General approach
7. In someone with long COVID, symptoms of possible non-COVID-19-related issues should be investigated and referred as per local guidelines. Long COVID alone is not a sufficient diagnosis unless other causes have been excluded (strongly agree = 21, 64%; agree = 8, 24%; neither agree nor disagree = 2, 6%; disagree = 1, 3%; strongly disagree = 1, 3%). 8. Carry out a face-to-face assessment including a thorough history and examination, consider other non-COVID-19-related diagnoses, and measure full blood count, renal function, C-reactive protein, liver function test, thyroid function, haemoglobin A1c (HbA1c), vitamin D, magnesium,a B12, folate, ferritin, and bone studies (strongly agree = 24, 73%; agree = 9, 27%; neither agree nor disagree = 0, 0%; disagree = 0, 0%; strongly disagree = 0, 0%).
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Respiratory
9. In those with respiratory symptoms, consider chest X-ray at an early stage. Be aware that a normal appearance does not exclude respiratory pathology (strongly agree = 27, 82%; agree = 4, 12%; neither agree nor disagree = 1, 3%; disagree = 1, 3%; strongly disagree = 0, 0%). 10. Be aware that simple spirometry may be normal but patients may have diffusion defects indicative of scarring, chronic pulmonary embolisms, or microthrombi. Consider referral to respiratory for full lung function testing (strongly agree = 23, 70%; agree = 10, 30%; neither agree nor disagree = 0, 0%; disagree = 0, 0%; strongly disagree = 0, 0%) 11. Measure oxygen saturation at rest and after an age-appropriate brief exercise test in people with breathlessness and refer for investigation if hypoxaemic or if any desaturation on exercise (strongly agree = 17, 52%; agree = 14, 42%; neither agree nor disagree = 2, 6%; disagree = 0, 0%; strongly disagree = 0, 0%).
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Cardiac
12. Consider the possibility of a cardiac cause of breathlessness (strongly agree = 27, 82%; agree = 5, 15%; neither agree nor disagree = 0, 0%; disagree = 0, 0%; strongly disagree = 1, 3%). 13. Be aware that a normal D-dimer may not exclude thromboembolism, especially in a chronic setting, and referral for investigation is therefore indicated if there is a clinical suspicion of pulmonary emboli. Additionally, be mindful that thromboembolism may occur at any stage during the disease course (strongly agree = 26, 79%; agree = 6, 18%; neither agree nor disagree = 1, 3%; disagree = 0, 0%; strongly disagree = 0, 0%). 14. In patients with inappropriate tachycardia and/or chest pain, carry out electrocardiogram, troponin, Holter monitoring, and echocardiography. Be aware that myocarditis and pericarditis cannot be excluded on echocardiography alone (strongly agree = 22, 67%; agree = 8, 24%; neither agree nor disagree = 2, 6%; disagree = 1, 3%; strongly disagree = 0, 0%). 15. In patients with chest pain, consider a referral to cardiology as cardiac magnetic resonance imaging may be indicated in a normal echo to rule out myopericarditis and microvascular angina (strongly agree = 25, 76%; agree = 6, 18%; neither agree nor disagree = 1, 3%; disagree = 1, 3%; strongly disagree = 0, 0%). 16. In patients with palpitations and/or tachycardia, consider autonomic dysfunction (strongly agree = 25, 76%; agree = 7, 21%; neither agree nor disagree = 0, 0%; disagree = 0, 0%; strongly disagree = 1, 3%).
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Others
17. In patients with urticaria, conjunctivitis, wheeze, inappropriate tachycardia, palpitations, shortness of breath, heartburn, abdominal cramps or bloating, diarrhoea, sleep disturbance, or neurocognitive fatigue,9 consider mast cell disorder (strongly agree = 15, 46%; agree = 14, 42%; neither agree nor disagree = 4, 12%; disagree = 0, 0%; strongly disagree = 0, 0%). 18. In patients with cognitive difficulties sufficient to interfere with work or social functioning, consider neurocognitive assessment (strongly agree = 23, 70%; agree = 9, 27%; neither agree nor disagree = 0, 0%; disagree = 1, 3%; strongly disagree = 0, 0%). 19. In patients with joint swelling and arthralgia, consider a diagnosis of reactive arthritis or new connective tissue disease and investigate and refer as appropriate (strongly agree = 20, 61%; agree = 12, 36%; neither agree nor disagree = 1, 3%; disagree = 0, 0%; strongly disagree = 0, 0%).
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