NICE sets out the treatment plan for patients with long Covid

NICE, the Royal College of General Practitioners (RCGP), and the Scottish Intercollegiate Guideline Network (SIGN) have published new guidelines on the management of the long-term effects of Covid-19.

The guidelines produced for health and care practitioners covers the identification of symptoms, and directions for the assessment and management of the often-fluctuating symptoms; as well as specifying that older people with ongoing symptoms of Covid-19 should be considered for additional support to cope with the various physiological and psychological symptoms attributed to long-Covid.

What are the symptoms of long-Covid? And how long can it last?

Long-Covid has been defined as a multisystem disease, that can severely impact on peoples quality of life, that includes multiple respiratory, cardiovascular, neurological, gastrointestinal, musculoskeletal, dermatological, and psychological symptoms; that can last for weeks or months after the initial infection of Covid-19.

For older people and children, the new guidelines said that presentation of symptoms can be different from symptoms from those most commonly seen in other age groups; for example, delirium, anorexia, and reduced appetite are more common in older populations. Consequentially, the guidelines advise that when investigating the causes of a gradual decline or worsening frailty in older people, healthcare professionals should be aware that these could be long-Covid symptoms.

While the majority of the symptoms of acute Covid-19 dissipate within weeks, there is a sizable minority of people who report symptoms for more than 12 weeks. Notably included in the guidelines is a distinction between clinical definitions of long-Covid by the duration of symptoms:

• Acute Covid-19: symptoms that last for up to a month.
• Ongoing symptomatic Covid-19: symptoms that last up to three months.
• Post-Covid-19 syndrome: symptoms that develop during or after an infection consistent with Covid-19, that continue for more than three months and are not explained by an alternative diagnosis.

The differences between these definitions impact on the proposed referral process, with a recommended, follow up consultation six weeks after discharge from hospital; and for people experiencing ongoing symptomatic and post-Covid-19 syndrome a further assessment by healthcare professionals on self-management of symptoms, and monitoring of symptoms as to whether they require specialist attention.

What care should be offered to older people with ongoing symptoms?

Because of the less common presentation of symptoms in older people, the authors of the guidelines were particularly interested in raising awareness of these symptoms, so to assist family members or carers in getting a full picture as to the signs of long-Covid. Additionally, healthcare professionals were urged by the authors to be especially vigilant to symptoms, especially as they said there is no clear evidence that developing symptoms that can endure long-term are correlated with prior hospitalisation.

The guidelines also asked that healthcare professionals consider additional support for older people with ongoing symptomatic Covid-19 or post-Covid-19 syndrome – such as short-term care packages, advanced care planning, and support in terms of social isolation, loneliness, and any potential grief. And, more generally, other support that is to be offered includes signposting to advice and support groups, and if needed a consultation and referral to rehabilitation services that set personalised treatment goals.

In a press release at the publishing of the guidelines Paul Chrisp, director of the Centre for Guidelines at NICE, said: “This guideline highlights the importance of providing people with good information after they’ve had acute COVID-19 so they know what to expect and when they should ask for more medical advice. This could help to relieve anxiety when people do not recover in the way they expect.

“Because this is a new condition and there is still much that we don’t know about it, the guideline will be adaptable and responsive as understanding of the condition grows and new evidence about how to manage it emerges.”