HNY Policy and Pathway Repository - North Yorkshire and York
Post Viral and Long Covid
Definition/Description
The York and Scarborough Post Viral and Long Covid Service has been designed to equip patients with the necessary skills for self-management of their symptoms. The service aims to deliver prompt, short-term interventions tailored to individual needs.
Definitions
Post-COVID-19 syndrome
Signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks, and are not explained by an alternative diagnosis. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body. Post-COVID-19 syndrome may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed.
Long COVID
In addition to the clinical case definitions, the term 'long COVID' is commonly used to describe signs and symptoms that continue or develop after acute COVID-19. It includes both ongoing symptomatic COVID-19 (from 4 to 12 weeks) and post-COVID-19 syndrome (12 weeks or more).
Red Flag Symptoms
None provided
Guidelines on Management
Exclusion Criteria
Referral should not be based solely on a specific diagnosis, although diagnosed complications must be referred to the appropriate specialty. This service is not for acute or emergency cases.
- Suicide risk (refer urgently to Access to Wellbeing team or Crisis team)
- Severe hypoxaemia or desaturation during exercise
- Signs of severe lung disease
- Cardiac chest pain
- Suspected VTE
- Conditions when waiting may pose clinical risk
- Previous ME/CFS diagnosis
Required Pre-Referral Investigations and Information
Respiratory
- CXR, Spirometry, FeNO, Pulse Oximetry, Sit to Stand test (as indicated)
- Sleep Study if Epworth Sleepiness or StopBang scores are elevated
Cardiovascular
- ECG, Lying/Standing BP, 10 Minute Lean Test (as indicated)
Examination Findings
- General Exam
- Respiratory Exam
- Cardiovascular Exam
- Gastrointestinal Exam
- Musculoskeletal Exam (if indicated)
- Neurological Exam (if required)
Blood tests should be performed based on clinical need, and may include the following:
- Full Blood Count (FBC)
- Urea and Electrolytes (U+E), Calcium (Ca++)
- Liver Function Tests (LFT)
- C-Reactive Protein (CRP)
- Vitamin B12, Folate, Haematinics, and Vitamin D levels
- HbA1c and Thyroid Function Tests (TFTs)
- D-Dimer (only if venous thromboembolism [VTE] is suspected; if positive, exclude VTE)
- B-type Natriuretic Peptide (BNP) (only if heart failure is suspected)
- Documented evidence of a positive PCR result, if available
Further information
- Current reasons for referral including functional problems
- Significant Past Medical History
- Significant Psychiatric History
- Current Medication and Allergies
Referral Criteria/Information
Referral for Post Viral / Long COVID assessment
A minority of patients presenting to primary care may require referral for a full MDT assessment (estimated as 1% of those infected with Covid-19).
Long COVID clinic appointments may be held in York at the hospital and at Haxby and Wiggington Surgery, Selby War Memorial Hospital and Scarborough Hospital. Online and Telephone appointments are also offered.
The team consists of a Respiratory Consultant, Specialist nurses, Physiotherapist, Occupational Therapists and a Clinical Psychologist. There is also the ability to arrange diagnostic support and consult with wider Consultant expertise (e.g. cardiology, neurology, ENT) where indicated.
Inclusion Criteria
Previous history and clinical signs consistent with Covid-19/viral infection and persistent post Covid-19/post viral symptoms lasting greater than 12 weeks from the time of suggested infection, and one or more of the following:
- New onset AND unexplained fatigue with Post Exertional Malaise (PEM) since presumed infection.
- New onset AND unexplained breathlessness or cough since presumed infection.
- New onset AND unexplained symptoms of Brain Fog/Cognitive difficulties related to fatigue
- New symptoms that may suggest Autonomic dysregulation such as, dizziness, palpitations, orthostatic symptoms, temperature regulation problems, sensory disturbance or sleep disruption since presumed infection.
-
New onset psychological or mental health issues occurring in relation to presumed infection.
In addition, patients are required to have been sent and self-completed the Modified Covid-19 Yorkshire Rehab Screen (C19-YRS)
PATIENTS DO NOT NEED POSITIVE LAB CONFIRMATION OF COVID-19 INFECTION.
How to refer
We are only able to accept patients from York, Selby, Scarborough and Ryedale GP Practices. Out of area patients can only be accepted in exceptional circumstances and with approval from the ICB.
Where GPs / practices wish to refer patients, they should ensure the patient fulfils the service referral criteria. All referrals need to be submitted via RSS and attach the patient completed Covid 19 Yorkshire Rehab Screening tool (C19-YRS).
Referral proforma
- EMIS - EMIS letter template along with a guide on how to import the letter into the clinical system
- SystmOne – The referral proforma has been published in the reporting units and can be located as follows: Set up > Referrals & Letters > “New” Word Letter template > NECS > GP Referral to Post Covid MDT Assessment
Assessment and Initial Support
Every patient is offered a face-to-face initial assessment with either a Consultant Doctor or a Specialist Nurse. This assessment provides an opportunity to discuss symptoms in detail. Following this, patients receive access to the Living with Covid Recovery App, which offers a comprehensive range of self-management resources and assessment tools.
Education and Self-Management Programme
Patients are invited to participate in an online group education and self-management programme, facilitated by in-house therapists. There are sessions on Managing Fatigue, Managing Brain Fog, Managing Breathlessness, Emotional Wellbeing and Returning to Activity. The programme also includes opportunities for peer support, fostering a sense of community among participants. Upon completion of the course, each patient’s progress is reviewed by a Specialist nurse.
Further Specialist Support
Depending on individual needs identified during the review, patients may be referred to specialist Occupational Therapy, Physiotherapy, Psychology, or NHS Talking Therapies. The clinician-led nature of the service allows for investigations to be ordered and medical treatments to be initiated where appropriate.
Accessibility and Additional Support
For patients who cannot access the digital resources, written information and personalised therapy interventions are provided to ensure care remains accessible to all.
Additional Resources & Reference
Associated Policies
Specialties
Places covered by
- North Yorkshire
- Vale of York
Hospital Trusts
-
York and Scarborough Teaching Hospitals