Post Covid Syndrome Assessment Service

This guideline applies to adults aged 18 years or older.

Introduction

This service has been established to support people with Post COVID syndrome. The pathway has been developed and is supported by a GP with Specialist Interest, Fatigue Occupational Therapy and Nurse, Respiratory Physiotherapy, Dietetics, Speech and Language Therapy, Vocational Occupational Therapy and Allied Health Professional Case Managers.

The team has established a single point access into the service and pathway based on the latest guidance. People referred into the service will be assessed, triaged for further investigations and/or referred onto the most appropriate post COVID service pathway or external appropriate service.

Examination and investigations prior to referral

Please consider the following:

HR, BP, Temperature, SaO2 and desaturation with activity
BMI
Urine dip
FBC CRP U&E LFT Ferritin TFT HbA1c Vitamin D Vitamin B12 Lipid profile; also check:
- If short of breath: BNP, consider troponin / echo
- If significant myalgia: CK
- If fatigued: chronic fatigue screen, including Coeliac Screen and Bone Profile
ECG
CXR

Inclusion criteria

Adults, aged 18 years or older, with suspected:

Ongoing symptomatic COVID-19: symptoms, lasting 4 to 12 weeks, may fluctuate and change over time and can affect any system in the body.
Post COVID-19 syndrome: features which develop during or following an infection consistent with COVID-19, continue for more than 12 weeks* and are not explained by an alternative diagnosis. Common features include fatigue, breathlessness, anxiety/depression, problems with memory & concentration (brain fog), chest pain, heart palpitations, dizziness, joint pain, earache, fever, rashes.

*Post COVID syndrome may be considered before 12 weeks while the possibility of an alternative diagnosis is also being assessed.

Please note: Do not exclude people from referral based on the absence of a positive SARS-CoV-2 test (PCR, antigen or antibody).

Exclusion criteria

Aged under 18yr – see guideline on ME/CFS
Acute COVID symptoms
Acute, severe, concerning symptoms or deterioration in physical or mental health causing clinical concern which imply need for urgent assessment
Patients with previous diagnosis of functional illness unless there is clear evidence of COVID infection and change in symptoms in the context of timing of pandemic

Referral Process

Complete the Post COVID Syndrome Referral Form and send via e-RS for:

RCHT facing practices, refer into the new Kernow RMS Post-COVID Syndrome (Post COVID syndrome) service

UHP facing practices, please refer into the existing DRSS respiratory medicine assessment service.

GPs have a right to refer in by referral letter as long as it contains the necessary clinical information.

Assessment and Rehabilitation pathways

In depth virtual holistic assessment with GP with Special Interest and AHP.
Assessment of physical, cognitive, psychological and functional impact on daily living, and work.
Guidance or onwards referral for additional assessment or investigations if indicated.
Personalised self-management advice and rehabilitation for managing post COVID syndrome, including fatigue and brain fog, breathlessness, dietetic advice, voice and swallow changes, return to work support
Service may refer or signpost to onward rehabilitation or services including:
- Peer support through the HOPE programme, ENO Breathe
- Cardiac services, respiratory physio, ENT, gastroenterology, pain services
- Talking Therapies Cornwall
- Community rehabilitation teams
HOPE Programme for Long COVID (South West): patients can use this link to self-refer

Supporting Information

For professionals:

For patients:

References

RCHT: Post COVID Syndrome Assessment Service

Page Review Information

Review date	24 April 2025
Next review date	24 April 2027
Specialty Lead GP	Dr Laura Vines
Contributors	Maria McDonough, Occupational Therapist Ingrid Watmough, Physiotherapist