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Long COVID

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Updated 2023 WHO guidelines for the management of long COVID.

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of long COVID are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2023), the World Health Organization (WHO 2023,2022), the European Respiratory Society (ERS 2022), and the European Society for Microbiology and Infectious Diseases (ESCMID 2022). ...
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Screening and diagnosis

Definition: as per WHO 2022 guidelines, define post-COVID-19 as a condition in patients with a history of probable or confirmed SARS-CoV-2 infection presenting with symptoms (including fatigue, shortness of breath, cognitive dysfunction, and other symptoms affecting everyday functioning; either with a new onset after initial recovery from an acute COVID-19 episode or persisting from the initial illness; fluctuating or relapsing over time) lasting for at least 2 months, usually 3 months from the onset of COVID-19, not explained by an alternative diagnosis.
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  • Differential diagnosis

Diagnostic investigations

Medical history: as per ESCMID 2022 guidelines, elicit clinical history to rule out previous underlying conditions, as well as iatrogenic causes or complications related to the acute episode.
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  • Pulmonary function testing

  • Cardiopulmonary function testing

  • Laboratory tests

  • Repeat PCR testing

  • Chest imaging

  • Cardiac imaging

  • Brain imaging

Medical management

General principles: as per WHO 2023 guidelines, consider including the following core components in the rehabilitation services for post-COVID-19 condition:
multidisciplinary rehabilitation teams
continuity and coordination of care
people-centered care and shared decision-making.
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  • Extended thromboprophylaxis

  • Antifibrotic agents

  • Management of breathlessness

  • Management of persistent cough

  • Management of fatigue

  • Management of arthralgia

  • Management of orthostatic intolerance

  • Management of olfactory impairment

  • Management of swallowing impairment

  • Management of voice impairment

  • Management of neurocognitive sequelae

  • Management of psychological/psychiatric sequelae

Follow-up and surveillance

Indications for referral: as per WHO 2023 guidelines, consider referring adult patients with post-COVID-19 condition for appropriate rehabilitation services when experiencing symptoms and impairments that are likely to be managed effectively and have an impact on everyday functioning, if red flags for safe rehabilitation have been considered.
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  • Return to normal activities