A new article published in the BMJ has mapped out what is known and what is still unknown about ‘long COVID’, where patients COVID-19 patients continue to experience symptoms many weeks after contracting the virus.
The article, co-authored by Professor Trish Greenhalgh and colleagues, provides preliminary guidance for primary care clinicians based on a review of the research literature and the authors’ clinical experience.
As we emerge from the first wave of COVID-19, many patients, some of those who experienced relatively mild symptoms during the outbreak, are still suffering from a range of symptoms including fatigue, breathlessness, chest and muscle pains and mental exhaustion.
Because COVID-19 is a new disease, there is uncertainty about what causes this ‘long COVID’ in some people, what tests are needed and what the long-term outlook is.
Until now, there has been little formal guidance for general practitioners on how to manage such cases.
Importantly, the diagnosis of long COVID does not need a swab-confirmed case of acute COVID, and indeed can occur in people whose initial COVID test was negative.
People can do a lot for themselves, say the authors, pacing their own recovery, and perhaps using a home oximeter to help monitor their progress.
GPs can help by keeping in touch, providing moral support, checking there are no ‘red flag’ symptoms, such as severe chest pain or rapidly worsening breathlessness, and by ordering tests if needed. The paper says the approach should be holistic and personalised, recognising that COVID affects every patent differently and improves at different rates in everyone.
One of the authors, Dr Matthew Knight, a respiratory physician who has managed more than 1,500 patients with long COVID in his virtual clinic, said: “Whilst some patients with long COVID should be referred to specialists and investigated for serious complications, many will slowly get better by carefully pacing themselves with support from their primary care team and peers.”
Prof Greenhalgh, a GP and a professor at the University of Oxford’s Nuffield Department for Primary Care Health Sciences, said: “I think the medical profession needs a new word to say to people with long COVID when they describe their symptoms going on for weeks or months. It would mean ‘I believe you, I witness your suffering, I share my uncertainty with you, I can’t cure you but I will not abandon you’.”
Professor Greenhalgh's work on the paper is funded by the NIHR Oxford Biomedical Research Centre and the UKRI COVID-19 Emergency Fund.
Management of post-acute covid-19 in primary care
Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L
BMJ 2020 DOI: https://doi.org/10.1136/bmj.m3026