NICE Issues Rapid Guideline on Long COVID

Peter Russell

December 18, 2020

People may have ongoing symptomatic COVID-19 if they present with symptoms 4 to 12 weeks after the start of acute symptoms, the National Institute for Health and Care Excellence (NICE) has said.

People may have post-COVID syndrome if their symptoms have not resolved after 12 weeks, it added.

The rapid guideline on managing the long-term effects of COVID-19, also known as 'long COVID', was produced by NICE in collaboration with the Scottish Intercollegiate Guidelines Network (SIGN) and the Royal College of General Practitioners (RCGP).

It was published as the NHS announced that patients with long-term symptoms of COVID-19 could now access specialist help at a growing number of clinics in England.

Fatigue, Cough, and Headaches

Latest research found that 1 in 5 people with COVID-19 develop longer term symptoms. Around 186,000 people experience health problems for up to 12 weeks, according to the Office for National Statistics.

The ONS estimated that 9.9% of people who had COVID-19 remained symptomatic after 12 weeks.

The most common symptoms were fatigue, cough, and headache.

The NICE guidance covers the care of people who have signs and symptoms that develop during or after an infection consistent with COVID-19, that continue for more than 4 weeks, and are not explained by an alternative diagnosis. It provides recommendations based on current evidence and expert consensus.

The guideline makes recommendations in a number of other key areas, including:

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

  • Investigations and referral

  • Planning care

  • Management, including self-management, supported self-management, and rehabilitation

  • Follow-up and monitoring

  • Service organisation

Paul Chrisp, director of the Centre for Guidelines at NICE, said: "This guideline highlights the importance of providing people with good information after they've had acute COVID-19, so they know what to expect and when they should ask for more medical advice.

"This could help to relieve anxiety when people do not recover in the way they expect, particularly because symptoms can fluctuate and there are so many different symptoms reported."

Safia Qureshi, director of evidence for Healthcare Improvement Scotland, said: "We appreciate how difficult it must be for people to face so much uncertainty with this condition and the significant impact it can have on people's quality of life."

Prof Martin Marshall, chair of the RCGP, said: "The College has been delighted to work with NICE and SIGN to develop these clinical guidelines. We hope they will be useful for GPs and other healthcare professionals and will have a positive impact on the care delivered to patients with prolonged symptoms of COVID-19."

NICE said the guidance would be adapted as new evidence emerges.

Recommendations for Future Research

The expert panel also made several recommendations for research. These included:

  • Identifying what factors influence the risk of developing post-COVID-19 syndrome and its trajectory

  • Establishing the most clinically effective interventions

  • Assessing whether the effectiveness of interventions varies for people of different ethnic and socioeconomic backgrounds

Michael Sharpe, professor of psychological medicine at the University of Oxford, said the guidelines were "an excellent starting point" for addressing the needs of people who had survived COVID-19 but remained ill.

He told the Science Media Centre: "All too often the NHS focusses on saving lives but neglects the needs of the survivors. We must not make that mistake this time. We now need to mobilise again to reduce the risk of long-term disability in those who survived COVID-19."

Charlotte Bolton, professor of respiratory medicine at the University of Nottingham, warned of challenges ahead. She said: "Core staff are already delivering standard clinical care during a busy winter period, additional frontline care for the wave two of patients with COVID-19, and also trying to support this follow-up.

"There are nationwide NHS staff shortages and extra infection control precautions required to ensure the care delivered is safe, at the time of the pandemic. The follow-up cannot be a tick box and the need is most definitely now.

"There will inevitably need to be some flexibility in the guidance as more evidence accumulates, but we cannot hold off addressing these persisting symptoms, which for some are impacting on their quality of life greatly."

Specialist Long COVID Clinics

As the rapid guideline was published, the NHS produced a list of 69 specialist clinics in England where patients could seek treatment for long COVID.

It said 10 sites were now operational in London, seven in the East of England, eight in the Midlands, South East and South West respectively, nine in the North West, and a further 18 across the North East and Yorkshire.

A further 12 sites have been earmarked to launch in January in the East Midlands, Lancashire, Cornwall, and the Isle of Wight.

Patients can be referred to a clinic by their GP or another healthcare professional if they experience symptoms of long-term COVID, such as brain fog, anxiety, depression, breathlessness, fatigue, and other debilitating symptoms.

NHS England has provided £10 million for the network of clinics, which started opening last month, staffed by doctors, nurses, physiotherapists, and occupational therapists.

Sir Simon Stevens, NHS England chief executive, said: "The NHS is taking practical action to help patients suffering ongoing health issues as a result of coronavirus.

"Bringing expert clinicians together in these clinics will deliver an integrated approach to support patients access vital rehabilitation, as well as helping develop a greater understanding of long COVID and its debilitating symptoms."

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