Management of Post acute COVID 19 in primary care 

Greenhalgh T, Knight M, A’Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care BMJ 2020; 

https://www.bmj.com/content/370/bmj.m3026

I chose to do my journal article summary based on my H&P 3 which was about my patient who has been having nonproductive cough for 1 month since having COVID 19. She was concerned since all of her tests came back negative, yet she was still having these lingering symptoms. I know it is common for a patient to have post viral symptoms such as cough, but since COVID is still such a novel disease of our generation, I wanted to do more research into the post-COVID symptoms and how to manage them in a primary care setting.  

This article is more of a informative article that goes through defining what a post acute covid patient is, and how one might treat it. They define Post acute OCVID as three weeks after symptoms first started up until 12 weeks post symptoms. Thos patients who have other inflammatory or immune deficiency diseases are more prone to this syndrome, such has those with comorbidities like asthma, diabetes, or cardiac disease. Some symptoms include cough, fever, fatigue, shortness of breath, chest pain, headaches, etc, all which can wax and wane. Those who have persistent symptoms should get regular blood work to check for RBC and WBC blood count as lymphopenia is a severe feature of acute post COVID. A patient may have elevated C reactive protein (if an acute infection), white cell count (due to inflammation), natriuretic peptide (heart failure) ferritin (prothrombic state) and D dimer (thromboembolic state). However if anything is increased excessively it is a cause for concern.  

The article then mentions certain common post-acute COVID symptoms and how to manage them, I will highlight a few. For residual cough, it is best to manage these patients with breathing exercises, as with COVID those who have breathing problems often use shallow breaths and accessory muscles and need to train their diaphragm. Patients who have continued breathlessness should monitor their oxygen leves with a pulse oximeter. Those with increased risk of thromboembolism should be put on a prophylactic anticoagulant such as Aspirin. Those with chronic fatigue should introduce graded exercise into their daily regimen. Also due to the devastating nature of COVID, a lot of patients have been left with increasing anxiety and mental distress and should be given a referral to a mental health specialist in order to ensure their overall wellbeing. They can also get referrals to support groups and talk therapies. Overall, patients will have a plethora of sequalae symptoms post COVID, and it is necessary to be aware of those symptoms and understand how as Primary practitioners, we can best manage them.