management (Long COVID)

Last edited 03/2021 and last reviewed 03/2023

Management

For full details then see NICE guideline [NG188]

These recommendations are for healthcare professionals providing care for people with ongoing symptomatic COVID-19 or post-COVID-19 syndrome in primary care and community settings or in multidisciplinary assessment and rehabilitation services.

Self-management and supported self-management

Give advice and information on self-management to people with ongoing symptomatic COVID-19 or post-COVID-19 syndrome, starting from their initial assessment. This should include:

• ways to self-manage their symptoms, such as setting realistic goals
• who to contact if they are worried about their symptoms or they need support with self-management
• sources of advice and support, including support groups, social prescribing, online forums and apps
• how to get support from other services, including social care, housing, and employment, and advice about financial support
• information about new or continuing symptoms of COVID-19 that the person can share with their family, carers and friends

Explain to people that it is not known if over-the-counter vitamins and supplements are helpful, harmful or have no effect in the treatment of new or ongoing symptoms of COVID-19.

Support people in discussions with their employer, school or college about returning to work or education, for example by having a phased return. For advice on returning to work, follow national guidance, for example NICE's guideline on workplace health: long-term sickness absence and capability to work.

Multidisciplinary rehabilitation

Assess people who have been referred to integrated multidisciplinary rehabilitation services to guide management. Include physical, psychological and psychiatric aspects of rehabilitation. Ensure that any symptoms that could affect the person being able to start rehabilitation safely have been investigated first. See also the recommendation on multidisciplinary rehabilitation teams.

Work with the person to develop a personalised rehabilitation and management plan that is recorded in a rehabilitation prescription and should include:

• areas of rehabilitation and interventions based on their assessment
• helping the person to decide and work towards goals
• symptom management for all presenting symptoms, for example advice and education on managing breathlessness, fatigue and 'brain fog'.

Encourage people to keep a record of, or use a tracking app to monitor, their goals, recovery and any changes in their symptoms (also see the linked item on follow-up and monitoring).

Support for older people and children

Consider additional support for older people with ongoing symptomatic COVID-19 or post-COVID-19 syndrome, for example short-term care packages, advance care planning and support with social isolation, loneliness and bereavement, if relevant.

Consider referral from 4 weeks for specialist advice for children with ongoing symptomatic COVID-19 or post-COVID-19 syndrome

Reference:

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