Incidence and factors associated with post–COVID-19 condition Emerging evidence may distinguish phenotypes relating to symptom clusters and trajectories. 3,9–11 Thus, there is variability in presentation of symptoms and symptom duration in people with post–COVID-19 condition. A combination of viral persistence, microvascular injury, immune dysfunction and loss of the angiotensin converting enzyme-2 protective pathway results in damage to various organs, hypercoagulability and ongoing inflammation that persists for months after infection. The pathophysiology of post–COVID-19 symptoms is likely to arise from virus-mediated damage at the time of acute infection and/or ongoing inflammation that may persist in the months following infection. We highlight current evidence-based guidelines from the broad recommendations of the NCET ( ), 6 general practice–specific guidance from The Royal Australian College of General Practitioners 7 and localised advice about investigation and referral from HealthPathways. This article summarises what is understood about the pathophysiology, frequency of symptoms, factors associated with increased risk of disease and how to approach both the assessment and care of people with post–COVID-19 condition in Australia. Post–COVID-19 condition may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed. Post–COVID-19 condition usually presents with clusters of symptoms, often overlapping, that can fluctuate and change over time and affect any system in the body. ![]() In this article, we will use the term post–COVID-19 condition, as contained in the Australian living guidelines developed by the National COVID-19 Clinical Evidence Taskforce (NCET), to describe the symptoms that develop during or after an infection consistent with SARS-CoV-2, continue for more than 12 weeks and are not explained by an alternative diagnosis. ![]() The National Institute of Clinical Excellence in the UK categorises symptoms lasting up to four weeks as acute COVID-19, while symptoms lasting 4–12 weeks are categorised as ‘ongoing symptomatic COVID-19’ post-acute COVID-19 begins from 12 weeks. 2 This definition has been criticised by consumers as it leaves a gap between acute illness and recognition of health impacts, during which time a person needs care. In late 2021, the World Health Organization used a consensus process to define post–COVID-19 condition as : ‘occurs(ing) in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually three months from the onset, with symptoms that last for at least two months and cannot be explained by an alternative diagnosis’. 2–4 Names for persisting symptoms include post–COVID-19 condition or syndrome, post-acute COVID-19, post-acute sequelae of COVID-19, long COVID and long haul COVID. 1 Symptoms are now understood to be experienced by both adults and children who had either mild, moderate or severe COVID-19, with variation in the duration of symptoms and clinical history. Consumers were instrumental in highlighting the issue to healthcare providers and policymakers. ![]() ![]() People with lived experience called this ‘long haul’ or ‘long COVID’. In 2020, months after the first reported cases of SARS-CoV-2 infection, reports of persisting symptoms post acute infection emerged.
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