At-a-glance (GP workflow)
- Suspect: new or ongoing symptoms ≥4 weeks after acute COVID-19 (confirmed or suspected).
- Define: ongoing symptomatic COVID-19 (4–12 weeks) vs post-COVID-19 syndrome (≥12 weeks).
- Outputs of the consult: symptom map + functional impact, targeted tests, initial management plan, and a clear follow-up/referral decision.
Assessment, red flags, and pragmatic tests
- History: symptom clusters (fatigue/PESE, breathlessness/cough, chest pain/palpitations, cognitive, autonomic/postural, mood/sleep) + impact on work/ADLs.
- Examination: vitals incl. sats, postural BP/HR, respiratory/cardiac exam; consider exertional desaturation if safe.
- Urgent escalation if: persistent hypoxia, syncope, haemoptysis, focal neurology, features of PE/MI/myocarditis, or severe deterioration.
- Tests (tailor to symptoms): common “baseline” set where appropriate: FBC, U&Es, LFTs, CRP, TFTs, HbA1c; add ferritin/B12/folate for fatigue, BNP for cardiac breathlessness, CXR/spirometry for ongoing respiratory symptoms per local pathway.
Management (what usually helps)
- Pacing (especially with PESE): energy-envelope / avoid boom–bust; do not prescribe rigid graded exercise if PESE is present.
- Rehab: consider referral to Long COVID service/MDT rehab where available; physiotherapy/OT input for function and return-to-work.
- Symptom-led care: manage headaches, sleep, anxiety/depression, cough/asthma/COPD, reflux etc using standard evidence-based pathways; optimise comorbidities.
- Safety-net: give clear triggers for urgent review and a planned follow-up to reassess function and investigate new symptoms.
Frequently asked questions
Should I order a “standard long COVID panel” for everyone?
No — use a pragmatic baseline set only when clinically indicated and tailor further tests to symptom clusters and red flags, to avoid incidental findings and delays.
What is the single highest-yield management principle?
Structured assessment + functional goals, pacing when PESE is present, and targeted rehab/referral. There is no one curative medication.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.