{"id":2598,"date":"2021-08-22T15:24:38","date_gmt":"2021-08-22T15:24:38","guid":{"rendered":"http:\/\/wp.cov19longhaulfoundation.org\/?p=2598"},"modified":"2021-08-22T15:24:38","modified_gmt":"2021-08-22T15:24:38","slug":"management-of-post-acute-covid-19-in-primary-care","status":"publish","type":"post","link":"https:\/\/cov19longhaulfoundation.org\/?p=2598","title":{"rendered":"Management of post-acute covid-19 in primary care"},"content":{"rendered":"\n<p><em>BMJ<\/em>\u00a02020;\u00a0370\u00a0doi:\u00a0<a href=\"https:\/\/doi.org\/10.1136\/bmj.m3026\">https:\/\/doi.org\/10.1136\/bmj.m3026<\/a>\u00a0(Published 11 August 2020)Cite this as:\u00a0<em>BMJ<\/em>\u00a02020;370:m3026<\/p>\n\n\n\n<p>Authors: Trisha Greenhalgh, professor of primary care health sciences<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#aff-1\">1<\/a>, \u00a0Matthew Knight, consultant respiratory physician<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#aff-2\">2<\/a>, \u00a0Christine A\u2019Court, general practitioner<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#aff-1\">1<\/a>, \u00a0Maria Buxton, consultant respiratory physiotherapist<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#aff-3\">3<\/a>, \u00a0Laiba Husain, research assistant<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#aff-1\">1<\/a><\/p>\n\n\n\n<h3 class=\"wp-block-heading\" style=\"font-size:24px\">What you need to know<\/h3>\n\n\n\n<ul class=\"wp-block-list\" id=\"list-1\" style=\"font-size:22px\"><li>Management of covid-19 after the first three weeks is currently based on limited evidence<\/li><li>Approximately 10% of people experience prolonged illness after covid-19<\/li><li>Many such patients recover spontaneously (if slowly) with holistic support, rest, symptomatic treatment, and gradual increase in activity<\/li><li>Home pulse oximetry can be helpful in monitoring breathlessness<\/li><li>Indications for specialist assessment include clinical concern along with respiratory, cardiac, or neurological symptoms that are new, persistent, or progressive<\/li><\/ul>\n\n\n\n<p id=\"p-7\" style=\"font-size:24px\">Post-acute covid-19 (\u201clong covid\u201d) seems to be a multisystem disease, sometimes occurring after a relatively mild acute illness.<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#ref-1\">1<\/a>&nbsp;Clinical management requires a whole-patient perspective.<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#ref-2\">2<\/a>&nbsp;This article, intended for primary care clinicians, relates to the patient who has a delayed recovery from an episode of covid-19 that was managed in the community or in a standard hospital ward. Broadly, such patients can be divided into those who may have serious sequelae (such as thromboembolic complications) and those with a non-specific clinical picture, often dominated by fatigue and breathlessness. The specialist rehabilitation needs of a third group, covid-19 patients whose acute illness required intensive care, have been covered elsewhere.<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#ref-3\">3<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Defining post-acute covid-19<\/h2>\n\n\n\n<p id=\"p-8\" style=\"font-size:24px\">In the absence of agreed definitions, for the purposes of this article we define post-acute covid-19 as extending beyond three weeks from the onset of first symptoms and chronic covid-19 as extending beyond 12 weeks. Since many people were not tested, and false negative tests are common,<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#ref-4\">4<\/a>&nbsp;we suggest that a positive test for covid-19 is not a prerequisite for diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" style=\"font-size:22px\">How common is it?<\/h3>\n\n\n\n<p id=\"p-9\" style=\"font-size:24px\">Around 10% of patients who have tested positive for SARS-CoV-2 virus remain unwell beyond three weeks, and a smaller proportion for months (see\u00a0<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#boxed-text-2\">box 1<\/a>).<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#ref-7\">7<\/a>\u00a0This is based on the UK COVID Symptom Study, in which people enter their ongoing symptoms on a smartphone app. This percentage is lower than that cited in many published observational studies,<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#ref-8\">8<\/a><a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#ref-9\">9<\/a>\u00a0whose denominator populations were those admitted to hospital or attending specialist clinics. A recent US study found that only 65% of people had returned to their previous level of health 14-21 days after a positive test.<a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026#ref-10\">10<\/a><\/p>\n\n\n\n<p class=\"has-large-font-size\">For More Information: <a href=\"https:\/\/www.bmj.com\/content\/370\/bmj.m3026\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.bmj.com\/content\/370\/bmj.m3026<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>BMJ\u00a02020;\u00a0370\u00a0doi:\u00a0https:\/\/doi.org\/10.1136\/bmj.m3026\u00a0(Published 11 August 2020)Cite this as:\u00a0BMJ\u00a02020;370:m3026 Authors: Trisha Greenhalgh, professor of primary care health sciences1, \u00a0Matthew Knight, consultant respiratory physician2, \u00a0Christine A\u2019Court, general practitioner1, \u00a0Maria Buxton, consultant respiratory physiotherapist3, \u00a0Laiba [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":2599,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[289,290],"tags":[],"class_list":["post-2598","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-long-haul-disease","category-long-term-effects"],"_links":{"self":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts\/2598","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2598"}],"version-history":[{"count":0,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/posts\/2598\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=\/wp\/v2\/media\/2599"}],"wp:attachment":[{"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2598"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2598"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cov19longhaulfoundation.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2598"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}