Advice and resources for commonly reported symptoms and signs

 This content is derived from the Scottish Government's Implementation Support Note

Considerations specific to Covid-19

• On exertion - may persist for many weeks to months, usually with a gradual recovery
• Consider increased risk of VTE/PE post COVID-19 infection
• Intermitting chest pain not unusual

Initial investigations to consider/resources to support

• Consider CXR
• Patients discharged from hospital may have ongoing respiratory rehab requirements
• Consider BNP as part of any blood samples
• O₂ sats, and access to oxygen saturation remote monitoring pathway

 The following content is derived from the Scottish Government's Implementation Support Note 

Considerations specific to Covid-19

• Can persist for some weeks

Initial investigations to consider/resources to support

• Consider sputum culture if productive
• Any antibiotic treatment should follow current guidelines
• Follow local guidelines for suspected asthma/COPD

Red flags

• Be mindful of national criteria for suspicion of lung cancer

 This content is derived from the Scottish Government's Implementation Support Note. 

Considerations specific to Covid-19

• May need to exclude eg infection

Initial investigations to consider/resources to support

• Bloods (inc TFTs)
• Lying and standing BP
• ECG
• Consider orthostatic hypotension - NICE guidance

Red flags

• Urgent and non-urgent referral criteria for palpitations

 This content is derived from the Scottish Government's Implementation Support Note. 

Considerations specific to Covid-19

• Consider impact on role - eg carer, time off work and phased return
• Reassure that with time and self-management, fatigue usually improves gradually
• Consider local support groups, referral to community based services of CHSS Long COVID service
• Advice on pacing and energy management

Initial investigations to consider/resources to support

• Consider bloods as part of clinical assessment
• Modified Fatigue Impact Scale

Red flags

• Consider underlying cardio/respiratory disease

 This content is derived from the Scottish Government's Implementation Support Note. 

Considerations specific to Covid-19

• Commonly encountered symptoms of headache, abdominal pain, musculoskeletal pains
• Recovery may be prolonged
• Consider impacts on activities as well as personal and professional roles

Initial investigations to consider/resources to support

• Guided by clinical assessment, exclude alternative or treatable causes
• For Rheumatology advice regarding inflammatory conditions, see Investigations and Referral section (scroll down to 'Additional specialty advice')
• Pain Concern and Pain Association provide useful resources around guidance and management

 This content is derived from the Scottish Government's Implementation Support Note. 

Initial investigations to consider/resources to support

• 4AT Tool and SIGN Guideline if delirium suspected

 This content is derived from the Scottish Government's Implementation Support Note. 

Considerations specific to Covid-19

• Concentration and memory impairment can be linked to structural damage in more severe initial infections.  In milder community managed cases ("brain fog") appears to be commonly caused by functional cognitive disorders

Initial investigations to consider/resources to support

• 4AT Tool and SIGN Guideline if delirium suspected
• Information on functional cognitive disorders from neurosymptoms.org and BMJ Practice Pointer
• See the advice on Neurological and neuropsychiatric symptoms within Investigations and Referral - go to Additional Specialty Advice section

Red flags

• Focal neurological symptoms or stroke should be referred as per local pathways

Considerations specific to Covid-19

• Recovery may be prolonged
• Consider impacts on activities as well as personal and professional roles

Initial investigations to consider/resources to support

• Guided by clinical assessment, exclude alternative or treatable causes
• Pain Concern and Pain Association provide useful resources around guidance and management

 This content is derived from the Scottish Government's Implementation Support Note. 

Long-term COVID-19 symptom or sign

• Cognitive impairment, migraine, dizziness - commonly reported
• Concentration and memory impairment can be linked to structural damage in more severe initial infections.  In milder community managed cases ("brain fog") appears to be commonly caused by functional cognitive disorders

Considerations specific to Covid-19

• Consider impact on role - eg carer, time off work and phased return
• Reassure that with time and self-management, fatigue usually improves gradually
• Consider local support groups, referral to community based services of CHSS Long COVID service
• Advice on pacing and energy management

Initial investigations to consider/resources to support

• 4AT Tool and SIGN Guideline if delirium
• Information on functional cognitive disorders from neurosymptoms.org and BMJ Practice Pointer
• See the advice on Neurological and neuropsychiatric symptoms within Investigations and Referral - go to Additional Specialty Advice section

Red flags

• Focal neurological symptoms or stroke should be referred as per local pathways

 This content is derived from the Scottish Government's Implementation Support Note. 

Considerations specific to Covid-19

• Recovery may be prolonged
• Consider impacts on activities as well as personal and professional roles

Initial investigations to consider/resources to support

• Guided by clinical assessment, exclude alternative or treatable causes
• Pain Concern and Pain Association provide useful resources around guidance and management

 This content is derived from the Scottish Government's Implementation Support Note. 

Considerations specific to Covid-19

• Recovery may be prolonged
• Consider impacts on activities as well as personal and professional roles

Initial investigations to consider/resources to support

• Guided by clinical assessment, exclude alternative or treatable causes
• For Rheumatology advice regarding inflammatory conditions, see Investigations and Referral section (scroll down to 'Additional specialty advice')
• Pain Concern and Pain Association provide useful resources around guidance and management

 This content is derived from the Scottish Government's Implementation Support Note. 

Considerations specific to Covid-19

• Very common - up to 50%
• Commonly improves over a few weeks

Initial investigations to consider/resources to support

• Associated nasal symptoms
• Neurological symptoms
• 'NoseWell' - guide created by abScent and British Rhinological Society
• See Investigations and Referral. Further information is available in the section on change or loss of smell (anosmia, hyposmia or cacosmia).

Red flags

• Consider MRI / ENT referral if uncertainty or neurological finding

 This content is derived from the Scottish Government's Implementation Support Note. 

Long-term COVID-19 symptom or sign

• Urticaria
• Angioedema

Considerations specific to Covid-19

• These symptoms can be triggered by intercurrent infection or post viral illness and so can be expected following COVID-19 infection
• Further triggers include psychological stress, NSAIDs
• Treatment should follow standard care with antihistamines, titrated to achieve symptom control

Initial investigations to consider/resources to support

• Please see 'Managing Chronic Spontaneous Urticaria' for full immunology advice and resources
• Further guidelines on Chronic Urticaria and Angioedema - BSACI
• Where allergy suspected, this should be managed as per local guidelines

Red flags

• Anaphylaxis

 This content is derived from the Scottish Government's Implementation Support Note.  

Considerations specific to Covid-19

• Can persist for weeks to months but should resolve
• May cause ongoing pyrexia, tachycardia and breathlessness
• Respond well to conservative measures
• Some may need medication for a short period
• Respond well to pulmonary rehab

Initial investigations to consider/resources to support

• PUO work up should be considered

Red flags

• Unexplained weight loss
• Persistent lymphadenopathy