🧠 Long COVID (Post-COVID-19 condition) — persistent or new symptoms ≥12 weeks after acute infection, not explained by an alternative diagnosis. Multisystem; fluctuating course; pacing and symptom-guided rehab are central.

🗂️ One-Page Clinical Summary (no extra CSS)

Domain	Common features	Initial approach (primary care)
Energy / Fatigue	Profound fatigue; post-exertional symptom exacerbation (PESE/PEM); unrefreshing sleep	🧭 Teach pacing & energy envelope; avoid fixed graded exercise. Sleep hygiene; screen for anaemia, thyroid, B12, ferritin, HbA1c; occupational/education adjustments.
Breathlessness / Chest	Dyspnoea, chest tightness, cough; palpitations	Vitals incl. SpO₂; CXR (≥12 wks if persistent), ECG; consider BNP if HF symptoms; inhaler trial if variable wheeze/cough. Safety-net for red flags.
Neurocognitive	“Brain fog”, poor concentration, headaches, dizziness	Rule out depression, anxiety, sleep apnoea, migraine. Cognitive pacing, task chunking, screen/limit multitasking; consider work/study accommodations.
Autonomic / Orthostatic	Orthostatic intolerance, tachycardia (possible PoTS), temperature dysregulation	Active stand test; fluids 2–3 L/day, ↑salt if appropriate, compression stockings, slow position changes. Consider propranolol/ivabradine under specialist advice if PoTS suspected.
MSK / Pain	Myalgia, arthralgia, deconditioning	Gentle flexibility and symptom-contingent strengthening within energy envelope; heat/ice; simple analgesia; avoid NSAIDs if gastritis risk.
Mental health	Anxiety, low mood, PTSD-like symptoms	Validate; brief CBT-informed strategies; peer support; consider SSRIs/SNRIs if indicated; manage insomnia.
GI	Nausea, diarrhoea, abdominal pain	Hydration; low-FODMAP trial if IBS-like (short term, dietitian if possible); rule out red flags; treat reflux/IBS per guidelines.
ENT / Olfactory	Hyposmia/anosmia, dysgeusia	Olfactory training (twice daily, 12+ weeks); treat rhinitis/reflux if present.

🧪 Baseline Assessment (rule out differentials)

Tests	Why	Notes
FBC, U&E, LFTs, CRP, ferritin, TSH, HbA1c, B12/folate	Screen for anaemia, thyroid disease, inflammation, diabetes, deficiencies	Target correctables that mimic fatigue/brain fog
ECG; consider CXR (persistent respiratory symptoms ≥12 wks)	Exclude occult cardiopulmonary disease	Troponin/BNP guided by symptoms/exam
Urinalysis; pulse oximetry (rest/exertional)	Renal screen; exertional desaturation	6-minute walk if safe; stop if symptomatic
Directed tests	Only if red flags (PE, myocarditis, new neuro deficits)	D-dimer/CTPA, echo, neuro imaging per presentation

🛡️ Red Flags (urgent same-day assessment)

New/worsening chest pain, syncope, resting SpO₂ <94% (or <92% in COPD) or exertional desaturation
Focal neurology, severe new headache, confusion
Haemoptysis, calf swelling/pleuritic pain (consider PE)
Cardiac red flags after COVID (myocarditis/pericarditis features)

🎯 Management & Follow-up

Education & pacing: plan-do-review diary; avoid “boom-bust”.
Rehab: breathing control, gentle mobility, then symptom-contingent strengthening; refer to local Long COVID / pulmonary rehab services when available.
Sleep: regular schedule, light exposure, limit naps/caffeine; consider melatonin short-term.
Autonomic care: fluids/salt, compression, recumbent exercise start; meds via specialist if PoTS.
Return to work/school: phased, with adjustments; provide fit note specifying limitations.
Vaccination: associated with lower risk of developing Long COVID; keep up to date.

🧑‍🏫 Patient-friendly message

“Long COVID can wax and wane. Working within your energy limits, prioritising sleep, and tackling one problem at a time usually helps. We’ll rule out other causes, support your rehab, and review regularly. Seek urgent help if you develop chest pain, fainting, or new breathlessness.”

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Long COVID

🗂️ One-Page Clinical Summary (no extra CSS)

🧪 Baseline Assessment (rule out differentials)

🛡️ Red Flags (urgent same-day assessment)

🎯 Management & Follow-up

🧑‍🏫 Patient-friendly message

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