Patients with long-term effects of Covid-19 are those with symptoms for more than 12 weeks that ‘can affect any system in the body’, according to a new definition by NICE.
In its first definition of the different stages of Covid, NICE said ‘post-Covid-19 syndrome’ occurred following an infection, with symptoms – usually appearing as ‘clusters’ – ongoing for more than three months.
The symptoms are ‘often overlapping, which can fluctuate and change over time and can affect any system in the body’, said the new definition, ordered by NHS England and the chief medical officer of the Scottish Government.
Clusters of symptoms may occur across cardiovascular, respiratory, gastrointestinal, neurological, musculoskeletal, metabolic, renal, dermatological, otolaryngological, haematological and autonomic systems, said NICE.
Patients may also show signs of psychiatric problems, generalised pain, fatigue and persisting fever, it added.
NICE stressed the definition of post-Covid-19 syndrome did not mean coronavirus illness was over or that patients had recovered from it, only that ‘the acute phase has usually ended’.
The guideline body worked with the Scottish Intercollegiate Guidelines Network (SIGN) and the RCGP to define the three stages of Covid – acute Covid-19 infection, ongoing symptomatic Covid-19, and post Covid-19 syndrome.
It is still working on full guidance for UK GPs and other healthcare professionals about how to manage the longer term stages of Covid-19, having only releasing the scope of the guidance today.
The final version, which is due to be published before the end of the year, will focus on investigations and assessment, management and rehabilitation, referral, inequalities, and people’s lived experiences.
However, NICE said it will not cover the management of acute Covid-19 – for those experiencing symptoms up to four weeks.
It will also not be drawing up advice on the management of other conditions with similar features to longer-term Covid – such as post-intensive care syndrome – or the management of end-organ damage, because this already has defined pathways of care.
NICE noted it may not be possible to make recommendations in all areas and that there is ‘still uncertainty’ around what is known about the lasting effects of Covid.
It said its case definitions will be continuously reviewed and updated in response to emerging evidence.
Earlier this month, the National Institute for Health Research found that ‘long Covid’ can be split into four distinct syndromes, after thousands of sufferers reported symptoms incorporating breathlessness, chronic fatigue, brain fog, anxiety and stress, after initially recovering from the virus.
NHS England has stated GPs are set to staff specialist clinics to diagnose and treat patients with long Covid across England. This is to be backed by £10m of local funding.
Additional reporting by Eleanor Philpotts
NICE case definitions for Covid-19 stages
Acute Covid-19 infection
Signs and symptoms of Covid-19 for up to 4 weeks.
Ongoing symptomatic Covid-19
Signs and symptoms of Covid-19 from 4 weeks up to 12 weeks
Signs and symptoms that develop during or following an infection consistent with Covid-19, continue for more than 12 weeks and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body.
Post-Covid-19 syndrome may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed.