HSE’s model of care for long Covid patients ‘broadly consistent’ with global guidelines

The model of care developed by the Health Service Executive to treat long Covid patients is broadly consistent with international guidelines, according to a review by the State’s health watchdog.

However, it does not specifically emphasise the need for standardised assessment tools or structured patient follow-up, the Health Information and Quality Authority says in its review of clinical guidelines developed around the world.

Millions of people globally have contracted Covid-19 since 2020 and a sizeable proportion are suffering ongoing symptoms, often referred to as long Covid.

In the UK, it has been estimated that 3.5 per cent of the population – 2.3 million people – are living with long Covid, with about one in five having symptoms for more than two years.

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As the Hiqa review says, there is considerable variation in the definition used for long Covid across different countries and international bodies. The World Health Organisation defines long Covid as the continuation or development of new symptoms three months after initial infection, with these symptoms lasting for at least two months with no other explanation.

Long Covid symptoms, which may be quite debilitating, vary greatly from person to person but can include breathlessness, cough, brain fog, headache, sleep disturbance, pins and needles, numbness, dizziness, fatigue, abdominal pain, nausea and vomiting, diarrhoea, weight loss, reduced appetite, chest pain, chest tightness and palpitations, among others. In some people, symptoms respond spontaneously; in others they persist.

The HSE’s model of care for its national post-Covid service rests on three pillars: patient-led rehabilitation and recovery; general assessment, support and rehabilitation; and specialist assessment, support and rehabilitation.

The Hiqa review says the approaches and recommendations in this interim model of care are broadly consistent with those identified in international literature, while not emphasising the need for standardised assessment tools or structured patient follow-up. In the UK, for example, guidelines recommend Covid patients receive a follow-up consultation six weeks after discharge to check for new or ongoing symptoms or complications.

“We found that most guidelines are recommending a holistic, person-centred approach to diagnosis, management and treatment, with an emphasis on shared decision-making, which is consistent with the HSE’s interim model of care,” according to Dr Máirín Ryan, Hiqa’s director of health technology assessment.

“It’s clear from this international review that we are at an early stage of understanding long Covid and that the recommendations will change as more evidence becomes available, particularly in relation to safe and effective treatments.”

“Long Covid can affect a person’s ability to carry on with their normal daily activities. Currently, long Covid guidelines focus on management of the wide array of symptoms. The best way to avoid long Covid is to avoid Sars-CoV-2 infection.”

Hiqa says the evidence base for the diagnosis and management of long Covid is still emerging, so guideline recommendations were typically conditional or consensus based. It is expected that the approaches adopted will change as the evidence base evolves.