Three stages
Three stages
The National Institute for Health and Care Excellence (NICE) has defined three stages of Covid-19:
- Acute Covid-19 infection: signs and symptoms of Covid-19 for up to four weeks
- Ongoing symptomatic Covid-19: signs and symptoms of Covid-19 present from four weeks and up to 12 weeks
- Post-Covid-19 syndrome: signs and symptoms that develop during or after an infection consistent with Covid-19, present for more than 12 weeks and not attributable to alternative diagnoses.
Ongoing symptoms after acute Covid-19 infection is still a relatively new and emerging condition, and although the effects are increasingly recognised, people living with medium- and long-term effects often report experiencing misunderstanding and even scepticism from relatives, friends and colleagues. Employers may not be suitably sympathetic.
Patients can have single or multiple symptoms, which may be constant, transient or fluctuating, and can change in nature over time. Some clues to possible causes have been identified through research and there is some evidence that long-Covid might involve an active disease process, with immunological evidence of continued inflammatory responses, lingering viral activity and/or blood clotting disorders.
Together, NICE, the Scottish Intercollegiate Guidelines Network (SIGN) and the Royal College of General Practitioners (RCGP) have developed the guideline NG188, entitled ‘Covid-19 rapid guideline: managing the long-term effects of Covid-19’, which will be updated as new evidence emerges.
Long-Covid clinics
In December 2020, NHS England announced the setting up of more than 70 long-Covid clinics, each with a multidisciplinary team offering both physical and psychological assessments. Pharmacy teams can check to see where the nearest one is locally, although not all are open yet and demand has been so high that some have temporarily stopped accepting referrals. As of April 2021, specialist long-Covid clinics are not available in Scotland, Wales or Northern Ireland, and they are not available to children in England.