This guidance has been developed by involving local clinicians from Primary Care, Leeds Teaching Hospitals NHS Trust and Leeds Community Healthcare NHS Trust to support Primary Care on assessing and managing patients with ongoing needs post COVID -19 infection. It applies to patients both with confirmed or suspected COVID- 19 infection who have either been admitted to hospital or cared for in the community.
NB. This guidance has not been clinically validated and should not replace individual clinical judgement based on patient assessment by clinicians in practice. The responsibility for care remains with the assessing clinician.
Who is the COVID-19 Rehabilitation Pathway for?
The COVID-19 Rehabilitation Pathway has been developed to help people in Leeds who are experiencing new, long lasting problems after a confirmed or suspected COVID-19 infection which are significantly impacting how they are able to function in day to day life.
The initial infection with COVID-19 can present with a wide range of different symptoms and severities and not everyone required hospital care or got a test.
So how do I know if this pathway is relevant for my patient?
Problems are suspected to be post-COVID when they began with a period of acute viral-like illness in February 2020 or later. The initial illness does not necessarily need to have been severe for long lasting problems to be present. The nature of long lasting problems may be very wide ranging, and could include: fatigue, limited exercise tolerance, breathlessness, pains, anxiety, depression, brain fog/thinking problems, loss of appetite or weight, as well as other problems.
It is recognised that patients who have had a prolonged hospital stay or ICU admission are more likely to develop complications. An initial audit of 100 patients showed illness-related fatigue was the most common reported symptom by 72% participants in ICU group and 60.3% in ward group. The next most common symptoms were breathlessness (65.6% in ICU group; 42.6% in ward group) and psychological distress (46.9% in ICU group; 23.5% in ward group). You can read more in this research paper.
Clearly as the evidence base on complications and needs of patients post COVID-19 infection emerges and develops, the guidance will be reviewed and updated to reflect best practice.
The guidance outlines recommendations for assessment and investigation in Primary Care in addition to referral pathways to relevant dedicated services in the community. This includes criteria/relevant information needed on referral in order to triage to appropriate service. Advice and further clarification can be obtained through contacting SPUR directly. The advice on individual symptom assessment and management should be used in addition to assessing the needs of patient as a whole.
Supporting COVID-19 research
One of the key aspects of post-COVID-19 care is for us to understand the natural history and longer-term follow-up of patients who have experienced COVID-19 infection. Leeds has been chosen as a site for the P-HOSP follow-up study which is the only national UK study examining longer-term consequences of COVID-19 and is funded by the NIHR. If you see a patient post-COVID we would be grateful if you could ask if they would agree to their details being passed onto the research team clair.favager@nhs.net
More information
- Leeds COVID-19 Recovery Follow-up in Primary Care Pathway and Guidance
- The guidance is also available on Leeds Health Pathways
- GP Covid Referral Form – S1 Final Version