Prolonged symptoms following acute COVID-19 in adults — Diagnosis and management

Recent developments

Risk factors for the onset of prolonged symptoms following acute COVID-19 have been identified: hospitalisation and high number of symptoms during the initial episode.

New symptoms have been described, such as digestive tract, skin, and eye-related symptoms. They are discussed in new toolkit guides.

Prolonged symptoms following acute COVID-19 can affect adolescents and, in rarer cases, children (a specific toolkit guide will be formulated).

WHO has proposed a definition of “post-COVID condition”. This definition is liable to change over time. It defines this condition particularly via the presence of symptoms beyond 3 months after the acute episode.

The scope of this rapid response is not confined to this definition, but provides guidance on earlier management of persistent symptoms (beyond 4 weeks), in order to rule out any differential diagnoses, including some emergency scenarios, as soon as possible, and initiate treatments and/or rehabilitation.

Key points

This document is made up of two parts:

• Primary care strategies
• Toolkit guides by symptom or specialism:
  • Autonomic Dysfunction Symptoms Toolkit Guide
  • Chest Pains Toolkit Guide
  • Digestive Tract Symptoms Toolkit Guide
  • Dyspnoea Toolkit Guide
  • Eye Disorders Toolkit Guide
  • Fatigue Toolkit Guide
  • Functional Somatic Disorders Toolkit Guide
  • Neurological Signs Toolkit Guide(updated)
  • Physiotherapy Toolkit Guide - exercise therapy
  • Physiotherapy Toolkit Guide - hyperventilation syndrome
  • Skin Lesions Toolkit Guide
  • Taste and Smell Problems Toolkit Guide

Context

This rapid response follows a referral by the French Minister of Health dated 14 December 2020 requesting that the French National Authority for Health draft, based on a multidisciplinary approach, procedures to follow, aimed at healthcare professionals, and essentially those involved in primary care, for the management and referral of patients presenting with prolonged symptoms following acute COVID-19.

COVID-19 is a disease expressed in varied forms, in terms of clinical presentation, as well as severity and duration.

From the end of the first wave of the epidemic in May 2020, symptoms persisting several weeks or months after symptom onset were reported in over 20% of patients after 5 weeks or longer, and in over 10% of patients after 3 months.[1]

To date, hospitalisation and a large number of symptoms during the initial episode have been identified as risk factors for prolonged symptoms.

The polysymptomatic and fluctuating nature of these clinical signs has given rise to questions and concerns for patients and clinicians.

COVID outcome data are still rare and the physiopathological mechanisms are hypothetical at this stage. The term “Long Covid” has been created and used by patients and adopted in the literature to describe this phenomenon. Given the lack of accurate physiopathological and epidemiological data, this document uses the broader concept of prolonged symptoms following acute COVID-19.

Pragmatic, rational and scientific management of these patients, as part of a potentially multidisciplinary approach, with a shared medical decision, is needed.

These symptoms can be managed in a primary care setting in the large majority of cases. Additional investigations may be required. 

Escalation of irrelevant investigations should be avoided.

The purpose of this document is to define the primary care of adult patients presenting with long-term symptoms. The associated toolkit guides give information on the clinical and paraclinical investigations required in a primary care setting based on organ involvement and/or the symptoms presented. They identify emergency situations and situations where specialist referral is needed.

These rapid responses have been drafted on the basis of available knowledge on the date of publication. They are liable to evolve on the basis of new data.

[1] Office for National Statistics. The prevalence of long COVID symptoms and Covid-19 complications: ONS; 2020.

https://www.ons.gov.uk/news/statementsandletters/theprevalenceoflongcovidsymptomsandcovid19complications