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REMEDY : BNSSG referral pathways & Joint Formulary

Long COVID (4-12 weeks)

Checked: 25-06-2021 by Rob.Adams Next Review: not set yet

Overview

NICE guidelines suggest that patients with COVID-19 infection should be divided into 3 groups or stages.

  1. Acute COVID-19: signs and symptoms of COVID-19 for up to 4 weeks. See Acute Assessment page.
  2. Ongoing symptomatic COVID-19: signs and symptoms of COVID-19 from 4 to 12 weeks (this page).
  3. Post-COVID-19 syndrome: signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis. See Long COVID (after 12 weeks) page.

Stages 2 and 3 are also otherwise known as Long COVID.

This section will deal with the management of patients with ongoing symptomatic COVID-19 which is defined as signs and symptoms of COVID-19 that persist for longer than 4 weeks and less than 12 weeks following infection.

Long COVID in children

Please see the Long COVID in children page.

Health inequalities in Long COVID

It is recognised both locally and nationally that there are signficant health inequalities in COVID -19. Clinicians should be mindful that some patient groups may need more help in accessing Long COVID  services and support.

Primary Care Assessment

Acute or Severe symptoms that may require admission

During the initial weeks following COVID-19 it is important to be vigilant for signs of acute deterioration that require more urgent medical care. Please see the Acute Assessment page for further advice.

Ongoing symptoms following COVID-19

Please refer to the BNSSG Primary Care Assessment and Management of Adults with Persistent Symptoms Following COVID-like Illness. (April 2021). This document gives advice to clinicians about the possible complications following COVID-19 infection.

Unexplained respiratory symptoms following COVID-19

For patients with unexplained respiratory symptoms please refer to Appendix A: Flow chart for persistent unexplained respiratory symptoms in context of recent illness consistent with COVID-19 infection. (updated June 2021)

This document has been created by the STP Respiratory Board - further details and references are available here - and was provisionally updated in June 2021 to clarify the use of d-Dimer testing. D-dimer should only be considered in patients with suspected acute VTE. See the Pulmonary Embolism (suspected) page for further advice. This updated document is awaiting final ratification by the STP respiratory board. Further updates will be published on this page.

Advice and Guidance for professionals available to support community management

Weekday IUC professional line: Telephone advice about medical patients is available from the Severnside GP team 8am-6.30pm Monday-Friday (via the IUC Professional Line 0117 244 9283)

Community respiratory specialist team: For all patients with respiratory problems, irrespective of whether they have Covid or not (to try to offset acute referrals). They are operational 7 days a week, 0800-18.30. Telephone: 0333 230 1471. This service can escalate cases for consultant advice on a daily call, Monday to Friday, with on-call support at weekends, as required.

Mental Health problems following COVID-19

Some patients may develop anxiety or depression following COVID-19 or existing mental health problems may be exacerbated.

Early help in managing mental health problems will aid recovery in patients. Several resources are available to patients and further information is available on the Mental Health Support for patients page.

Patients can also be referred or self refer to IAPT services (VitaMinds).

Your COVID Recovery

Once other more concerning medical conditions have been excluded then all patients should be directed to the Your Covid Recovery website produced by the NHS, which has advice for patients on self care and managing expectations during recovery. 

The site has lots of useful support for patients who have had either a severe or mild COVID illness. It is divided into sections for patients depending on their ongoing symptoms:

Effects on your body:

  • Breathlessness
  • Fatigue
  • Cough
  • Managing your oxygen
  • Taste and smell
  • Voice and swallowing
  • Musculoskeletal
  • Chest pain
  • Palpitations
  • Headache
  • Skin disorders

Effects on your mind: 

  • Managing fear and anxiety
  • Managing your mood and coping with frustration
  • Memory and concentration

There is also advice about pacing and returning to work after COVID-19 and when further advice should be sought.

Paper versions of Your COVID Recovery and translation into different languages are currently being worked on nationally.

Long COVID Clinic

Referral to the community Long COVID single point of access clinic run by Sirona should only be considered if other medical conditions have been excluded and symptoms persist for more than 12 weeks - see the Long COVID (after 12 weeks) page

Management of other specific symptoms

See the Long COVID (after 12 weeks) page for advice on managment of some more common specific symptoms that may persist after COVID-19.