Symptoms and signs: general recommendations

Managing the long-term effects of COVID-19 (SIGN/NICE/RCGP)
Healthcare Improvement Scotland

Related information: Clinical case definitions

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 evidence 2 and the panel’s own experience do not support this.

Rationale

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 also did not want healthcare professionals to assume that people who had been hospitalised were more likely to develop post-COVID-19 syndrome because the current evidence and the panel’s own experience do not support this.

The panel discussed and agreed that healthcare professionals should be aware that older people may not present with the common symptoms associated with ongoing symptomatic COVID-19 or post-COVID-19 syndrome. The panel agreed on signs that might prompt a healthcare professional to consider ongoing symptomatic COVID-19 or post-COVID-19 syndrome alongside other possible causes in an older person.

Recommendations: no assumptions

RecommendationDo 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.
RecommendationWhen 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. 

 

Rationale

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.

Recommendation: cognitive symptoms

RecommendationIf the person reports new cognitive symptoms, use a validated screening tool to measure any impairment and impact.

 This content is derived from the Scottish Government's Implementation Support Note. 

References

Full details of the evidence and the panel's discussion are in the evidence reviews on: