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Introduction & module overview

Covid-19 is now recognised as a multi-organ disease and roughly one in five adults who test positive for Covid-19 will experience symptoms for four weeks or more. These patients are commonly said to have ‘long Covid’, while the subgroup of patients whose symptoms continue for longer than 12 weeks are said to have post-Covid-19 syndrome. 

The development of long Covid is not predicted by initial Covid-19 severity and the burden of illness that is gradually being revealed includes many people who had mild to moderate infections. Patients who had severe disease and were hospitalised are also likely to have aggravation of pre-existing conditions such as heart or lung disease. It is thought that asymptomatic patients may also develop long Covid but this is currently less clear. 

Patients of all ages are affected and there is growing evidence of long Covid in children. Although it may feel that Covid-19 has been around for a long time it is still a relatively new disease and research continues to generate new evidence at a rapid rate. Community pharmacists need to keep abreast of this evolving new specialty. This module reflects the situation in April 2021.

Ongoing symptoms after acute Covid-19 infection form part of a still relatively new and emerging condition and, although the effects are increasingly recognised, people living with medium and long-term effects of Covid-19 often report experiencing misunderstanding and even scepticism from relatives, friends and colleagues. Employers may not be suitably sympathetic. 

Patients may have a single or multiple symptoms that may be constant, transient or fluctuating, and can change in nature over time. Some clues to possible causation have been identified through research and there is evidence that long Covid might involve an active disease process with immunological evidence of continued inflammatory responses, lingering viral activity and/or blood clotting disorders.

The National Institute for Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network (SIGN) and the Royal College of General Practitioners (RCGP) have developed the Covid-19 Rapid Guideline: Managing the Long-Term Effects of Covid-19, which will be reviewed as new evidence emerges.