RT Journal Article
SR Electronic
T1 Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e815
OP e825
DO 10.3399/BJGP.2021.0265
VO 71
IS 712
A1 Martine Nurek
A1 Clare Rayner
A1 Anette Freyer
A1 Sharon Taylor
A1 Linn Järte
A1 Nathalie MacDermott
A1 Brendan C Delaney
YR 2021
UL http://bjgp.org/content/71/712/e815.abstract
AB 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.