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Latest post-COVID evidence and guidelines

About
Resource Hub
Guidance
— Assessing lung damage
— Rehabilitation
— Treatments for the lung
How are we influencing post-COVID policy?

About

We have created this hub to help share the latest evidence and guidance for the care and rehabilitation of people with breathing difficulties after having COVID. This has been possible by working alongside leading respiratory experts and professional bodies, including the British Thoracic Society and the Primary Care Respiratory Society,

Globally, tens of thousands of people are being admitted to hospital for acute care, with some needing treatment in an intensive care unit (ICU). Early studies suggest COVID-19 may leave some people with breathing problems after they are discharged from hospital. There are also reports of people developing Acute Respiratory Distress Syndrome (ARDS) during their acute infection, with complications afterwards. Read more about post-COVID lung damage research.

We’ve also heard from lots of people who have been managing COVID at home, many with mild or moderate symptoms. Our health advice covers recovery information for post-COVID side effects, including breathlessness, sleep difficulties and fatigue. We also know that people with COVID are also living with side effects that aren’t respiratory, so we signpost to other leading organisations in these areas.

It’s important to acknowledge the mental and emotional impact of post-COVID recovery as well. Many people are now living with depression, PTSD or health anxiety. Some people are struggling with daily tasks that involve organising, planning and problem solving. Post-COVID stories are vital in helping us understand how coronavirus affects people around the world, whether they are treated in hospital or manage their symptoms at home.

Resource hub

Our resource hub curates the latest evidence related to post-COVID breathing difficulties and interventions, including the incidence of ARDS following coronavirus.

Visit resource hub

Guidance

There is currently limited data on the incidence, causes, long-term implications, or best practice for managing people with breathing difficulties post-COVID. Working with partners we have curated the most relevant guidance and will continue to update.

To ensure we are signposting to the latest and most relevant clinical guidance for post-COVID breathing difficulties, we are looking for feedback from those providing care to those with potential post-COVID breathing difficulties and associated professional bodies. Please email us.

If you would like to discuss embedding any of the below guidance into care pathways for post-COVID breathing difficulties, please email us.

Relevant guidance:

NHS England – After-care needs of inpatients recovering from COVID-19

BTS guidance on respiratory follow up of patients with radiologically confirmed COVID-19 pneumonia

Assessing lung damage

In order to identify post-COVID lung damage, including ARDS, chest radiograph (CXR) and computed tomography (CT) scans may be helpful. This data will also help us better understand and assess the impact of COVID-19 on lung in the short and longer term.

The British Society of Thoracic Imaging are establishing a database, allowing the imaging of COVID-19 patients to be uploaded anonymously to allow onward training, learning, and upskilling.

Relevant guidance:

COVID-19 for the radiologist – A British Society of Thoracic Imaging statement

Rehabilitation

For people that have been admitted to critical care, the below guidance for rehabilitation after critical illness may be helpful, alongside guidance for pulmonary rehabilitation.

According to NICE’s rehabilitation after critical guidance, adults who were in critical care and at risk of long-term problems, should get on discharge:

an individualised, structured rehabilitation programme (if identified as being at risk during critical care)
review by a healthcare professional (2 to 3 months after leaving critical care) to talk about their recovery and identify any physical, cognitive and psychological issues

Relevant guidance

BTS Pulmonary Rehabilitation Resource Pack

BTS Guideline on Pulmonary Rehabilitation

NICE Guideline Generalised anxiety disorder and panic disorder in adults: management

NICE Guideline Depression in adults: recognition and management

NICE Guideline Post-traumatic stress disorder: management

Other relevant information

Report of an ad-hoc international task force to develop an expert-based opinion on early and short-term rehabilitative interventions (after the acute hospital setting) in COVID-19 survivors

British Lung Foundation: Pulmonary Rehabilitation

Italian Thoracic Society – Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis: the Italian position paper

Treatments for the lung

Below we have included the clinical guidelines for the management of post-COVID breathing difficulties, including the management of Acute Respiratory Distress Syndrome (ARDS), as early reports suggest this could be relevant after COVID-19.

Relevant guidance

Post-COVID Helpline: Our team of experts are here to support people with post-COVID breathlessness on 0300 222 5942

We are keen to work with professional bodies to ensure the content and guidelines on this hub are relevant and up to date. Please email us if you would like to partner with us.

How are we influencing post-COVID policy?

We’ve inputted into the development of all relevant COVID-19 rapid guidelines produced by NICE. These include:

how COVID-19 symptoms should be managed for patients in the community
condition-specific guidance for managing conditions that have an increased risk for COVID-19, such as severe asthma, COPD and ILD.

These guidelines set the scene for how the NHS and wider health system supports and treats patients with COVID-19, as well as those at high risk from it. In our feedback, we stressed the importance of providing digital options for managing healthcare wherever possible, ensuring access to mental health support and putting patients at the centre of decisions about their care.

We work closely with leading respiratory experts and professional bodies, including the:

We’re also engaging with NHS England and NHS Improvement and the Department of Health and Social Care on a regular basis to share information, feed in issues raised through our helplines, and contribute to guidance and planning. For example, we are supporting the development of Your Covid Recovery – an NHSE online post-COVID-19 rehabilitation platform.

It is vital that clinical guidance on management of post-COVID symptoms, such as breathlessness and fatigue, is developed as soon as possible.

The NHS has released guidance on the after-care needs of inpatients recovering from COVID-19. This is helping GPs and community health services to support people with immediate and long-term needs after being in hospital with COVID-19.

We continue to use opportunities in the media to raise attention of post-COVID difficulties, such as recovery times for people who were not hospitalised.