Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

May 6, 2021

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Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

Publicated to:International Journal Of Environmental Research And Public Health. 18 (8): 4350- - 2021-04-02 18(8), DOI: 10.3390/ijerph18084350

Authors: Siso-Almirall, Antoni; Brito-Zeron, Pilar; Conangla Ferrin, Laura; Kostov, Belchin; Moragas Moreno, Anna; Mestres, Jordi; Sellares, Jaume; Galindo, Gisela; Morera, Ramon; Basora, Josep; Trilla, Antoni; Ramos-Casals, Manuel

Affiliations

Board Spanish Soc Managers Primary Care SEDAP, Madrid 28026, Spain - Author

Catalan Soc Family & Community Med CAMFiC, Permanent Board, Barcelona 08009, Spain - Author

Coll Catalan Phys, Barcelona 08017, Spain - Author

Consorci Atencio Primaria Salut Barcelona Esquerr, Primary Care Ctr Corts, Barcelona 08028, Spain - Author

Hosp CIMA Sanitas, Dept Med, Autoimmune Dis Unit, Barcelona 08034, Spain - Author

Hosp Clin Barcelona, Dept Autoimmune Dis, ICMiD, Barcelona 08036, Spain - Author

IDIAP Jordi Gol, Barcelona 08007, Spain - Author

IDIBAPS CELLEX, Lab Autoimmune Dis Josep Font, Barcelona 08036, Spain - Author

Inst Invest Biomed August Pi & Sunyer IDIBAPS, Primary Healthcare Transversal Res Grp, Barcelona 08036, Spain - Author

Spanish Soc Family & Community Med semFYC, Permanent Board, Barcelona 08009, Spain - Author

Univ Barcelona, Fac Med & Hlth Sci, Barcelona 08036, Spain - Author

Univ Politecn Catalunya UPC, Dept Stat & Operat Res, Barcelona 08034, Spain - Author

Univ Rovira & Virgili, Inst Catala Salut, Jaume Hlth Ctr 1, Tarragona 43005, Spain - Author

Abstract

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors' clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.

Keywords

AnosmiaArthralgiaCoronavirus disease 2019CoughingCovid-19Differential diagnosisDisease durationDisease managementDysgeusiaDyspneaEmotional well-beingEmpowermentEvidence based medicineEvidence based practiceFatigueFollow upGastrointestinal symptomGuidelineHeadacheHealth impactHealth policyHeart diseaseHolistic careHumanHumansImmunopathologyInfectious diseaseLaboratory testLong covid-19Lung diseaseManagement practiceMental healthMultidisciplinary teamMyalgiaPatient carePatient care planningPhysical examinationPractice guidelinePrimary carePrimary health careRehabilitation careReviewSars coronavirusSars-cov-2Severe acute respiratory syndromeSymptomatologyThorax painThrombosis

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal International Journal Of Environmental Research And Public Health due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2021, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Public Health, Environmental and Occupational Health.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 10.32. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

Weighted Average of Normalized Impact by the Scopus agency: 6.67 (source consulted: FECYT Feb 2024)
Field Citation Ratio (FCR) from Dimensions: 58.32 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-03, the following number of citations:

WoS: 124
Scopus: 148
Europe PMC: 48

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Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

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Keywords

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

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