Acute COVID definition:
Signs and symptoms of COVID-19 for up to 4 weeks.

Ongoing symptomatic COVID-19 definition:
Signs and symptoms of COVID-19 from four weeks to twelve weeks.

Post COVID syndrome definition:
Signs and symptoms that develop during or after an infection consistent with COVID-19 continuing for more than 12 weeks and not explained by an alternative diagnosis.

Long COVID definition: 
This term is commonly used to describe signs and symptoms that continue to develop after acute COVID-19.  It includes both ongoing symptomatic COVID-19 from four to 12 weeks and post COVID-19 from 12 weeks or more.

Identify patients with ongoing symptomatic COVID-19 or post COVID-19 syndrome, patients who have had suspected or confirmed acute COVID-19 irrespective of whether they were hospitalised or had a positive or negative SARS-CoV-2 test.

Knowledge:
Give the patient information and advice on common new or ongoing symptoms after COVID-19 – what they might expect during their recovery.

Screening questionnaire:
For patients with ongoing symptomatic COVID-19 or suspected post COVID-19 syndrome use a holistic, person centred approach with comprehensive clinical history, appropriate examination involving assessing physical, cognitive, psychological and psychiatric symptoms as well as functional abilities.

The clinical history should include nature and severity of previous and current symptoms, timing and duration of symptoms, history of other health conditions.

Discuss how the person’s life and activities, for example their work or education, mobility and independence have been affected by ongoing symptomatic COVID-19 or suspected post COVID-19 syndrome.

Consider COVID-19 or suspected post COVID-19 syndrome in older patients with a gradual decline, deconditioning, worsening frailty or dementia or loss of interest in eating and drinking.

Investigations and referral: 
Consider these with any patient with new or ongoing symptoms four weeks or more after the start or suspected or confirmed acute COVID-19.

Refer urgently if they have some symptoms that could be caused by an acute of life threatening complication – including but not limited to:

  1. Severe hypoxaemia or oxygen desaturation on exercise.
  2. Signs of severe lung disease.
  3. Cardiac chest pain.
  4. Multi system inflammatory syndrome in children.

Offer tests and investigations tailored to people signs and symptoms.

Consider other diagnoses unrelated to COVID-19 and offer appropriate investigations.

Offer blood tests which may include full blood count, kidney, liver function, C-reactive protein, ferritin, BNP and thyroid function tests.  Consider D-Dimer and troponin.

Offer an exercise tolerance test suited to the person’s ability, for example, the one minute sit to stand test.  During the exercise test record levels of breathlessness, heart rate and oxygen saturation.

For people with postural symptoms, for example, palpitations or dizziness on standing, carry out lying and standing blood pressure and heart rate recordings.

Offer a chest x-ray by 12 weeks after acute COVID-19 if the person has not already had one and they have continuing respiratory symptoms.  Consider CT scan.

Refer person with ongoing symptomatic COVID-19 or suspected post COVID-19 syndrome urgently for psychiatric assessment if they have severe psychiatric symptoms or are at risk of self-harm or suicide.

Consider multidisciplinary assessment service i.e. specialist referral, physiotherapy, neurorehab.

Common symptoms of ongoing symptomatic COVID-19 and post COVID-19 syndrome:

Respiratory symptoms:

  • Breathless cough

Cardiovascular symptoms:

  • Chest tightness
  • Chest pain.
  • Palpitation.

Generalised symptoms:

  • Fatigue.
  • Fever.
  • Pain.

Musculoskeletal symptoms:

  • Joint pain.
  • Muscle pain.

 

Gastrointestinal symptoms:

  • Abdominal pain.
  • Nausea.
  • Diarrhoea.
  • Anorexia and reduced appetite in the older population.

Ear, nose and throat symptoms:

  • Tinnitus.
  • Earache.
  • Sore throat.
  • Dizziness.
  • Loss of taste and/or smell.

Dermatological:

  • Skin rashes

 

Psychological/psychiatric symptoms:

  • Symptoms of depression and symptoms of anxiety

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 the older population.

Dr Paul Ettlinger
BM, DRCOG, FRCGP, FRIPH, DOccMed

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