December 18, 2020

expert reaction to COVID-19 rapid guideline: managing the long-term effects of COVID-19, developed by NICE, SIGN and RCGP

The National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN) and Royal College of General Practitioners (RCGP) have published a guideline on the management of the long-term effects of COVID-19.

Prof Charlotte Bolton, Professor of Respiratory Medicine, University of Nottingham, said:

“As a respiratory physician offering a clinical service for patients recovering after Covid-19 hospitalisation and for those referred in from primary care with persisting breathlessness, I really welcome further clarity and detail from NICE, SIGN and RCGP in these guidelines. It is of huge importance if we are to try and enable patients back to full recovery, back to their work and an active life. This period of recovery is vital and requires a holistic approach to address sometimes complex problems and detecting potential new issues. Alongside the guidelines however, there are challenges. Core staff are already delivering standard clinical care during a busy winter period, additional frontline care for the wave 2 of patients with Covid-19 and also trying to support this follow-up. There are nationwide NHS staff shortages and extra infection control precautions required to ensure the care delivered is safe, at the time of the pandemic. The follow-up cannot be a tick box and the need is most definitely now. There will inevitably need to be some flexibility in the guidance as more evidence accumulates, but we cannot hold off addressing these persisting symptoms, which for some are impacting on their quality of life greatly.”

Prof Michael Sharpe, Professor of Psychological Medicine, University of Oxford, said:

“When COVID-19 struck, we mobilized a huge clinical effort to reduce the risk of  death in those affected. Most people affected survived, but a significant minority of these have remained ill. These rapidly produced guidelines are an excellent starting point for addressing their needs. They recommend a combination of supported self- care and a proactive multidisciplinary approach based on available evidence and sound clinical principles. The initial modest NHS funding to implement these recommendations is to be welcomed. But if we are to avoid an epidemic of post-COVID disability we need to do more. All too often the NHS focusses on saving lives but neglects the needs of the survivors. We must not make that mistake this time. We now need to mobilize again to reduce the risk of long term disability in those who survived COVID-19.”

Prof Martin McKee, Professor of European Public Health, London School of Hygiene and Tropical Medicine, said:

“By focusing on what is routinely measured, tests and deaths, we have paid far too little attention to what the Office of National Statistics now estimates to be one in 10 Covid survivors with symptoms persisting for 12 weeks or longer. Yet we know that many of those affected are struggling to have their problems taken seriously. I see two major benefits from this guidance. First, it makes clear that a diagnosis of Long Covid should not depend on a positive test. There are many people who were affected early in the pandemic who were unable to get tested but who clearly have persisting complications of infection. Second, it stresses the importance of multidisciplinary assessment teams. Early in the pandemic we reviewed the complex multisystem nature of Covid.[1] This virus, and the accompanying immune response, affects almost all body systems and it is essential that those affected are assessed in a holistic way. Evidence on the long term consequences of this condition is accumulating all the time and some who survived the acute infection will be affected for the rest of their lives.”

1. Roberts CM, Levi M, McKee M, Schilling R, Lim WS, Grocott M. COVID-19: a complex multi-system disease Br J Anaesthesia 2020; 125: 238-242

Prof Kamlesh Khunti, Professor of Primary Care Diabetes and Vascular Medicine, University of Leicester, said:

“This guidance is a welcome step on learning the epidemiology and impact of this new pandemic. There are still a number of unknows such as how we classify Long-COVID including timeframe and the symptoms to be included. Much more research needs to be done on how it affects different populations such as ethic minority, deprived populations, people with severe (hospitalised) and milder disease and people with pre-existing chronic diseases particularly those with multimorbidity.  We need to continue assessing ongoing evidence to determine the longer term physical and psychological impact of this and interventional studies to improve outcomes of people with longer term consequences of COVID-19.”

‘COVID-19 rapid guideline: managing the long-term effects of COVID-19’, developed by NICE, SIGN and RCGP, was published at 00:01 UK time Friday 18 December.

All our previous output on this subject can be seen at this weblink:

www.sciencemediacentre.org/tag/covid-19

Declared interests

Prof Michael Sharpe: “No conflicts.”

None others received.