National Comprehensive Guidelines for Management of Post-COVID Sequelae

Post-COVID Syndrome

In the absence of universally accepted definition, Post-COVID Syndrome by consensus is defined as signs and symptoms that develop during or after an infection consistentwith COVID-19 which continue for more than 12 weeks and are not explained by alternative diagnosis.

“Sequelae” is a pathological condition resulting from a prior disease, therapy or other trauma. A typical sequela is a chronic complication of an acute condition: long term effectof a temporary disease or injury. 

Scope of the document

The purpose of this document is to guide doctors on managing post-COVID complications affecting cardiovascular, gastrointestinal, nephrological, neurological and respiratory systems.

Guidelines on Post-COVID Cardiovascular Sequel

COVID-19 impacts cardiovascular system in the recovery phase and is part of the overall PostCOVID syndrome. Physicians managing Post-COVID clinicsshould be aware of these symptoms and cardiovascular implications of COVID-19 sequelae. Discrete screening, appropriate investigations and evidence-based treatment of cardiovascular Long COVID is mandated to reduce long term impact of COVID-19.

Guidelines on Post-COVID Gastrointestinal Sequelae

. Beside the common respiratory symptoms, some COVID-19 patients experience gastrointestinal symptoms such as ageusia, lack of appetite, nausea, vomiting, dyspepsia, diarrhea, abdominal pain and hepatitis. Most symptoms pertaining to GI tract are mild and self-limiting. Presence of angiotensin converting enzyme 2 (ACE 2) receptors in the epithelium of gastrointestinal (GI) tract facilitates the entry and replication of the virus in the GI system resulting in GI manifestations.

Guidelines for Screening and Management of Post-COVID-19 Nephrological sequelae

The common kidney related complications following- COVID are as follows

• New onset Acute Kidney Injury (AKI) in native kidney or transplant kidney
• Rapid progression of pre-existing CKD in native kidney or transplant kidney
• Progression of CKD to End Stage kidney Disease (ESKD) in native kidney or transplant kidney
• New onset glomerular disease – proteinuria, hematuria and renal dysfunction
• New onset hypertension or worsening of hypertension

Guidelines for Management of Post-COVID Neurological Sequelae

Common Post-acute COVID–19 Neurological Symptoms:

• Fatigue (most common sequelae)
• Changes in concentration
• Impaired memory
• Persistent muscle weakness and myalgias
• Headaches
• Sleep disorders
• Dizziness
• Impairment in smell (Anosmia) and taste (ageusia)
• Rarely new onset status epilepticus, stroke, acute inflammatory demyelinating polyneuritis (AIDP), autonomic dysfunction such as orthostatic symptoms.
• Non-specific sensory complaints such as paresthesias, numbness, tingling in limbs

Guidelines for the Management of Long-Term Respiratory Effects of COVID-19

The respiratory system bears the maximum brunt of the direct viral damage that may persist for several weeks following initial infection.

The National Institute of Health and Care Excellence (United Kingdom) has coined the term “Post-COVID syndrome” for persistent symptoms and signs beyond 12 weeks of illness onset which could not be explained by an alternative etiology. Additionally, the terms “Long COVID” and “Post-COVID conditions” have been used to denote the new, persistent or returning health problems beyond 4 weeksof onset of acute COVID-19. Other terms which have been used include chronic COVID-19, post-acute sequelae of COVID-19 and long-haul COVID-19.

To view the complete guidelines document, click here.

Source : Ministry of Health and Family Welfare