COVID-19 rapid guideline: managing the long-term effects of COVID-19
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This summary covers identifying, assessing, and managing the long-term effects of COVID-19, often described as ‘long COVID’. It makes recommendations for primary care about care for adults, children, and young people who have new or ongoing symptoms 4 weeks or more after the start of acute COVID-19
the following clinical definitions for the initial illness and long COVID have been used at different times:
- acute COVID-19: signs and symptoms of COVID-19 for up to 4 weeks
- ongoing symptomatic COVID-19: signs and symptoms of COVID-19 from 4 to 12 weeks
- 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
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Common symptoms of ‘long COVID’
Symptoms after acute COVID-19 are highly variable and wide ranging. The 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 symptoms
- Skin rashes
Identifying people with ongoing symptomatic COVID-19 or post-COVID-19 syndrome
- Give people who have had suspected or confirmed acute COVID-19 (and their families or carers, as appropriate) advice and written information on:
- the most common new or ongoing symptoms after acute COVID-19
- 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
- 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 4–12 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.
Assessing people with new or ongoing symptoms after acute COVID-19
- For people with ongoing symptomatic COVID-19 or suspected post-COVID-19 syndrome who have been identified as needing an assessment, use a holistic, person-centred approach. Include a comprehensive clinical history and appropriate examination that involves assessing physical, cognitive, psychological and psychiatric symptoms, as well as functional abilities
- Include in the comprehensive clinical history:
- history of suspected or confirmed acute COVID-19
- the nature and severity of previous and current symptoms
- timing and duration of symptoms since the start of acute COVID-19
- history of other health conditions
- Be aware that people can have wide-ranging and fluctuating symptoms after acute COVID-19, which can change in nature over time
- Discuss how the person’s life and activities, for example their work or education, mobility and independence, have been affected by ongoing symptomatic COVID-19 or suspected post-COVID-19 syndrome
- Discuss the person’s experience of their symptoms and ask about any feelings of worry or distress. Listen to their concerns with empathy and acknowledge the impact of the illness on their day-to-day life, for example activities of daily living, feelings of social isolation, work and education, and wellbeing
- For people who may benefit from support during their assessment, for example to help describe their symptoms, include a family member or carer in discussions if the person agrees
- Do not predict whether a person is likely to develop post-COVID-19 syndrome based on whether they had certain symptoms (or clusters of symptoms) or were in hospital during acute COVID-19
- When investigating possible causes of a gradual decline, deconditioning, worsening frailty or dementia, or loss of interest in eating and drinking in older people, bear in mind that these can be signs of ongoing symptomatic COVID-19 or suspected post-COVID-19 syndrome
- If the person reports new cognitive symptoms, use a validated screening tool to measure any impairment and impact.
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