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Latest post-COVID evidence and guidelines

About
Resource hub
Guidance
– Materials for clinicians
– Assessing lung damage
– Rehabilitation
How are we influencing post-COVID policy and guidelines?

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-19. This has been possible by working alongside leading respiratory experts and professional bodies, including the British Thoracic Society and the Primary Care Respiratory Society.

Across the UK, a significant number of people have been admitted to hospital because of COVID-19. You can see these numbers on the UK government’s website, along with the number of patients currently in hospital and on ventilation. Unfortunately, many people continue to experience breathlessness, cough, fatigue and other symptoms for a prolonged period of time after they have left hospital.

We’ve also heard from lots of people who have been managing COVID-19 at home, who are living with symptoms months after first becoming ill. Some people who had relatively severe COVID-19 but avoided hospital admission also have a prolonged recovery time. Others experience lower level symptoms that take a long time to get better. This is known as Long COVID. The BMJ has information on the management of post-acute COVID-19 in primary care.

Our health advice focusses on recovery information for respiratory-related post-COVID side effects, including breathlessness, sleep difficulties and fatigue 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

Guidance

Materials for clinicians

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. 

There are limited data on the incidence, causes, long-term implications, or best practice for managing people with breathing difficulties post-COVID. However, most patients are still symptomatic when followed up after discharge from hospital. Thorax has published a review of respiratory follow-up of patients with COVID-19 pneumonia. Working with partners, we have curated the most relevant guidance and will continue to update this. 

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, as well as associated professional bodies.

Relevant guidance:

ACPRC: Physiotherapy Management for COVID-19 in the Acute Hospital Setting: Recommendations to guide clinical practice

BTS: COVID-19 information for the respiratory community

BTS: Guidance for the resumption and continuation of urgent and elective outpatient respiratory services

Guidelines on the management of acute respiratory distress syndrome

IPCRG: COVID-19 open source sources of information

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

NHS England: COVID-19 Speciality Guides

NHS Wales: All Wales COVID-19 Secondary Care Management Guideline

NICE COVID-19 guidance

PCRS: Recovering after COVID-19 – a practical guide for clinicians and commissionersRCGP: COVID-19 information page

RCGP: COVID-19 information page

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.

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

The British Society of Thoracic Imaging (BSTI) and Cimar UK’s Imaging Cloud Technology have built and deployed a free to use, anonymised and encrypted COVID-19 imaging database, to hold the imaging of patients with confirmed or suspected COVID-19. The aim is to build an imaging database of UK patient examples for reference and teaching to frontline healthcare workers.

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.

The NHS has also launched Your COVID Recovery which is a digital programme designed to support the recovery of patients who have had COVID-19. It has been developed by experts representing a wide range of professional bodies and societies, as well as people who have experienced COVID-19.

Relevant guidance:

BTS Pulmonary Rehabilitation Resource Pack

BTS Guideline on Pulmonary Rehabilitation

BTS guidance on Pulmonary Rehabilitation: resuming services and on adapting pulmonary rehabilitation for people with post-covid symptoms

Chartered Society of Physiotherapy: Rehabilitation of adults who are hospitalised due to Covid-19: physiotherapy service delivery

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

NICE Guideline Depression in adults: recognition and managementNICE Guideline Post-traumatic stress disorder: management

Other relevant information

British Lung Foundation: Pulmonary Rehabilitation

COVID-19: Interim Guidance on Rehabilitation in the Hospital and Post-Hospital Phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force

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

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

Scotland: Framework for supporting people through Recovery and Rehabilitation during and after the COVID-19 Pandemic

Wales: Rehabilitation – a framework for continuity and recovery 2020 to 2021

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

How are we influencing post-COVID policy and guidelines?

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:

• British Thoracic Society
• Primary Care Respiratory Society.

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.

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.