Last reviewed 17 June 2020
New guidance has been published, which supports primary care and community health services to meet the immediate and longer-term care needs of patients discharged following an acute episode of Covid-19.
The guidance, issued by NHS England, describes the typical expected healthcare needs of these patients, post-discharge.
Patients with pre-existing health conditions may also require immediate or longer-term changes to the management of their conditions as a result of their Covid-19 episode, but this is not the focus of the new guidance. It lists almost 30 healthcare issues expected to affect discharged patients, including respiratory, cardiac and urological problems.
Nutritional rehabilitation needs and insomnia problems will probably create additional pressure on GPs, and a lack of existing chronic cough management services in the community means GPs will be expected to work with other providers to set up care pathways.
Sleep disturbance is common in critically ill patients up to 12 months after hospital discharge, with prevalence ranging between 10% to 60% at six months. This presents as typical insomnia or as a consequence of "flashbacks" and survivor guilt, and similar to PTSD.
Nutrition is a vital part of recovery for all Covid-19 patients, according to the guidance, especially for those who have suffered cardiac distress, pulmonary distress, or those who have been critically ill due to the weight loss, frailty or sarcopenia associated with these conditions. It says diet enrichment "should suffice for most" but noted there also seemed to be an increased need to use oral nutritional supplements alongside this in malnourished patients.
NHS England also made suggestions on longer-term respiratory care for Covid-19 patients, although these were only based on emerging data. It said there was emerging evidence to show that non-pharmacological treatment approaches and specifically physiotherapy and speech and language therapy interventions could improve or eliminate chronic cough, and primary care should work with other providers to ensure appropriate care pathways exist.
The guidance focuses on the clinical interventions that the NHS will lead on. It states, though, that holistic care is impossible without the partnership with adult social care professionals and social care providers, and NHS England will be working with the Department for Health and Social Care (DHSC) to support them in their roles.