When should I refer a patient with Long COVID symptoms to a specialist for further evaluation?

Refer a patient with Long COVID symptoms to a specialist for further evaluation if:

• Symptoms consistent with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have persisted for 3 months and are not explained by another condition.
• There is uncertainty in primary care about interpreting signs and symptoms or whether further investigations are needed at 3 months.
• In adults, refer directly to an ME/CFS specialist team to confirm diagnosis and develop a care and support plan.
• In children and young people, seek advice from a paediatrician early if ME/CFS is suspected, and refer to a paediatric ME/CFS specialist team after diagnosis.
• Patients exhibit complex symptoms such as orthostatic intolerance, autonomic dysfunction, or severe fatigue impacting daily functioning that require specialist assessment.

Primary care professionals should also consider referral if there is diagnostic uncertainty or if symptoms worsen or new symptoms develop before 3 months, ensuring timely specialist input.

This approach ensures appropriate diagnosis, management, and support planning for Long COVID patients with ME/CFS-like symptoms.

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