assessing people with new or ongoing symptoms after acute COVID-19 (Long COVID)

Last edited 03/2021 and last reviewed 05/2021

Assessing people with new or ongoing symptoms after acute COVID-19

These recommendations are for healthcare professionals assessing people in any healthcare setting, 4 weeks or more after the start of suspected or confirmed acute COVID-19.

For people with ongoing symptomatic COVID-19 or suspected post-COVID-19 syndrome who have been identified as needing an assessment, use a holistic, person-centred approach. Include a comprehensive clinical history and appropriate examination that involves assessing physical, cognitive, psychological and psychiatric symptoms, as well as functional abilities.

Include in the comprehensive clinical history:

• history of suspected or confirmed acute COVID-19
• the nature and severity of previous and current symptoms
• timing and duration of symptoms since the start of acute COVID-19
• history of other health conditions

Be aware that people can have wide-ranging and fluctuating symptoms after acute COVID-19, which can change in nature over time.

Discuss how the person's life and activities, for example their work or education, mobility and independence, have been affected by ongoing symptomatic COVID-19 or suspected post-COVID-19 syndrome.

Discuss the person's experience of their symptoms and ask about any feelings of worry or distress. Listen to their concerns with empathy and acknowledge the impact of the illness on their day-to-day life, for example activities of daily living, feelings of social isolation, work and education, and wellbeing.

For people who may benefit from support during their assessment, for example to help describe their symptoms, include a family member or carer in discussions if the person agrees.

Do not predict whether a person is likely to develop post-COVID-19 syndrome based on whether they had certain symptoms (or clusters of symptoms) or were in hospital during acute COVID-19.

When investigating possible causes of a gradual decline, deconditioning, worsening frailty or dementia, or loss of interest in eating and drinking in older people, bear in mind that these can be signs of ongoing symptomatic COVID-19 or suspected post-COVID-19 syndrome.

If the person reports new cognitive symptoms, use a validated screening tool to measure any impairment and impact

Reference:

• NICE (December 2020). COVID-19 rapid guideline: managing the long-term effects of COVID-19