Healthcare professionals in all services need to be alert to whether people may need support. Although most people with ongoing symptoms will start to improve between 4 and 12 weeks, some will need further investigation and others will need rehabilitation to help them recover. The panel therefore agreed that ongoing symptomatic COVID-19 and post-COVID-19 syndrome should be considered as part of the differential diagnosis at 4 to 12 weeks and beyond 12 weeks, respectively.
The panel reviewed the evidence on the case definitions for the November 2021 update and agreed that no changes should be made to this recommendation. The panel also emphasised that this recommendation applies to children and young people as well as adults.
The expert panel agreed that an initial consultation would help identify people who need further assessment. A detailed discussion between the person and a healthcare professional is an important part of understanding their symptoms, and the way in which the symptoms affect their daily life. This discussion will form the first part of an assessment, and inform decisions about whether further assessment and investigations are needed (see the section on assessment). The panel also agreed that the format of the consultation should be discussed and agreed with the person according to their needs and preferences and local availability of services.
Some screening questionnaires are being used in practice, but none are validated for this use. Examples of questionnaires include the COVID-19 Yorkshire Rehab Questionnaire, and the Newcastle screening tool, recommended by NHS England. Questionnaires should ideally be developed in partnership with patients and be validated.
The panel reviewed expert testimonies from Nicol 2021, Nuffield Heath 2021 and Locke 2021, provided for the November 2021 update, that supported the recommendation on initial consultation and so the panel agreed that it should be retained.