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These recommendations are for healthcare professionals assessing people in any healthcare setting,
four weeks or more after the start of suspected or confirmed acute COVID-19.
The evidence suggested that healthcare professionals should use a holistic approach to assessment and the panel agreed assessment should cover both symptoms and how they affect the person overall. Evidence from patient experience showed many people feel their symptoms are not taken seriously. There are also people who don’t realise that their symptoms are connected with COVID-19, so taking time to listen, showing empathy, taking a careful history and making an assessment are important.
For people with ongoing symptomatic COVID-19 or suspected post-COVID-19 syndrome who
have been identified as needing an assessment, use a holistic, person-centred approach.
Include a comprehensive clinical history and appropriate examination that involves assessing
physical, cognitive, psychological and psychiatric symptoms, as well as functional abilities.
Include in the comprehensive clinical history:
• history of suspected or confirmed acute COVID-19
• the nature and severity of previous and current symptoms
• timing and duration of symptoms since the start of acute infection
• history of other conditions.
Be aware that people can have wide-ranging and fluctuating symptoms after acute COVID-19,
which can change in nature over time.
The panel wanted to raise awareness about people who may have less common symptoms,
particularly older people. They also highlighted the value of talking to family members or carers,
with the person’s agreement, to help get a full clinical picture for people who need extra support
For people who may benefit from support during their assessment, for example to help
describe their symptoms, include a family member or carer in discussions if the person
Discuss how the person’s life and activities, for example their work or education, mobility
and independence, have been affected by ongoing symptomatic COVID-19 or suspected
Discuss the person’s experience of their symptoms and ask about any feelings of worry or
distress. Listen to their concerns with empathy and acknowledge the impact of the illness
on their day-to-day life, for example act
There were too many uncertainties in the evidence to provide any symptoms that could predict whether people might develop post-COVID-19 syndrome. The panel did not want healthcare professionals to assume that people who had been hospitalised were more likely to develop post-COVID-19 syndrome because, at the moment, the evidence2 and the panel’s own experience do not support this.
The panel wanted to raise awareness about people who may have less common symptoms, particularly older people.
Do not predict whether a person is likely to develop post-COVID-19 syndrome based on whether they had certain symptoms (or clusters of symptoms) or were in hospital during acute COVID-19.
When investigating possible causes of a gradual decline, deconditioning, worsening frailty or dementia, or loss of interest in eating and drinking in older people, bear in mind that these can be signs of ongoing symptomatic COVID-19 or suspected post-COVID-19 syndrome.
Many people experience cognitive symptoms, such as brain fog, confusion and loss of memory. The panel agreed that validated screening tools are useful for measuring and monitoring any impairment and the impact of this. The panel were aware of several tools but were unable to recommend any specifically because the evidence was not reviewed. They also agreed that the type of tool will differ depending on the setting and level of assessment needed.
If the person reports new cognitive symptoms, use a validated screening tool to measure any impairment and impact.
Full details of the evidence and the panel's discussion are in evidence review 1: risk factors, evidence reviews 2 and 3: prevalence, evidence review 4: investigations and evidence review: views and experiences of patients, their families and carers.