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Nice guideline summary: managing the long-term effects of COVID-19

Nice has published a rapid guideline to identify, assess and manage the long-term effects of COVID-19, often described as ‘long COVID’

Unplanned learning

It may be useful to print this summary as a resource for your pharmacy team – PDF available here.

This rapid guideline is a ‘living’ guideline - evidence may emerge that can result in changes to the original guideline.

This summary was correct at the time of publishing 

Terminology

The stage of COVID-19 infection is determined by the duration of signs and symptoms:

  • Acute COVID-19 - up to 4 weeks
  • Ongoing symptomatic COVID-19 - from 4 to 12 weeks
  • Post-COVID-19 syndrome - longer than 12 weeks; signs and symptoms may develop during or after an infection that are not better explained by an alternative diagnosis
  • Long COVID - includes both ongoing symptomatic COVID-19 and post-COVID-19 syndrome.
Identification of ongoing symptomatic COVID-19 or post-COVID-19 syndrome

Give people with suspected or confirmed acute COVID-19, and their carers and families where appropriate, information about:

Common new or ongoing symptoms post-acute infection (some people, such as children and the elderly, may present with symptoms other than those listed below). Symptoms can be wide-ranging, fluctuating, change in nature over time and affect people in different ways at different times:

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

Expectations of recovery:

  • symptoms usually resolve by 12 weeks
  • development of ongoing symptomatic COVID-19 or post COVID-19 syndrome is not related to the severity of the acute COVID-19 infection.

Self-management advice (see Management of confirmed ongoing symptomatic COVID-19 or post-COVID-19 syndrome, below)

When to contact their healthcare professional.

Who to contact if there is concern about symptoms that are new, ongoing or worsening - especially if symptoms occur more than 4 weeks after the start of acute COVID-19.

Presentation of symptoms 4 to 12 weeks after the start of acute COVID-19 should raise suspicion for ongoing symptomatic COVID-19, or if symptoms have not resolved after 12 weeks, post-COVID-19 syndrome may be suspected. People who have been in hospital with acute COVID-19 should receive a follow-up 6 weeks post-discharge to assess for new or ongoing symptoms.

Assessment

When assessing new or ongoing symptoms, consider: type and severity of the symptoms, including previous symptoms, relationship between the onset of acute COVID-19 and the timing and duration of symptoms, comorbidities and patients’ history for confirmed or suspected cases of acute COVID-19. Discuss with the person the impact the condition has had on their daily activities and life, including work, education, well-being, mobility and independence.

Referral

If there is concern, from either the patient or the pharmacist, about new or ongoing symptoms 4 weeks or more after acute COVID-19 infection, refer patients for medical review, where they will be offered an initial consultation. Screening questionnaires, such as the Yorkshire rehab questionnaire and the Newcastle screening tool, may be used as part of the initial consultation. However, none of these are validated for this use and should only be used in combination with a complete medical review.

Urgent referral to acute services is required if people have symptoms that could represent a complication of COVID-19 that is acute or life-threatening. This includes but isn’t limited to:

  • severe hypoxaemia or oxygen desaturation on exercise
  • signs of severe lung disease
  • cardiac chest pain
  • multisystem inflammatory syndrome (in children).
Management of confirmed ongoing symptomatic COVID-19 or post-COVID-19 syndrome

Ensure people are aware of:

  • self-management measures, such as setting realistic goals
  • where to go for advice and support (eg support groups, online forums or apps)
  • support that is available from other services and how to access it (eg housing, social care, employment, financial advice)
  • new or continuing symptoms of COVID-19, provided to them in a format they can share with family, carers or friends

People who request vitamins or supplements for management of COVID-19 symptoms should be advised that it is unknown if these are beneficial, harmful or have no effect on treatment. The use of a tracking app or recording of goals, symptoms and recovery is recommended.

Additional support may be required for older people eg short-term care packages, support with isolation, lonelieness and bereavement.

Monitoring and follow-up

People who have ongoing symptomatic COVID-19 or post-COVID-19 syndrome should:

  • know how often follow-up and monitoring is required
  • be aware of measuring parameters and when to seek help if they are conducting self-monitoring of heart rate, blood pressure or pulse oximetry
  • be aware of new or worsening symptoms that may require them to contact their healthcare professional.

This summary is intended as a quick resource for pharmacy teams on the Nice COVID-19 rapid guideline: managing the long-term effects of COVID-19. For more detailed information, please see the full guideline here.

References

National Institute for health Care and Excellence (2020) COVID-19 rapid guideline: managing the long-term effects of COVID-19. Nice guideline (NG188).

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