Long COVID: The recommendations of the High Health Authority

The HAS states that there are 3 criteria for identifying patients with prolonged symptoms of COVID-19:

• they have exhibited a symptomatic form of COVID-19;
• they have one or more initial symptoms 4 weeks after disease onset;
• none of these symptoms can be explained by another diagnosis.

More than half of these patients still have at least one of the initial symptoms 1 month after disease onset and more than 10% after 6 months, severity and recovery time vary among patients.

To better respond to this phenomenon, HAS set up, at the request of the Ministry of Solidarity and Health, a working group made up of health professionals and patients' associations which helped to define the optimal care that should be offered to patients suffering from prolonged symptoms.

The results show that the state of health improves progressively, generally within a few months, thanks to a personalized overall treatment that can include symptomatic treatments, rest and respiratory rehabilitation, possibly with progressive exercise training.

The recommendations

The HAS offers a dozen quick answers (may change with new data).

It also publishes 10 data sheets detailing the necessary clinical care and the elements of first-aid treatment according to the most common symptoms: fatigue, dyspnoea (respiratory disorders), chest pain, taste and smell disorders, pain, neurological manifestations, deconditioning during exertion, hyperventilation, functional somatic disorders (palpitation, disturbance of attention, nausea, motor weakness...) and disorders of the autonomic nervous system (vertigo, chills...).

Key recommendations include:

• The medical consultation should include both an assessment of the patients' current state of health to identify the factors triggering the onset of symptoms and their impact on quality of life, as well as an assessment of the initial episode. Clinicians should ensure that these symptoms are not related to unnoticed complications of infection, for example.
• Health care practitioners should propose a personalized care plan with achievable goals and follow-up that they discuss with the patient (including family or friend members and caregivers if needed). In addition to appropriate symptomatic treatment, rehabilitation is an important aspect of management.
• HAS advises doctors to provide patients with all the information they need to invest in their rehabilitation: contact lists, reliable sources of advice (support groups, patient associations), validated sources of information on COVID-19, social services...
• HAS urges physicians to listen and empathize with patients with prolonged symptoms, and to reassure them of the treatment options and the temporary and reversible nature of their situation.
• HAS reminds us of the benefits of a good lifestyle with daily physical activity, in the capacity of the patients and if necessary with the help of a physiotherapist. Psychologic management, based on cognitive-behavioral therapy (CBT) and, if needed, psychiatric intervention, may also help.
• In the absence of improvement or in case of severe symptoms or complications, primary care practitioners are encouraged to refer patients to territorial teams experienced in this type of care.