Cover
Title Page
Copyright
Contents
Preface
Foreword
Abbreviations
Section I: Long COVID syndrome
Chapter 1: Coronavirus disease
Introduction
Aetiology
Variants of SARS-CoV-2
Delta variant
Omicron variant (PANGO lineage B.1.1.529)
Key Points
References
Chapter 2: What is long COVID syndrome?
Introduction
Presentation of long COVID syndrome
Health impact of long COVID syndrome
Definition of long COVID syndrome
Recognising and managing long COVID syndrome
Key Points
References
Chapter 3: Epidemiology of long COVID syndrome
Introduction
Prevalence in the United Kingdom
Prevalence after hospital discharge in the UK
Prevalence in other countries
Demographics
Predictors and risk factors
Key Points
References
Chapter 4: Aetiopathogenesis of long COVID syndrome
Introduction
Long-term immunological changes
Post-intensive care syndrome
Persistent inflammation
Vascular and autonomic nervous systems
Pulmonary fibrosis
Organ damage
Psychosocial factors
Dysregulation of the renin-angiotensin-aldosterone system
Energy substrate depletion
Cellular changes
Key Points
References
Chapter 5: Prolonged clinical manifestations of post-acute COVID-19
Introduction
Signs and symptoms of long COVID syndrome
The REACT-2 study on long COVID symptoms
Other studies
Postural orthostatic tachycardia syndrome
Psychological impact
Social impact
Key Points
References
Chapter 6: Problems after intensive care stay in COVID-19 patients
Introduction
Post-intensive care syndrome: long-term sequelae following intensive care stay
Problems specific to COVID-19 illness
Sleep disturbances and delirium
Cognitive impairment
Lessons learnt from past experience: SARS outbreak
Critical care neuropathy.

Critical care myopathy
Prone positioning in intensive care to improve oxygenation
Chronic pain after COVID-19-related intensive care admission
Key Points
References
Chapter 7: Risk factors for developing long COVID syndrome
Introduction
Type and number of symptoms in early infection
Illness severity during acute infection
Age
Gender
Socioeconomic status
High body mass index
Other systemic illnesses associated with long COVID syndrome
Prediction models of long COVID syndrome
Long COVID syndrome and symptom relapse
Key Points
References
Chapter 8: Effects of long COVID syndrome on economy and society
Introduction
'Long economic COVID'
Costs due to mental health impairment
Costs due to disruption of children's education
Costs on vital social issues
Costs due to job losses
Burden of long COVID syndrome
Delayed care and associated costs
Impact of abnormal sense of smell in long COVID syndrome
Costs due to COVID-induced disability
Challenges in estimating costs
Tackling long COVID syndrome in the UK's National Health Service
Key Points
References
Section II: Symptoms and investigations
Chapter 9: Respiratory problems
Introduction
Aetiopathogenesis of respiratory problems
Acute COVID-19 and lung damage
Long COVID syndrome and the lungs
Respiratory signs and symptoms in long COVID syndrome
Presentation of multiple comorbidities
Key Points
References
Chapter 10: Cardiovascular problems
Introduction
Aetiopathogenesis of cardiovascular problems
Acute COVID-19 and cardiac damage
Long COVID syndrome and the heart
Long COVID syndrome and the vascular system
Cardiovascular signs and symptoms in long COVID syndrome
Postural hypotension
Cardiovascular effects of antiviral medications
Key Points
References.

Chapter 11: Neurological problems
Introduction
Incidence of neurological problems in long COVID syndrome
Aetiopathogenesis of nervous system involvement
Neurological signs and symptoms in long COVID syndrome
Classification of neurological involvement
Brain fog
Stroke in COVID-19 illness
Encephalitis
Complications from intensive care stay
Mental health problems
Sleep problems
Peripheral nerve and muscle problems
Key Points
References
Chapter 12: Pain problems
Introduction
Chronic pain in long COVID syndrome
Aetiopathogenesis of pain problems in long COVID syndrome
Risk factors for chronic pain in COVID-19 illness
Pain presentations and sequelae in long COVID syndrome
Neurological conditions causing persistent pain in long COVID syndrome
Neuropathic pain in long COVID syndrome
Mood, fatigue and pain
Exacerbation of chronic pain due to disruption of services
Key Points
References
Chapter 13: Mental health problems
Introduction
Aetiopathogenesis of mental health problems in long COVID syndrome
Epidemiology of mental health problems due to long COVID syndrome
Signs and symptoms of mental health problems in long COVID syndrome
Mental health of families and carers
Key Points
References
Chapter 14: Taste and smell problems
Introduction
Incidence of taste and smell problems
Aetiopathology of taste and smell problems in long COVID syndrome
Symptoms of smell and taste dysfunction
Objective measurements vs. self-reporting of symptoms of smell dysfunction
How long do symptoms of abnormal smell and taste sensations last?
Consequences of taste and smell problems
Key Points
References
Chapter 15: Other problems found in long COVID syndrome
Introduction
Prevalence
Other signs and symptoms in long COVID syndrome.

Fatigue and extreme tiredness in long COVID syndrome
Key Points
References
Chapter 16: Differential diagnosis
Introduction
Ruling out other respiratory causes
Ruling out cardiac causes
Ruling out rheumatological causes
Ruling out neurological causes
Ruling out endocrine causes
Key Points
Chapter 17: Investigations in long COVID syndrome
Introduction
Confirmed or suspected COVID-19 illness
Urgent referral in the presence of life-threatening symptoms
Patient-tailored investigations
NICE guidelines on investigations
Exercise tolerance test
Tests for postural symptoms
Chest X-ray
Further respiratory investigations
Cardiovascular assessment
Psychiatric assessment
Psychological assessment
Referral to specialist services
Key Points
References
Section III: Guidelines and policies
Chapter 18: NHS England plans for long COVID syndrome
Introduction
Long COVID syndrome: NHS plan for 2021/2022
Five-point plan (October 2020)
Ten key steps from June 2021
Care pathways and resource projection for patients with long COVID syndrome
NHS Long COVID Taskforce
Key Points
References
Chapter 19: NICE guidelines on long COVID syndrome
Introduction
NICE criteria for long COVID syndrome
Identifying people with long COVID syndrome
Assessment
Investigations and referral
Care planning
Management
Follow-up and monitoring
Controversies in the NICE guideline
Key Points
References
Chapter 20: ME Association guidelines on long COVID syndrome
Introduction
Key messages from the ME Association on long COVID syndrome
Long COVID syndrome and myalgic encephalomyelitis/ chronic fatigue syndrome
Patient self-reporting on long COVID syndrome
Red flag symptoms
Management guidelines from the ME Association.

Prognosis of long COVID syndrome
Key Points
References
Chapter 21: American guidelines for long COVID syndrome
Introduction
CDC guidance on long COVID syndrome
Interim guidance on post-COVID conditions
National Institutes of Health guidelines on long COVID syndrome
Key Points
References
Chapter 22: Guidelines from other health organisations
Introduction
Guidance from the World Health Organization (Europe)
Guidance from the Scottish Intercollegiate Guidelines Network on long COVID syndrome
Guidance from the European Agency for Safety and Health at Work
Health systems and policy analysis guidance from the World Health Organization
Key Points
References
Section IV Management of long COVID syndrome
Chapter 23: Management principles for long COVID syndrome
Introduction
Course of recovery
Self-management
Patient-specific management plan
Exclusion of serious complications
Pacing of patient recovery
Mental health
Referral to specialist rehabilitation services
Pulmonary rehabilitation
Management of fatigue
Exercise rehabilitation recommendations
Pathways
Encouraging patients to 'own' their recovery
Key Points
References
Chapter 24: Long COVID assessment centres
Introduction
Initial start of assessment centres
Expansion of specialist services to include children and young people
Long COVID: the NHS plan for 2021/22
Commissioning for long COVID assessment clinics
Core features of long COVID support services
Modelling demand for specialist services
Key Points
References
Chapter 25: Online recovery and rehabilitation platforms
Introduction
'Your COVID Recovery' online support
Online self-management digital tool
Features of 'Your COVID Recovery' platform
Practicalities of 'Your COVID Recovery' platform.

Other online platforms.