Long covid—an update for primary care

The comprehensive report from the British Medical Journal (BMJ) provides a detailed overview of managing and understanding long COVID, a condition that continues to affect a significant number of individuals even after recovering from the acute phase of COVID-19.

Here’s a detailed summary of the key points and guidance provided in the report:

Understanding Long COVID

  • Definition and Symptoms: Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is a condition where individuals continue to experience symptoms after the acute phase of the infection. The symptoms are wide-ranging and can affect any system in the body, but commonly include fatigue, breathlessness, and cognitive dysfunction, often referred to as “brain fog.”
  • Epidemiology: The report notes that up to 10% of people experience prolonged symptoms after COVID-19, with a higher prevalence observed in women. The duration and severity of symptoms vary greatly among patients.

Management in Primary Care

  • Primary Care’s Role: The report emphasizes the pivotal role of primary care in the management of long COVID. It includes initial assessment and investigation, continuity of care, coordination with specialists, and holistic support addressing both physical and mental health.
  • Initial Approach: The primary care approach should be individualized, considering the patient’s history, symptom profile, and comorbidities. A thorough examination is crucial, and initial investigations should be guided by predominant symptoms, aiming primarily to exclude other serious diagnoses.
  • Follow-up and Monitoring: The recovery trajectory in long COVID is highly variable, and regular follow-up is important. The Covid-19 Yorkshire Rehabilitation Scale (C19YRS) is recommended for assessing symptom severity and monitoring progress over time.

Investigations and Treatment

  • Investigations: There’s no standard protocol for assessing long COVID due to its diverse manifestations. Investigations should be symptom-led and might include tests for organ-specific issues based on the patient’s presentation.
  • Treatment: Treatment primarily focuses on symptom management, with no standard treatment protocol available. It includes medication for symptom relief (like paracetamol for fever and pain), and COVID vaccines, which might help some patients. Rehabilitation programs are also recommended, although their optimal structure is still under research.

Referral to Specialists

  • When to Refer: Patients with severe, persistent, or atypical symptoms may require specialist referral. This is particularly important for those with “red flag” symptoms indicating potentially serious conditions.
  • Specialist Services: Ideally, patients should be referred to integrated long COVID clinics offering multidisciplinary care. However, due to the stretched healthcare services, there might be delays in referral and treatment.

Challenges and Ongoing Research

  • Prognosis Uncertainty: The prognosis of long COVID is uncertain, and while many improve, some patients experience a plateau in their recovery or a fluctuating course of illness. It’s currently challenging to predict the recovery timeline or the likelihood of developing long-term conditions.
  • Need for Comprehensive Care Models: The report acknowledges the necessity for evolving care models to manage long COVID as a long-term condition. This includes integrated care models, community-based services, and adequate training for healthcare professionals to cater to the increasing number of individuals living with long COVID.

In conclusion, the BMJ report highlights the complexity of long COVID and the need for a patient-centered, flexible approach in management. It calls for ongoing research, integrated care models, and a supportive healthcare infrastructure to address the multifaceted challenges posed by this condition​​​​​​.

Read More: https://www.bmj.com/content/378/bmj-2022-072117

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