Long Covid

Vignette: A 35-year-old lady has been referred in via her GP surgery as she feels ongoing tiredness, muscle pains, shortness of breath, retrosternal discomfort, and poor memory.

Past medical history: Covid-19 (4 months ago), nil else

Medications: Nil regular, paracetamol PRN

Observations: 68 bpm, BP 125/70, Sats 95% on air, RR 20, Temp 37.1

Please discuss your approach in this patient.

Model answer:

As the patient appears haemodynamically stable, candidate may choose to focus more on history taking. Full history taking should include each system to exclude potential illnesses. May explore history of Covid-19 – if severe and symptomatic?

Physical examination:

May take a systemic approach, start from respiratory system (mild exp. wheeze), CVS (normal), GI system (normal), skin (normal), MSK (normal), AMTS (10/10).

Investigations:

• Blood tests including FBC, U&Es, CRP, LFTs, clotting, amylase/lipase, CK, TFTs
• 12-lead ECG and CXR

Differential Diagnosis:

• Asthma
• Viral upper respiratory tract infection
• Thyroid disorder
• Fibromyalgia
• Myalgic encephalomyelitis
• GORD/Barrett’s oesophagus

Treatment:

May trial salbutamol nebulisers to see if any improvement, may trial Gaviscon/PPI and encourage simple analgesia.

Further events:

Nurse bleeps informing all blood tests are normal except a mildly raised CRP at 12. Patient’s observations remain normal. She is requesting for a doctor’s update. How would you manage this patient further?

Answer:

Candidate should show understanding that no specific illness has been found and be honest with the patient regarding this. They should reassure the patient. They may suggest continuing taking a PPI + inhaler PRN and may suggest GP to follow up. Secondary referrals should generally be avoided at this point.

Candidate may think of mentioning post-Covid syndrome/long Covid to the patient. Show empathy and suggest ways to self-manage such as setting realistic goals, support groups, who and when to seek help, use of MDT to guide rehabilitation (including physical, psychological and psychiatric aspects). Some hospitals may have a designated long Covid service?

Post-COVID-19 syndrome:

Signs and symptoms that develop during or after 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.