Mapping post-acute COVID syndrome in Europe: Data and Guidelines in primary health care across 30 Countries

Raquel Gómez-Bravo, Sandra León-Herrera, Ileana Gefaell, Marina Guisado-Clavero, Limor Adler, Maria Bakola, Sabine Bayen, Thomas Beaney, Sherihane Bensemmane, Elena Brutskaya-Stempkovskaya, Nicola Buono, Jako Burgers, Iliana-Carmen Busneag, Daniel Croucher, Maryher Delphin Peña, Philippe-Richard Domeyer, Marina Dotsenko, Sabine Feldmane, Louise Fitzgerald, Marta Fournier, Thomas Frese, Dragan Gjorgjievski, Miroslav Hanževački, Bruno Heleno, Kathryn Hoffmann, Oksana Ilkov, Ivanna Shushman, Gabriele Kerr, Erva Ücüncü, Alexander Kirkovski, Snežana Knežević, Büsra Çimen Kork, Milena Kostić, Anna Krztoń-Królewiecka, Liga Kozlovska, Heidrun Lingner, Pekka Mäntyselkä, Tatjana Meister, Sarah Moreels, Achim Mortsiefer, Liubovė Murauskienė, Katarzyna Nessler, Ana Luisa Neves, Naldy Parodi, Ábel Perjés, Davorina Petek, Ferdinando Petrazzuoli, Xenia Wöstmann, Anna Repovská, Martin Sattler, Anna Segernäs, Theresa Sentker, Aleksander Stepanović, Kadri Suija, Gunta Ticmane, Péter Torzsa, Francesca Vassallo La Ferla, Shlomo Vinker, Sara Ares Blanco, María Pilar Astier Peña

Keywords: post-acute COVID-19 syndrome, Primary Care, Prevalence, diagnosis, signs and symptoms, physical examination.

Background:

The prevalence of post-acute Covid syndrome or long COVID (LC) across Europe remains unknown, including those in Primary health care (PHC). Additionally, guidelines for the diagnosis and management of LC are still under development.

Research questions:

What is the prevalence of LC in Europe and within PHC? How many official guidelines for LC exist across Europe? How consistent are these guidelines regarding long COVID symptoms and recommendations for physical examinations?

Method:

This descriptive, cross-sectional, retrospective study collected qualitative data through a semi-structured questionnaire to assess LC prevalence and LC guidelines across PHC in 30 European countries. The main variables were LC prevalence and pathways in PHC. All variables were collected between May and September 2024.

Results:

Among 30 countries, seven (Belgium, Finland, France, the Netherlands, Sweden, Spain, and the United Kingdom) reported LC data, but only three provided updated information. Finland and Spain included data specific to PHC. Based on available data, approximately 4.5 million LC patients were identified in these countries.

National guidelines for LC were identified in 16 countries. The most commonly reported symptoms across these guidelines included fatigue, dyspnoea, and brain fog (94%), followed by cough and chest pain (89%). Additional symptoms included headache, depression, anxiety, joint or muscle pain, and changes in smell or taste (84%) and sleep disturbances, dizziness, palpitations (78%) and neurological symptoms (73%).

Recommended physical examinations included oxygen saturation and heart rate (81%), blood pressure measurement (75%), respiratory rate (68%), and temperature (66%), lung and heart auscultation (62%), abdominal palpation and neurological examination (56%), and musculoskeletal assessments (31%).

Conclusions:

There are 4.5 million LC patients across seven countries. Sixteen national guidelines show strong concordance regarding symptoms, but less agreement on recommended physical examinations.

Points for discussion:

How can we improve the collection of LC data?

What evidence is needed to improve LC guidelines?

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