Mount Sinai releases the nation's first clinical manual for infection-associated chronic illnesses, co-written by Dr. Raven Baxter

Mount Sinai released the country's first clinical manual for treating infection-associated chronic illnesses on Aug. 13, 2025. Dr. Raven Baxter, Director of Science Communication at the Cohen Center for Recovery from Complex Chronic Illness, co-authored the 180-page guide.

The manual is free to any clinician. It covers long COVID, long Lyme disease, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Ehlers-Danlos syndrome. It runs from diagnosis in conditions with few or no definitive biomarkers to long-term care and patient communication. Sections address brain fog, mast cell activation and post-exertional malaise. More than a dozen experts in the United States and abroad reviewed it, according to the release.

David Putrino, PhD, the center's Nash Family Director, said 400 million people around the world have experienced long COVID. "Our clinic can only take on around 700 new patients a year, so clearly there's a huge discrepancy there," he said in the release.

The first edition of the manual, released Aug. 13, 2025. Baxter is not pictured. Image: Mount Sinai Cohen Center for Recovery from Complex Chronic Illness

The manual followed changes in how science and government treat long COVID. In June 2024, the National Academies issued a new definition that classed long COVID as an infection-associated chronic condition. In March 2025, Scientific American reported that HHS was closing its Office of Long COVID Research and Practice. The magazine put the number of people in the U.S. with long COVID at an estimated 23 million. A day later, a University of Surrey study found that people with long COVID often feel dismissed and disbelieved by clinicians.

"Infection-associated chronic illnesses remain disabling, costly, and widely misunderstood across much of medicine," Baxter said in the release. "Recent research from our team shows that even a single well-designed educational intervention can dramatically increase clinicians' confidence, preparedness, and empathy in managing these conditions." She called the manual "a proactive answer to calls for better training, less stigma, and more practical support for both new and experienced clinicians."

Baxter described the manual in May 2025 on Raise the Line, the podcast from Osmosis from Elsevier. "It is essentially a blueprint for how we run our center," she said. "All of the recommendations that we provide are evidence-based."

Education, she said, changes minds. The center surveyed clinicians before and after one accredited workshop. "Before the workshop, 10% of the people who signed up strongly doubted the existence of some of these illnesses," Baxter said. Afterward, "we nearly erased all doubt of the existence of these illnesses. And that was just one workshop."

The center's teaching aimed at clinicians first, through accredited courses and an elective at the medical school. "Right now we are emphasizing primary care physicians because these are people who perhaps see their patients most frequently," she said.

The Cohen Center opened on Oct. 10, 2024, at 5 East 98th Street in Manhattan. It is part of the Icahn School of Medicine at Mount Sinai. The $10 million center was funded by donors including the Steven & Alexandra Cohen Foundation and Beth and Joshua Nash. It calls itself "the world's first medical center dedicated to the research and treatment of infection-associated chronic conditions and illnesses."

The Santa Barbara County Health Department in California, an early adopter of the center's educational program, praised the manual. "It is the first step in standardizing care and is based on proven practices and successes," said its director, Mouhanad Hammami, MD. Becker's Hospital Review covered the release as the first U.S. guide of its kind.

Baxter is a molecular biologist who worked in drug discovery before turning to science education. She led science communication at the Cohen Center from 2024 to 2025.

The manual is free through the Cohen Center's resources page, and a second edition is at coresinai.org/manual. Baxter's Raise the Line interview is on Apple Podcasts.