Caring for patients with post–COVID-19 conditions

Introduction

Introduction

Evidence regarding the incidence and spectrum of post–COVID-19 illness and management is evolving and will continue to develop in years to come.

The National COVID-19 Clinical Evidence Taskforce continues to monitor and review latest research in this space.


Defining post–COVID-19 conditions

The World Health Organization recently developed a clinical case definition for ‘post–COVID-19 condition’:

Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.1 

Another suggested definition that describes a range of post-acute COVID-19 symptoms is ‘chronic COVID-19’ or ‘post–COVID syndrome’; that is, illness extending beyond 12 weeks from initial symptoms.2,3

The term ‘long COVID’ has been commonly used to describe COVID-19 symptoms following acute illness, irrespective of how long the symptoms take to resolve, and could be used to refer to either of the above two conditions.4

This guide contains information for general practitioners (GPs) and their teams, who are providing care for patients who have previously tested positive to COVID-19 or have a history suggestive of undiagnosed COVID-19 and have – or are at risk of – post– COVID-19 conditions at any point after the initial acute infection. 

Incidence of post–COVID-19 sequelae

The incidence of post–COVID-19 sequelae in those who have tested positive and who have been managed in an outpatient setting (such as management in the home) is thought to be between 10% and 35%, but for those admitted to hospital, this could be closer to 85%.5 The incidence of prolonged illness significantly increases with age, comorbidities and initial severity of the acute illness.

In a UK study of 20,000 people who had tested positive to COVID-19, 13.7% reported having symptoms 12 weeks after acute infection.6 In an Australian study of 3000 people, 80% reported full recovery within one month, and 5% reported experiencing symptoms after three months.7 Other studies reported significantly higher prevalence of symptoms at both time points.3

Studies indicate that the risk of post–COVID symptoms in people who contract COVID-19 after their second dose of COVID-19 vaccine is approximately halved.8 

Management of post–COVID-19 conditions

Global experience with the epidemics of severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) in 2003 and Middle Eastern respiratory syndrome (MERS) in 2012 has added to the evidence used in current recommendations in post–COVID-19  management.9

General practice presentations in a post-acute COVID-19 scenario are likely to be based on:

  • non-specific post-viral symptoms, particularly fatigue, breathlessness, persistent cough and cognitive dysfunction10
  • specific serious sequelae resulting from the acute infection, or as delayed complications
  • recovery following severe illness that required intensive care management
  • mental health impacts of the acute illness, stigma, ongoing symptoms and functional impairment.

For patients with ongoing symptomatic COVID-19 or suspected post–COVID-19 conditions, a holistic, person-centred approach should be used, including a comprehensive clinical history and appropriate examination that involves assessing physical, cognitive, psychological and psychiatric symptoms, as well as functional abilities.4 

This resource

The purpose of this resource is to provide advice and support to GPs and their teams when caring for patients with post–COVID-19 conditions, and to encourage the development of individualised plans for their ongoing management.

This document provides generic guidance and should be used to support any local or other more contemporaneous advice, such as the National COVID-19 Clinical Evidence Taskforce guidelines and clinical flowcharts for the care of people with post–COVID-19 and local HealthPathways, acknowledging that uncertainties remain in our understanding of the sequelae of COVID-19 and its management.

This guide can be used in conjunction with the patient resource, Managing post–COVID-19 symptoms.

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