Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study

Martine Nurek; Clare Rayner; Anette Freyer; Sharon Taylor; Linn Järte; Nathalie MacDermott; Brendan C Delaney; Delphi panellists

doi:10.3399/BJGP.2021.0265

Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study

Br J Gen Pract. 2021 Oct 28;71(712):e815-e825. doi: 10.3399/BJGP.2021.0265. Print 2021 Nov.

Authors

Martine Nurek¹, Clare Rayner², Anette Freyer², Sharon Taylor³, Linn Järte⁴, Nathalie MacDermott⁵, Brendan C Delaney⁶; Delphi panellists

Affiliations

¹ Department of Surgery and Cancer, Imperial College London, London.
² Department of Acute Medicine, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham.
³ Central and North West London NHS Foundation Trust and honorary senior clinical lecturer, Imperial College School of Medicine, London.
⁴ Anaesthetics Department, Morriston Hospital, Swansea Bay University Health Board, Swansea.
⁵ King's College London, St Thomas' Hospital, London.
⁶ Department of Surgery and Cancer, Imperial College London, London, and principal in general practice, Albion Street Group Practice, London.

Abstract

Background: In the absence of research into therapies and care pathways for long COVID, guidance based on 'emerging experience' is needed.

Aim: To provide a rapid expert guide for GPs and long COVID clinical services.

Design and setting: A Delphi study was conducted with a panel of primary and secondary care doctors.

Method: Recommendations were generated relating to the investigation and management of long COVID. These were distributed online to a panel of UK doctors (any specialty) with an interest in, lived experience of, and/or experience treating long COVID. Over two rounds of Delphi testing, panellists indicated their agreement with each recommendation (using a five-point Likert scale) and provided comments. Recommendations eliciting a response of 'strongly agree', 'agree', or 'neither agree nor disagree' from 90% or more of responders were taken as showing consensus.

Results: Thirty-three clinicians representing 14 specialties reached consensus on 35 recommendations. Chiefly, GPs should consider long COVID in the presence of a wide range of presenting features (not limited to fatigue and breathlessness) and exclude differential diagnoses where appropriate. Detailed history and examination with baseline investigations should be conducted in primary care. Indications for further investigation and specific therapies (for myocarditis, postural tachycardia syndrome, mast cell disorder) include hypoxia/desaturation, chest pain, palpitations, and histamine-related symptoms. Rehabilitation should be individualised, with careful activity pacing (to avoid relapse) and multidisciplinary support.

Conclusion: Long COVID clinics should operate as part of an integrated care system, with GPs playing a key role in the multidisciplinary team. Holistic care pathways, investigation of specific complications, management of potential symptom clusters, and tailored rehabilitation are needed.

Keywords: COVID-19; clinical guidelines; general practice; long COVID; long-hauler; post-COVID-19 condition; post-acute sequelae of COVID-19 (PASC).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / complications
COVID-19* / diagnosis
COVID-19* / therapy
Consensus
Delphi Technique
Humans
Post-Acute COVID-19 Syndrome

Grants and funding

FS/17/16/32560/BHF_/British Heart Foundation/United Kingdom