Post-COVID-19 syndrome and 'long-COVID' - guidance for clinicians

The National Institute for Health and Care Excellence (NICE) outlines the clinical case definitions used to identify and diagnose the long-term effects of COVID-19: 

• Ongoing symptomatic COVID-19: signs and symptoms of COVID-19 from 4 to 12 weeks.
  

• Post-COVID-19 syndrome: signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body. Post‑COVID‑19 syndrome may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed.

Below is the recently updated COVID-19 rapid guideline which can support health and care practitioners in managing these symptoms and provide adequate care for patients experiencing difficulties with mental health symptoms associated with the long-term effects of COVID-19. This guideline has been developed jointly by NICE, the Scottish Intercollegiate Guidelines Network (SIGN) and the Royal College of General Practitioners (RCGP).

The guideline includes recommendations on identifying people with ongoing symptomatic COVID-19 or post-COVID-19 syndrome, investigations and referral and planning care. It recommends that:

• For people with ongoing symptomatic COVID-19 or suspected post-COVID-19 syndrome who have been identified as needing an assessment, a holistic, person-centred approach should be used. It should include a comprehensive clinical history and appropriate examination that involves assessing physical, cognitive, psychological and psychiatric symptoms, as well as functional abilities.
  

• People with ongoing symptomatic COVID-19 or suspected post‑COVID‑19 syndrome should be referred urgently for psychiatric assessment if they have severe psychiatric symptoms or are displaying high risk of self‑harm or suicide. 
  

• Relevant national or local guidelines should be followed on referral for people who have anxiety and mood disorders, or other psychiatric symptoms. Referral should be considered:
  •  for psychological therapies if they have common mental health symptoms, such as symptoms of mild anxiety and mild depression or
  • to a liaison psychiatry service if they have more complex needs (especially if they have a complex physical and mental health presentation).
• A multidisciplinary approach to guide rehabilitation should be used, which includes physical, psychological and psychiatric aspects of management. Any symptoms that could affect the person being able to start rehabilitation safely should be investigated first. 

• Integrated, multidisciplinary rehabilitation services should be provided, based on local need and resources. The core team could include, but not be limited to, the following specialist areas:
  • occupational therapy
  • physiotherapy
  • clinical psychology and psychiatry
  • rehabilitation medicine.
• NICE have applied a ‘living’ approach to the guidance which means that targeted areas of the guideline will be continuously reviewed and updated in response to emerging evidence. 

View the guidance:  COVID-19 rapid guideline: managing the long-term effects of COVID-19

NHS England and NHS Improvement have also provided national guidance for post-COVID syndrome assessment clinics. This will assist local healthcare systems to establish post-COVID syndrome assessment clinics for patients.

Clinics will offer physical, cognitive and psychological assessments with the aim of providing consistent services to patients. 

• National guidance for post-COVID syndrome assessment clinics

Further information from NHS England and Improvement on post-COVID Syndrome (Long COVID), including educational materials for clinicians, can be found here:

• Post-COVID Syndrome (Long COVID)