NICE guideline on long covid (Sivan et al. BMJ 2020)

Invited editorial re NICE guideline on long covid – Manoj Sivan (Leeds) & Sharon Taylor (London) Published: 23 December 2020 BMJ 2020; 371 doi:

Research must be done urgently to fill the many gaps in this new “living guideline”

(Manoj Sivan and Sharon Taylor, 2020) The covid-19 pandemic has killed over 1.6 million people worldwide,1 caused the worst healthcare crisis of this century, and put a huge dent in our economies. The magnitude of the population still struggling with symptoms four weeks after their acute illness—commonly called “long covid”—is becoming obvious and demands urgent prioritisation to prevent a further blow to health systems and the healthcare workforce.

Long covid is thought to occur in approximately 10% of people infected,2 3 so there are likely more than 5 million people affected globally. The National Institute for Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network, and the Royal College of General Practitioners have developed a rapid guideline for managing the long term effects or antibody test. Any other approach risks missing the many thousands of people who did not have access to testing in the early phases of the pandemic. The recommendations emphasise comprehensive assessment by a multidisciplinary team and support the use of virtual methods of assessment, including screening questionnaires such as C19-YRS (Yorkshire)

The guidance mentions screening blood tests (such as full blood count; clotting profile; renal, liver, and thyroid functions; and C reactive protein) and tests of both cardiac and lung function to capture reversible abnormalities, but it lacks detail on the management of serious life threatening complications of covid-19 to assist long covid services being set up in the NHS5 and elsewhere. A lack of systematic research means that the current guideline is necessarily preliminary, but it will be updated regularly as new evidence emerges—becoming a “living guideline.” This approach is essential as the current guideline lacks important detail, including a comprehensive list of organ complications seen in patients with long covid, the investigations required, and specific interventions for these complications.