identifying people with ongoing symptomatic COVID-19 or post-COVID-19 syndrome (Long COVID)

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Identifying people with ongoing symptomatic COVID-19 or post-COVID-19 syndrome

For full details then see NICE guideline [NG188]

Give people who have had suspected or confirmed acute COVID-19 (and their families or carers, as appropriate) advice and written information on:

Common symptoms of ongoing symptomatic COVID-19 and post-COVID-19 syndrome

  • symptoms after acute COVID-19 are highly variable and wide ranging
  • most commonly reported symptoms include (but are not limited to) the following
Respiratory symptoms
  • Breathlessness
  • Cough
  • Cardiovascular symptoms
  • Chest tightness
  • Chest pain
  • Palpitations
  • Generalised symptoms
  • Fatigue
  • Fever
  • Pain

 

 

 

 

 

Neurological symptoms
  • Cognitive impairment ('brain fog', loss of concentration or memory issues)
  • Headache
  • Sleep disturbance
  • Peripheral neuropathy symptoms (pins and needles and numbness)
  • Dizziness
  • Delirium (in older populations)

 

Gastrointestinal symptoms
  • Abdominal pain
  • Nausea
  • Diarrhoea
  • Anorexia and reduced appetite (in older populations)

 

 

 

 

 

Musculoskeletal symptoms
  • Joint pain
  • Muscle pain

 

 

 

 

 

 

 

 

 

Psychological/psychiatric symptoms
  • Symptoms of depression
  • Symptoms of anxiety

 

 

 

 

 

 

 

 

 

Ear, nose and throat symptoms
  • Tinnitus
  • Earache
  • Sore throat
  • Dizziness
  • Loss of taste and/or smell

 

 

 

 

 

Dermatological
  • Skin rashes

 

 

 

 

 

 

 

 

 

  • what they might expect during their recovery, including that:
    • recovery time is different for everyone but for many people symptoms will resolve by 12 weeks
    • the likelihood of developing ongoing symptomatic COVID-19 or post-COVID-19 syndrome is not thought to be linked to the severity of their acute COVID-19 (including whether they were in hospital)
    • if new or ongoing symptoms occur they can change unpredictably, affecting them in different ways at different times
  • how to self-manage ongoing symptomatic COVID-19 or post-COVID-19 syndrome (see the recommendations on self-management and supported self-management)
  • symptoms to look out for that mean they should contact their healthcare professional
  • who to contact if they are worried about new, ongoing or worsening symptoms, especially if they have them more than 4 weeks after the start of acute COVID-19.

Suspect previous COVID-19 illness as a possible underlying cause of new or ongoing symptoms in people after acute COVID-19 as follows:

  • ongoing symptomatic COVID-19 if people present with symptoms 4 to 12 weeks after the start of acute COVID-19 or
  • post-COVID-19 syndrome if the person's symptoms have not resolved 12 weeks after the start of acute COVID-19.

For people who are concerned about new or ongoing symptoms 4 weeks or more after acute COVID-19, offer an initial consultation and use shared decision making to discuss and agree with the person whether it should be by video, phone or in person.

Consider using a screening questionnaire as part of the initial consultation to help capture all of the person's symptoms. These should only be used in conjunction with clinical assessment.


Be aware that some people (including children and older people) may not have the most commonly reported new or ongoing symptoms after acute COVID-19.


Based on the initial consultation, use shared decision making to discuss and agree with the person whether they need a further assessment and whether this should be by phone, video or in person. Take into account whether they may have symptoms that need investigating in person or require urgent referral to an appropriate service

Support access to assessment and care for people with new or ongoing symptoms after acute COVID-19, particularly for those in underserved or vulnerable groups who may have difficulty accessing services, for example by:

  • providing extra time or additional support (such as an interpreter or advocate) during consultations
  • raising awareness about possible new or ongoing symptoms of COVID-19 – this may include working with local community leaders or organisations - particularly in vulnerable groups and black, Asian and minority ethnic groups.

Consider follow-up by primary care or community services for people in vulnerable or high-risk groups who have self-managed in the community after suspected or confirmed acute COVID-19.


A healthcare professional in secondary care should offer a video or phone follow-up consultation at 6 weeks after discharge to people who have been in hospital with acute COVID-19 to check for new or ongoing symptoms or complications

Reference:

Last edited 03/2021 and last reviewed 07/2021

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