Nurek, Martine;
Rayner, Clare;
Freyer, Anette;
Taylor, Sharon;
Jaerte, Linn;
MacDermott, Nathalie;
Delaney, Brendan C;
(2021)
Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study.
British Journal of General Practice
, 71
(712)
E815-E825.
10.3399/BJGP.2021.0265.
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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.
| Type: | Article |
|---|---|
| Title: | Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.3399/BJGP.2021.0265 |
| Publisher version: | http://dx.doi.org/10.3399/bjgp.2021.0265 |
| Language: | English |
| Additional information: | This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third-party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ |
| Keywords: | 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 |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10198763 |
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