Recommendations for the Recognition, Diagnosis, and Management of Patients with Post COVID-19 Condition ('Long COVID'): A Delphi Study

Background: The present work aims to provide a rapid expert guide for Post Covid-19 Condition (“long covid”) clinical services. In the absence of research into mechanisms, therapies and care pathways, yet faced with an urgent need, guidance based on “emerging experience” is required. Methods: The authors generated 33 recommendations pertaining to the recognition, investigation, and management of long covid. These were distributed online to a Delphi panel of UK doctors (any specialty) with an interest in, lived experience of, and/or experience treating long covid. Over two rounds of Delphi testing, panellists indicated their agreement with each recommendation (a 5-point Likert scale) and gave comments. Recommendations eliciting a response of “strongly agree”, “agree”, or “neither agree nor disagree” from ≥90% of respondents were taken as showing consensus.  Findings: Thirty-three UK-based clinicians representing 14 specialties completed both rounds of the Delphi. Twenty-nine (88%) had lived experience of long covid and five (15%) were clinicians developing services for long covid. Of the 33 recommendations presented in Round 1, 18 were incorporated into the final list, 13 were amended to reflect respondents’ feedback, and two were excluded.  Of the 19 presented in Round 2, 17 were added to the final list and two were excluded. The final list thus comprised 35 recommendations: six pertaining to clinic organisation, 13 to diagnosis of the underlying disorder, and 16 to management. Interpretation: Long covid clinics need to operate not in isolation but in the context of rapidly evolving practice amongst both GPs and specialists. Care pathways in holistic care, investigation of specific complications, management of potential symptom clusters in cardiac disease, dysautonomia and mast cell disorder, and individualised rehabilitation are needed. Funding: The first author is funded by the NIHR Imperial PSTRC; however, this research received no specific grant from any funding agency. Declaration of Interest: There are no conflicts of interest. Ethical Approval: As this is considered service development, ethical approval was not required for this study. Delphi participants gave informed consent before taking part. All aspects of the study were conducted in the UK in January-March 2021.