Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study
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Published version
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Author(s)
Type
Journal Article
Abstract
Background In the absence of research into therapies and care pathways for long COVID, guidance based on ‘emerging experience’ is needed.
Aim To provide a rapid expert guide for GPs and long COVID clinical services.
Design and setting A Delphi study was conducted with a panel of primary and secondary care doctors.
Method 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.
Results 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.
Conclusion 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.
Aim To provide a rapid expert guide for GPs and long COVID clinical services.
Design and setting A Delphi study was conducted with a panel of primary and secondary care doctors.
Method 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.
Results 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.
Conclusion 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.
Date Issued
2021-10-04
Date Acceptance
2021-06-07
Citation
British Journal of General Practice, 2021, 71 (712), pp.E815-E825
ISSN
0960-1643
Publisher
Royal College of General Practitioners
Start Page
E815
End Page
E825
Journal / Book Title
British Journal of General Practice
Volume
71
Issue
712
Copyright Statement
© The Authors
http://creativecommons.org/licenses/by/4.0/
This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/).
http://creativecommons.org/licenses/by/4.0/
This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/).
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http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000704982300001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Primary Health Care
Medicine, General & Internal
General & Internal Medicine
clinical guidelines
COVID-19
general practice
long COVID
long-hauler
post-acute sequelae of COVID-19 (PASC)
post-COVID-19 condition
CONSENSUS
ILLNESS
DISEASE
Publication Status
Published