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Long COVID: A GP’s Perspective
or most of 2020, the acute management of patients with COVID-19 was the top priority for the NHS. Over time, it became clear that at least 20% of patients would have symptoms that persisted for 5 weeks and 10% of patients would have symptoms for more than 12 weeks.[1] The term long COVID is acknowledged by the National Institute for Health and Care Excellence (NICE) as commonly being used to describe signs and symptoms that persist for more than 4 weeks after the initial illness.[2]
Dr Toni Hazell GP, freelance medical writer, blogger and editor Toni is a GP in North London and works for the Royal College of General Practitioners (RCGP) as an eLearning fellow, writing and editing eLearning. She also does similar work for a variety of other organisations and is a regular presenter and chair at GP educational events. She is a GP appraiser and sits on her local individual funding review panel. Her blog can be found online at www.tonihazell.co.uk
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Healthcare professionals with long COVID have described a range of experiences, including difficulty in accessing healthcare, varying patterns of symptoms and dismissive behaviour from health professionals.[3] A particular issue has been when patients are told that because they never had a positive COVID-19 test, or they do not have antibodies to the virus, their current symptoms cannot be due to long COVID. For much of 2020 only those admitted to hospital were tested,[4] so clearly it is possible that some patients with COVID-19 never acquired a positive test. We also know that levels of COVID-19 antibodies decrease over time[5],[6] and NICE[2] now clearly states that their guidance applies irrespective of previous COVID-19 test status or admission.
The aetiology of long COVID is unclear, but it may have an autoimmune element.[7] It is understandable that healthcare professionals may feel nervous or uncertain about encountering a patient with possible long COVID. This is a new disease, and it presents with a wide variety of symptoms (some of which are listed in the box below). A return to first principles is therefore important – take a good history, starting with open questions to ensure that the patient feels heard and has an opportunity to tell you everything Cardiac/Respiratory shortness of breath, reduced exercise tolerance, chest pain, palpitations Neurological dizziness, memory loss, difficulty in concentrating, headache, sensory symptoms (pins and needles / numbness), delirium (more common in older patients) General fatigue, insomnia, ongoing fever Psychiatric anxiety, depression, symptoms of post-traumatic stress disorder Gastrointestinal diarrhoea, nausea, abdominal pain, reduced appetite and weight
