Management of post-acute covid-19 in primary care
Correspondence to: T Greenhalgh trish.greenhalgh@phc.ox.ac.uk What you need to know Management of covid-19 after the first three weeks is currently based on limited evidence Approximately 10% of people experience prolonged illness after covid-19 Many such patients recover spontaneously (if slowly) w...
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| Veröffentlicht in: | BMJ (Online) Jg. 370; S. m3026 |
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| Hauptverfasser: | , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
England
British Medical Journal Publishing Group
11.08.2020
BMJ Publishing Group LTD |
| Schlagworte: | |
| ISSN: | 1756-1833, 1756-1833 |
| Online-Zugang: | Volltext |
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| Zusammenfassung: | Correspondence to: T Greenhalgh trish.greenhalgh@phc.ox.ac.uk What you need to know Management of covid-19 after the first three weeks is currently based on limited evidence Approximately 10% of people experience prolonged illness after covid-19 Many such patients recover spontaneously (if slowly) with holistic support, rest, symptomatic treatment, and gradual increase in activity Home pulse oximetry can be helpful in monitoring breathlessness Indications for specialist assessment include clinical concern along with respiratory, cardiac, or neurological symptoms that are new, persistent, or progressive Post-acute covid-19 (“long covid”) seems to be a multisystem disease, sometimes occurring after a relatively mild acute illness.1 Clinical management requires a whole-patient perspective.2 This article, intended for primary care clinicians, relates to the patient who has a delayed recovery from an episode of covid-19 that was managed in the community or in a standard hospital ward. The specialist rehabilitation needs of a third group, covid-19 patients whose acute illness required intensive care, have been covered elsewhere.3 Defining post-acute covid-19 In the absence of agreed definitions, for the purposes of this article we define post-acute covid-19 as extending beyond three weeks from the onset of first symptoms and chronic covid-19 as extending beyond 12 weeks. Since many people were not tested, and false negative tests are common,4 we suggest that a positive test for covid-19 is not a prerequisite for diagnosis. [...]called mild covid-19 may be associated with long term symptoms, most commonly cough, low grade fever, and fatigue, all of which may relapse and remit.47 Other reported symptoms include shortness of breath, chest pain, headaches, neurocognitive difficulties, muscle pains and weakness, gastrointestinal upset, rashes, metabolic disruption (such as poor control of diabetes), thromboembolic conditions, and depression and other mental health conditions.424 Skin rashes can take many forms including vesicular, maculopapular, urticarial, or chilblain-like lesions on the extremities (so called covid toe).25 There seems to be no need to refer or investigate these if the patient is otherwise well. Box 5 links to patient resources, including a comprehensive patient guide from Homerton University Hospital.28 Respiratory symptoms and support Cough The British Thoracic Society defines chronic cough as one that persists beyond eight weeks.26 Up to that time, and unless there are signs of super-infection or other complications such as painful pleural inflammation, cough seems to be best managed with simple breathing control exercises28 (see box 2) and medication where indicated (such as proton pump inhibitors if reflux is suspected). |
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| Bibliographie: | Practice Pointer ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 |
| ISSN: | 1756-1833 1756-1833 |
| DOI: | 10.1136/bmj.m3026 |