Referral

Some complications of Covid-19, even in patients who self-managed at home, are conditions such as lung damage, myocarditis (inflammation of heart muscle) and postural hypotension, and these will be expected to cause protracted symptoms. However, other unrelated diseases may also emerge (such as coronary heart disease). 

A patient with significant symptoms who has not already seen or spoken with a GP should be advised to do so. Some patients are reluctant to bother their GP as they perceive them to be too busy with Covid vaccinations and trying to catch up with patients who may have cancer or other serious conditions. 

Long Covid patients with lung or cardiac symptoms may be given heart rate monitors or pulse oximeters to monitor their blood oxygen levels at home, and may be asked to send the information to their doctor between appointments.

Guidelines recommend that patients who have continuing respiratory symptoms and have not already had an x-ray are sent for one 12 weeks after having acute Covid-19, and this may be a reason why referral is needed. Blood tests may be indicated. 

Investigations will depend on the range of symptoms experienced. Red flags include:

• Severe or worsening shortness of breath
• Low oxygen saturation (≤94 per cent at rest) or desaturation on exertion
• Unexplained chest pain
• Severe dizziness or syncope on exertion
• Palpitations or tachycardia at rest or on minimal exertion
• Focal weakness (for example: of the face or an arm or leg)
• New confusion or expressive dysphasia (unable to speak coherently).

In December 2020, NHS England announced that there will be more than 70 long Covid clinics, each with a multidisciplinary team and intending to offer both physical and psychological assessments. You can check to see where the nearest one is in your locality, although not all are open yet and demand has been so high that some have temporarily stopped accepting referrals. 

Depending on location your patients may face a long waiting list or might be outside the catchment area of a clinic. They may also have to be sent for a series of tests before they are able to access a clinic consultation. At the time of writing (April 2021) specialist long Covid clinics are not available in Scotland, Wales or Northern Ireland, and they are not available to children in England.

Reflection exercise

Do you know which patients with possible long Covid your local GP practices want you to refer? Do they agree with the questions you are asking and the symptoms you are looking out for? Contact them for a two-way exchange of information.