Clinical guidance for ongoing symptoms post COVID-19 infection

  • The National COVID-19 Clinical Evidence Taskforce
National COVID-19 Clinical Evidence Taskforce
Samantha Chakraborty, Sarah Larkins, Mark Morgan, Nicole Allard, Kathryn Bailey, Lyn Byers, Penny Burns, Sabina Knight, Alistair Miller, Carmel Nelson, Bernard Shiu, Georgina Taylor, Mieke Van Driel and Dina Watterson

While most people with a COVID-19 infection get better within a few weeks, a small proportion of people experience new or ongoing symptoms after the acute illness has resolved. People may experience a range of symptoms of varying severity and length. The most commonly reported symptoms include cough, shortness of breath, fatigue, with less common symptoms including headache, neurological symptoms, difficulty concentration, changes in mood and affect, pain and fever. For some people these symptoms will resolve on their own with self-directed care, while others may require care from a health professional. At present, we cannot accurately predict who is at greatest risk of experiencing what symptoms.

Because of this uncertainty, there is no current Australian or international definition for the combination of symptoms that a person may experience after an acute COVID-19 infection has resolved. For people who experience these symptoms, however, the physical and psychosocial consequences are important. Equally important to these individuals, is that their symptoms are recognised and acknowledged.The community has therefore coined the term ‘long COVID’ to refer to the combination of symptoms that may follow an acute COVID-19 infection. Until now, the majority of acute COVID-19 infections have been managed in small pockets, largely metropolitan, across Australia.

However, as people are discharged from hospital, move around the country or return home from other countries, people with ongoing or emerging symptoms may present to health professionals throughout the nation.

For some clinicians, these will be the first cases of COVID-19 they have managed. Care may need to be multidisciplinary involving primary care practitioners along with a range of other health professionals. For rural and remote residents, this may involve establishing new collaborative care relationships and care pathways to provide people with person-centred, effective and efficient care.

The National COVID-19 Clinical Evidence Taskforce was established in March 2020 with support of the Commonwealth, state and territory governments to provide unified national clinical guidelines for the care of people with suspected or proven COVID-19. It’s a diverse collaboration of 32 peak clinical bodies and more than 200 leading medical experts from across primary, acute and critical care settings. The Taskforce develops ‘living guidelines’ using an evidence-based GRADE process and updating frequently as new evidence emerges.

Watching overseas trends in the number of people who reported new or ongoing symptoms following a COVID-19 infection, it was apparent that the Taskforce needed to support Australian primary care clinicians by providing guidance on this topic. A printable, two-page flowchart on the care of people with new or emerging symptoms post an acute COVID-19 infection was therefore published in December 2020.

Led by the Primary and Chronic Care panel of the Taskforce, the recommendations were developed using evidence, where available, or expert consensus to specify principles that can help the person by alleviating anxieties about symptoms, setting realistic recovery expectations and managing symptoms. Since many of the symptoms reported after acute COVID-19 infection have common features with symptoms that are regularly managed in primary care, the panel has drawn on current best-practice approaches to guide care.

The Taskforce has been collaborating with other international evidence-based guideline developers including the UK’s National Institute for Health and Care Excellence and the World Health Organization to better understand the needs of people who have had COVID-19 and clinicians, and the emerging evidence base for care.

Research is underway across the globe about these symptoms, the clinical course, risk of the illness and effective management approaches. The Taskforce recommendations will be updated as new evidence on the care of people with symptoms following an acute COVID-19 infection emerges.

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