Clinical update

Long-COVID: what it means and how to manage the longer-term effects

Advice from NICE on how to care for patients with ongoing symptoms and post-coronavirus syndrome

Advice from NICE on how to care for patients with ongoing symptoms and post-coronavirus syndrome

The most commonly reported symptoms after acute COVID-19 include fatigue, headache, loss of concentration and sleep disturbance Picture: iStock

Essential information

Many people who have contracted COVID-19 have reported struggling with ongoing symptoms weeks and months after they first fell ill.

The government has said there is accumulating evidence that people can experience long-term health effects. Around 10% of people with mild coronavirus symptoms who are not admitted to hospital report symptoms lasting more than four weeks.

What’s new?

A guideline on the management of the long-term effects of COVID-19, also known as long-COVID, has been published by the National Institute for Health and Care Excellence (NICE), the Royal College of General Practitioners and the Scottish Intercollegiate Guidelines Network.

It includes the following three definitions:

  1. Acute COVID-19: the first four weeks of symptoms.
  2. Ongoing symptomatic COVID-19: symptoms from four to 12 weeks.
  3. Post-COVID-19 syndrome: symptoms for more than 12 weeks.

NICE says long-COVID covers ongoing symptomatic COVID-19 and post-COVID-19 syndrome.

Meanwhile, an England-wide network of specialist clinics helping people recover from the long-term effects of COVID-19 has grown to more than 60 sites, NHS England announced in late December 2020.

The Queen’s Nursing Institute has also published a resource for community nurses called Living with Covid-19 (long-Covid) and Beyond.

Signs and symptoms

Symptoms after acute COVID-19 are highly variable and wide ranging, NICE says.

The most commonly reported include:

  • Breathlessness.
  • Cough.
  • Chest tightness.
  • Chest pain.
  • Palpitations.
  • Fatigue.
  • Fever.
  • Loss of concentration or memory issues.
  • Headache.
  • Sleep disturbance.
  • Dizziness.
  • Delirium in older people.
  • Pins and needles.
  • Skin rash.
  • Depression and anxiety.

Ear, nose and throat and gastrointestinal problems and joint and muscle pain problems are also reported.

Causes and risk factors

Much remains unknown about what puts someone at risk of developing post-COVID-19 syndrome, but the likelihood is not thought to be linked to the severity of acute COVID‑19 for the individual, including whether they were admitted to hospital.

How you can help your patient

  • For people with ongoing symptoms 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.
  • Be aware that people can have wide-ranging and fluctuating symptoms after acute COVID‑19, which can change in nature over time.
  • 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 well-being.
  • Explain that recovery time is different for everyone but for many people symptoms will resolve by 12 weeks.
  • Consider additional support for older people with ongoing symptoms, for example short-term care packages, advance care planning and support with social isolation, loneliness and bereavement, if relevant.
  • Give advice and information on self-management to people with ongoing symptoms. This could include advice on setting realistic goals.
  • Healthcare professionals in secondary care should offer a follow‑up consultation via video or phone at six weeks after discharge to people who have been in hospital with acute COVID‑19, to check for new or ongoing symptoms or complications.
View our COVID-19 resource centre

Expert comment

Sharon Aldridge-Bent, director of nursing programmes (leadership) at the Queen’s Nursing Institute

‘The impact of long-COVID on the UK population is of huge significance as we continue to see this new wave of physical and emotional health problems.

‘People are presenting to primary and community care services for information, advice and support. The National Institute for Health and Care guidance has been particularly useful in confirming clinical definitions of the acute stage, ongoing symptoms and the post-COVID stage of the virus. It highlights the importance of assessment, with an emphasis on the fluctuating nature of long-COVID. This information is fundamental to all nurses, including district and general practice nurses who will come into daily contact with these patients.

‘The most important aspect of the guidance, which is also emphasised in the Queen’s Nursing Institute resource, is the need to listen to the ‘‘lived experience’’ of the person and holistic assessment to ensure the investigation and referral of patients to appropriate treatment centres.’

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