Caring for patients with post–COVID-19 conditions

Escalating care for patients with red flag symptoms

Caring for patients with post–COVID-19 conditions
  1. Additional resources
  2. Acknowledgements
  3. Disclaimer

Escalating care for patients with red flag symptoms

Red flag symptoms and vital signs are suggestive of severe disease. Patients with red flag symptoms should be immediately assessed. They might require urgent care in a hospital emergency department or by ambulance services.

Red flag symptoms include:12

  • severe, new onset, or worsening breathlessness or hypoxia
  • syncope
  • unexplained chest pain, palpitations or arrhythmias
  • new delirium, or focal neurological signs or symptoms.

Remember that the patient might have a different illness that is not COVID-19 related. Your assessment should include the consideration of other causes of these symptoms.

Remember if a patient speaks a language other than English and requires an interpreter, provide an explanation about this new situation using an interpreter to reduce the patient’s anxiety and maximise their ability to comprehend the situation and management plan. Ensure the patient’s cultural needs are met and record specific language and cultural needs in any referral letters.

 
 
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  3. Nalbandian A, Sehgal K, Gupta K, et al. Post-acute COVID-19 syndrome. Nat Med 2021;27(4):601–15.
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  6. Office for National Statistics. Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 1 April 2021. UK: Office for National Statistics, 2021 omsfollowingcoronaviruscovid19infectionintheuk/1april2021#measuring-the-data [Accessed 24 November 2021].
  7. Liu B, Jayasundara D, Pye V, et al. Whole of population-based cohort study of recovery time from COVID-19 in New South Wales Australia. Lancet Reg Health West Pac 2021;12:100193.
  8. Antonelli M, Penfold R, Merino J, Sudre C. Risk factors and disease profile of post- vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: A prospective, community-based, nested, case-control study. Lancet Infect Dis 2021;S1473-3099(21)00460-6.
  9. Barker-Davies R, O’Sullivan O, Senaratne K, et al. The Stanford Hall consensus statement for post-COVID 19 rehabilitation. Br J Sports Med 2020;54(16):949–59.
  10. Venkatesan P. NICE guideline on long COVID. Lancet Respir Med 2021;9(2):129.
  11. Australian Institute of Health and Welfare. The first year of COVID-19 in Australia: Direct and indirect health effects. Canberra: Australian Government, 2021 phe-287.pdf [Accessed 23 November 2021].
  12. National COVID-19 Clinical Evidence Taskforce. Care of people with post-COVID-19 (version 4.0). Melbourne: National COVID-19 Clinical Evidence Taskforce, 2022   [Accessed 5 May 2022].
  13. British Society of Rehabilitation Medicine. Rehabilitation in the wake of COVID-19 – A phoenix from the ashes. UK: BSRM, 2020 downloads/covid-19bsrmissue1-published-27-4-2020.pdf  [Accessed 23 November 2021].
  14. Selvaraj V, Dapaah-Afriyie K. Lung cavitation due to COVID 19 pneumonia. BMJ Case  Rep 2020;13(7):e237245.
  15. Carfi A, Bernabei R, Landi R, Gemelli Against COVID-19 Post-Acute Study Group. Persistent symptoms in patients after acute COVID-19. JAMA 2020;324(6):603–05.
  16. Spruit MA, Holland AE, Singh SJ, et al. COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society and American Thoracic Society-coordinated international task force. Eur Respir J 2020;56(6):2002197.
  17. Rroku A, Kottwitz J, Heidecker B. Update on myocarditis – what we know so far and where we may be heading. Eur Heart J Acute Cardiovasc Care 2020 (ahead of print).
  18. Firth J, Marx W, Dash S, et al. The effects of dietary improvement on symptoms of depression and anxiety: A meta-analysis of randomized controlled trials. Psychosom Med  2019;81(3):265–80.
  19. National COVID-19 Clinical Evidence Taskforce. Management of adults with mild-COVID-19 (version 42). Melbourne: National COVID-19 Clinical  Evidence Taskforce, 2022  [Accessed 5 May 2022].
  20. National COVID-19 Clinical Evidence Taskforce. Australian guidelines for clinical care of people with COVID-19 (version 56.1) – Venous thromboembolism (VTE) prophylaxis. Melbourne: National COVID-19 Clinical evidence Taskforce, 2022 [Accessed 5 May 2022].
  21. American Society of Haematology. COVID-19 and VTE/anticoagulation: Frequently asked questions (version 12). Washington: American Society of Haematology, 2021 [Accessed 6 December 2021].
  22. Herrera JE, Niehaus WN, Whiteson J, et al. Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients. PM R 2021;13(9):1027–43.
  23. Thurber K, Barrett E, Agostino J, et al. Risk of severe illness from COVID-19 among Aboriginal and Torres Strait Islander adults: The construct of ‘vulnerable populations’ obscures the root causes of health inequities. Aust N Z J Public Health 2021;4(6):658–63.
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  25. Zimmermann P, Pittet L, Curtis N. How common is long COVID in children and adolescents? Pediatr Infect Dis J 2021;40(12):e482–87.
  26. Murdoch Children’s Research Institute. Frequently asked COVID-19 questions. Melbourne: MCRI, 2021 [Accessed 24 November 2021].
  27. Australian Technical Advisory Group on Immunisation. Clinical guidance  for COVID-19 vaccine providers. Canberra; ATAGI, 2022  [Accessed 5 May 2022].
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