NICE focus: support for care of long Covid

What’s the guidance?

NG188: COVID-19 rapid guideline: managing the long-term effects of COVID-19

Does it replace earlier guidance?

No, the guideline is new and was created using a different approach to normal that supports the development of guidance in response to health and social care emergencies.

What does it cover?

NICE, the Royal College of General Practitioners (RCGP) and the Scottish Intercollegiate Guidelines Network (SIGN) have published a guideline on the management of the long-term effects of Covid-19 (also known as long Covid).

The guideline covers the care of people who have signs and symptoms that develop during or after an infection consistent with Covid-19, that continue for more than four weeks and are not explained by an alternative diagnosis. It provides recommendations based on the current evidence and expert consensus, and will be adapted as new evidence emerges.

The guideline makes recommendations in a number of other areas, including:

• Assessing people with new or ongoing symptoms after acute Covid-19
• Investigations and referral
• Planning care
• Management, including self-management, supported self-management, and rehabilitation
• Follow-up and monitoring
• Service organisation.

It says that people should be given good information after thy have had Covid-19 so that they know what to expect and when to ask for more medical advice. This could help to relieve anxiety when people do not recover in the way they expect. The guideline offers advice for self-management and the development of personalised rehabilitation and management plans for those needing multidisciplinary support.

A number of recommendations are also made for research that will help inform and enhance future versions of guidance as evidence and practice develops.

Who is it for?

• Health and care practitioners
• Health and care staff involved in planning and delivering services
• Commissioners

Who is affected by the condition?

Most people’s symptoms of Covid-19 resolve within 12 weeks. However, for a sizeable minority of people, symptoms can persist or new ones develop, and can sometimes worsen, and have a continuing negative impact on their quality of life. Longer term impacts can include shortness of breath, fatigue, and problems involving the heart, lungs, kidneys, nervous system and muscles and joints.

What are the benefits for patients?

The guideline highlights the importance of providing people with good information after they’ve had acute Covid-19 so they know what to expect and when they should ask for more medical advice. This could help to relieve anxiety when people do not recover in the way they expect, particularly because symptoms can fluctuate and there are so many different symptoms reported.

What are the financial implications?

NHS England has provided £10m to support the assessment and management of the long-term effects of Covid-19. The exact geographic configuration of services will be agreed with NHS England and NHS Improvement regional leads.

Due to current uncertainty related to patient volumes, diagnostics, follow-up and outcomes, a resource impact template has not been produced to support the guideline. More detail can be found in the resource impact statement published alongside the guidance. Clinical coding is being developed to enable post-Covid-19 syndrome to be recorded in clinical information systems and commissioners are expected to put in place systems to capture details of patient volumes and outcomes.

Gary Shield is resource impact assessment manager at Nice