Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study

In the absence of research into therapies and care pathways for long COVID, guidance based on 'emerging experience' is needed. To provide a rapid expert guide for GPs and long COVID clinical services. A Delphi study was conducted with a panel of primary and secondary care doctors. Recommen...

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Bibliographic Details
Published in:British journal of general practice Vol. 71; no. 712; p. e815
Main Authors: Nurek, Martine, Rayner, Clare, Freyer, Anette, Taylor, Sharon, Järte, Linn, MacDermott, Nathalie, Delaney, Brendan C
Format: Journal Article
Language:English
Published: England 01.11.2021
Subjects:
Consensus
COVID-19 - complications
COVID-19 - diagnosis
COVID-19 - therapy
Delphi Technique
Humans
Post-Acute COVID-19 Syndrome
COVID-19
clinical guidelines
general practice
post-COVID-19 condition
post-acute sequelae of COVID-19 (PASC)
long COVID
long-hauler
ISSN:1478-5242, 1478-5242
Online Access:Get more information
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Summary:In the absence of research into therapies and care pathways for long COVID, guidance based on 'emerging experience' is needed. To provide a rapid expert guide for GPs and long COVID clinical services. A Delphi study was conducted with a panel of primary and secondary care doctors. Recommendations were generated relating to the investigation and management of long COVID. These were distributed online to a panel of UK doctors (any specialty) with an interest in, lived experience of, and/or experience treating long COVID. Over two rounds of Delphi testing, panellists indicated their agreement with each recommendation (using a five-point Likert scale) and provided comments. Recommendations eliciting a response of 'strongly agree', 'agree', or 'neither agree nor disagree' from 90% or more of responders were taken as showing consensus. Thirty-three clinicians representing 14 specialties reached consensus on 35 recommendations. Chiefly, GPs should consider long COVID in the presence of a wide range of presenting features (not limited to fatigue and breathlessness) and exclude differential diagnoses where appropriate. Detailed history and examination with baseline investigations should be conducted in primary care. Indications for further investigation and specific therapies (for myocarditis, postural tachycardia syndrome, mast cell disorder) include hypoxia/desaturation, chest pain, palpitations, and histamine-related symptoms. Rehabilitation should be individualised, with careful activity pacing (to avoid relapse) and multidisciplinary support. Long COVID clinics should operate as part of an integrated care system, with GPs playing a key role in the multidisciplinary team. Holistic care pathways, investigation of specific complications, management of potential symptom clusters, and tailored rehabilitation are needed.
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ISSN:1478-5242
1478-5242
DOI:10.3399/BJGP.2021.0265