Long COVID should be considered in someone who has had suspected or confirmed acute COVID-19.
These individuals are likely to present to primary care, often with non-specific symptoms of fatigue, breathlessness, brain fog, palpitations, tachycardia, chest pain, joint pain, pain on eye movements, and many more. Symptoms are multi-factorial, and it is important to consider Long COVID in any patients with symptoms that persist more than 12 weeks, and cannot be explained by any alternative diagnosis.
For more information, check out the NICE guideline and Red Whale publication, both linked below.
Whilst taking a history from a patient, it is important to rule out any red flag symptoms, including symptoms of ACS, myocarditis, focal neurological issues, and acute mental health problems. Any red flags should be referred to a specialist clinic for further investigations.
For further guidance around taking a history, there are a number of screening tools that have been developed for Long COVID, including the Newcastle and Yorkshire screening tools (also linked below).
General investigations that might be useful for a patient presenting with symptoms of long COVID include:
- Blood tests (FBCs, U&E, LFT, TFT, CRP, ferritin, troponin and D-dimers)
- Chest x-ray (especially if the patient is breathless and has a cough)
- Exercise tolerance test (ask the patient to sit and stand for one minute, while measuring pulse oximetry for desaturations)
- PoTS assessment (measure pulse for spikes in heart rate when standing)
If the red flag symptoms have been ruled out and the investigations are found to be normal, as expected in long COVID, discuss with the patient the next steps for their recovery, including referral to your local multidisciplinary rehabilitation team, or self-management at home with the support of the NHS Wales COVID Recovery App.