Many patients who under normal circumstances would have been admitted to hospital, manage their own extremely difficult circumstances at home during the crisis.

How do we deal with its effects following COVID-19?

Following the active rehabilitation from the start, organic pathology needs to be detected and managed with appropriate investigations.

A rehabilitation regime can then be set up for the individual.
One stop clinics which allow the clinicians to identify and manage sequelae of COVID-19 are required to be established.

These clinics need to reflect the multisystem nature of COVID-19 and involve multidisciplinary teams with access to the relevant investigations to detect known complications of COVID-19 following clinical review.

The reliance on a one size fits all rehabilitation service risks serious harm to patients when pathology is undetected. For example, NICE cautioned events to correct graded exercise therapy in the context of COVID-19. This needs to be communicated to clinicians and patients themselves.

The patient needs to be involved in his own rehabilitation. Patients experiencing persistent symptoms had a great deal of knowledge to their own solution.

Access to service – A clinical services commission need to be available for all and not to discriminate for those with a negative test.

Testing – Adherence to positive test results as a criteria for access to medical services or specific COVID-19 arrangements is not acceptable in the context of clinical diagnosis of Covid-19. It is well known there were false negatives for COVID-19 PCR tests and indeed antibody tests were poorly sensitive early on in the disease process.

Little data exists regarding testing late in the disease course and false negatives are common. Some people do not seroconvert despite having previously tested positive.

Above all this is a new disease and a rapid transformative pathway to deal with long term sequelae of COVID-19, which includes full investigation of patients is urgently required to be established.

Dr Paul Ettlinger
The London General Practice

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