare environment.<\/jats:p>","DOI":"10.1007\/s11606-026-10901-w","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:08:17Z","timestamp":1791569297000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Long COVID in Primary Care: A Practical Approach to Evaluation and Management"],"prefix":"10.1007","author":[{"given":"Anita","family":"Chopra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector F.","family":"Bonilla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8166-0806","authenticated-orcid":false,"given":"Abby L.","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"10901_CR1","doi-asserted-by":"publisher","unstructured":"Global Burden of Disease Long CC, Wulf Hanson S, Abbafati C, et al. 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ALC reports an honorarium received from Mercy Hospital for a grand rounds presentation related to Long COVID; support for travel to attend a meeting for the Substance Abuse and Mental Health Services Administration (SAMHSA) 2023 Behavioral Impacts of Long Haul COVID Expert Panel; unpaid service as a co-chair of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Long COVID Collaborative; and unpaid service as a member of the Council of Medical Specialty Societies (CMSS) Long COVID Expert Panel. HFB reports no conflict of interest.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}