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style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng188er2-lrg.png" alt="Cover of COVID-19 rapid guideline: managing the long-term effects of COVID-19 (NG188)" /></a></div><div class="bkr_bib"><h1 id="_NBK567266_"><span itemprop="name">COVID-19 rapid guideline: managing the long-term effects of COVID-19 (NG188)</span></h1><div class="subtitle">Evidence reviews 2 and 3: prevalence</div><p><i>NICE Guideline, No. 188</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2020 Dec</span>.</div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2020.</div></div><div class="bkr_clear"></div></div><div id="niceng188er2.s1"><h2 id="_niceng188er2_s1_">Literature search</h2><p>NICE’s information services team identified relevant evidence through focused evidence searches between 22 and 28 October 2020 (see <a href="#niceng188er2.app3">appendix 3</a>). Additional studies were also considered from NICE surveillance up to 28 October 2020. Results from the literature searches and surveillance were screened using their titles and abstracts for relevance against the criteria from the protocol (see <a href="#niceng188er2.app2">appendix 2</a>). Four reviewers screened titles and abstracts. Having identified the evidence, four reviewers assessed the full text references of potentially relevant evidence to determine whether they met the inclusion criteria for this evidence review. All uncertainties were discussed amongst the reviewers and referred to an adviser if needed. See <a href="#niceng188er2.app4">appendix 4</a> for the study flow chart of included studies.</p><p>Healthcare Improvement Scotland knowledge management team also conducted a search to identify qualitative evidence to support the questions in this review. See <a href="https://www.sign.ac.uk/our-guidelines/managing-the-long-term-effects-of-covid-19" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing the long-term effects of COVID-19: the views and experience of patients, their families and carers</a> for more information. This review will be referred to in this document as “patient lived experience”.</p></div><div id="niceng188er2.s2"><h2 id="_niceng188er2_s2_">Methods and process</h2><p>This evidence review was developed using the methods and processes described the <a href="/books/NBK567266/bin/niceng188er2_bm1.pdf">methods chapter</a>.</p></div><div id="niceng188er2.s3"><h2 id="_niceng188er2_s3_">Review question 2</h2><p>What is the prevalence of symptoms or clusters of symptoms (physical and mental health) and problems carrying out usual activities, including work, education and leisure, among people who have symptoms of COVID-19 for a duration of 4 to 12 weeks?</p><p>The review protocol is shown in <a href="#niceng188er2.app2">appendix 2</a>.</p><div id="niceng188er2.s3.1"><h3>Included studies</h3><p>In total, 4104 references were identified through the searches. Of these, 505 were included and ordered for full text assessment. A total of 58 references were included for the whole guideline, 23 of which were included for this review. Of these 21, 12 were cohort studies and 9 were cross-sectional studies and 2 were published real world evidence analyses.</p><p>See <a href="/books/NBK567266/table/niceng188er2.tab1/?report=objectonly" target="object" rid-ob="figobniceng188er2tab1">tables 1</a> to <a href="/books/NBK567266/table/niceng188er2.tab3/?report=objectonly" target="object" rid-ob="figobniceng188er2tab3">3</a> for more details on the identified studies.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng188er2tab1"><a href="/books/NBK567266/table/niceng188er2.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img" rid-ob="figobniceng188er2tab1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng188er2.tab1"><a href="/books/NBK567266/table/niceng188er2.tab1/?report=objectonly" target="object" rid-ob="figobniceng188er2tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">Included studies for review question 2: hospitalised people. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng188er2tab2"><a href="/books/NBK567266/table/niceng188er2.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img" rid-ob="figobniceng188er2tab2"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng188er2.tab2"><a href="/books/NBK567266/table/niceng188er2.tab2/?report=objectonly" target="object" rid-ob="figobniceng188er2tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Included studies for review question 2: Non-hospitalised people. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng188er2tab3"><a href="/books/NBK567266/table/niceng188er2.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img" rid-ob="figobniceng188er2tab3"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng188er2.tab3"><a href="/books/NBK567266/table/niceng188er2.tab3/?report=objectonly" target="object" rid-ob="figobniceng188er2tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Included studies for review question 2: Real world evidence. </p></div></div></div><div id="niceng188er2.s3.2"><h3>Key results</h3><div id="niceng188er2.s3.2.1"><h4>Hospitalised people</h4><div id="niceng188er2.s3.2.1.1"><h5>Outcomes: Symptoms and conditions</h5><p>Evidence from 8 studies recorded various symptoms reported by participants between 4 to 12 weeks from onset of acute COVID-19 or hospital discharge. Prevalence of these symptoms were wide ranging. The most common symptoms reported across the studies are reported in <a href="/books/NBK567266/table/niceng188er2.tab3/?report=objectonly" target="object" rid-ob="figobniceng188er2tab3">Table 3</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng188er2tab4"><a href="/books/NBK567266/table/niceng188er2.tab4/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img" rid-ob="figobniceng188er2tab4"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng188er2.tab4"><a href="/books/NBK567266/table/niceng188er2.tab4/?report=objectonly" target="object" rid-ob="figobniceng188er2tab4">Table 3</a></h4><p class="float-caption no_bottom_margin">Common symptoms reported across studies in hospitalised people. </p></div></div><p>Only 1 study (<a class="bibr" href="#niceng188er2.app5.ref21" rid="niceng188er2.app5.ref21">Xiong 2020</a>) included a control group of people who had never had COVID-19. This study reported that when compared to people who had never had COVID-19 (n=184), COVID-19 survivors (n=583) were significantly more likely to report symptoms at 3 months after hospital discharge (all p values <0.01).</p><p><a class="bibr" href="#niceng188er2.app5.ref13" rid="niceng188er2.app5.ref13">Landi 2020</a> included a subgroup analysis. They tested participants with a nasopharyngeal swab RT-PCR test (approximately 8 weeks from COVID-19 onset) for SARS-CoV-2 infection. 22/131 (16.7%) tested positive. Comparison of symptoms at follow-up between people with positive and negative tests showed that people with a positive test were significantly more likely to report sore throat (p=0.04) and rhinitis (p=0.05).</p></div><div id="niceng188er2.s3.2.1.2"><h5>Outcomes: Carrying out usual activities (including work, education and leisure)</h5><p>There were 3 studies highlighted difficulties in people being able to carry out usual activities, due to both physical and mental health symptoms.</p><p><a class="bibr" href="#niceng188er2.app5.ref20" rid="niceng188er2.app5.ref20">Weerahandi 2020</a> reported that people experienced worse physical and mental health after COVID-19 illness compared to before (all p values <0.001) and also experienced worsened ability to carry out social activities (p <0.001) at 1 month from discharge.</p><p><a class="bibr" href="#niceng188er2.app5.ref11" rid="niceng188er2.app5.ref11">Halpin 2020</a> reported that 44/100 (44%) people reported worsened ability to carry out usual activities and that 15/100 (15%) were off sick from work at 4 to 6 weeks from discharge).</p><p><a class="bibr" href="#niceng188er2.app5.ref14" rid="niceng188er2.app5.ref14">Mazza 2020</a> (n=402) performed a psychiatric assessment around a month after hospital discharge. They found that a significant proportion of people self-rated symptoms in the pathological range: overall, 55.7% scored in the clinical range in at least one psychopathological dimension, 36.8% in two, 20.6% in three, and 10% in four. People with a previous psychiatric history reported a more significant impact on mental health (all p values <0.001).</p></div></div><div id="niceng188er2.s3.2.2"><h4>Non-hospitalised people</h4><div id="niceng188er2.s3.2.2.1"><h5>Outcomes: Symptoms and conditions</h5><p>Evidence from 13 studies recorded various symptoms reported by participants between 4 to 12 weeks from onset of acute COVID-19. Prevalence of these symptoms were wide ranging. The most common symptoms reported across the studies are reported in <a href="/books/NBK567266/table/niceng188er2.tab5/?report=objectonly" target="object" rid-ob="figobniceng188er2tab5">Table 4</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng188er2tab5"><a href="/books/NBK567266/table/niceng188er2.tab5/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img" rid-ob="figobniceng188er2tab5"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng188er2.tab5"><a href="/books/NBK567266/table/niceng188er2.tab5/?report=objectonly" target="object" rid-ob="figobniceng188er2tab5">Table 4</a></h4><p class="float-caption no_bottom_margin">Common symptoms reported across studies in non-hospitalised people. </p></div></div><p>The following studies illustrate how these symptoms can vary across time and demonstrates their fluctuating nature. Some of these symptoms led to diagnoses of cardiac conditions or psychiatric illness.</p><p><a class="bibr" href="#niceng188er2.app5.ref5" rid="niceng188er2.app5.ref5">Cirulli 2020</a> conducted longitudinal surveys on the general population in the USA regardless of history of COVID-19 infection or test. They found that the specific long-term symptoms of anosmia, ageusia, difficulty concentrating, dyspnoea, memory loss, confusion, headache, heart palpitations, chest pain, pain with deep breaths, tachycardia, and dry cough were significantly more common after 30 days in 233 people who had previously tested positive for SARS-CoV-2 compared to 3652 COVID-19 negative controls (p<0.001). However, after adjusting for initial numbers of symptoms, only long-term anosmia, ageusia, memory loss, and headache remained significantly associated with COVID-19 status. These symptoms remained significantly more common in people who had been COVID-19 positive after 60 days. Tachycardia became significantly more common at 60 days. After 90 days, all of these 5 symptoms, except for memory loss, remained significantly more common in COVID-19 positive cases.</p><p><a class="bibr" href="#niceng188er2.app5.ref10" rid="niceng188er2.app5.ref10">Goertz 2020</a> conducted a survey with 2113 participants from 2 Facebook groups and those registered on the Lung Foundation Netherlands website. They found that there was a median change of −7 (IQR −10 to −4) symptoms per person (p<0.001) at around 3 months from initial illness. The difference in median change of symptoms was highest in non-hospitalised patients with confirmed COVID-19 compared to hospitalised patients with COVID-19 and non-hospitalised suspected-based or symptom-based COVID-19 diagnosis (p<0.001).</p><p>Patient-led research (<a class="bibr" href="#niceng188er2.app5.ref2" rid="niceng188er2.app5.ref2">Assaf 2020</a>) conducted a survey of 640 participants found that the majority of people with symptoms experienced fluctuations both in the type (70%) and intensity (89%) of symptoms over the course of being symptomatic.</p><p><a class="bibr" href="#niceng188er2.app5.ref8" rid="niceng188er2.app5.ref8">Eiros 2020</a> carried out cardiac MRI investigations in health-care workers with previous COVID-19 illness. They found that cardiac MRI abnormalities were found in 104/139 (74.8%) 10 weeks after initial illness.</p><p><a class="bibr" href="#niceng188er2.app5.ref17" rid="niceng188er2.app5.ref17">Taquet 2020</a> retrospectively analysed data for 44,779 people with a diagnosis of COVID-19 without prior psychiatric illness. They found that at 3 months a diagnosis of COVID-19 led to significantly more first diagnoses of psychiatric illness (HR 1.58 to 2.24, all P values <0.0001). The most frequent diagnosis was anxiety disorder, and the other most common disorders were adjustment disorder, generalised anxiety disorder and PTSD to a lesser extent. Those not requiring hospital admission for COVID-19 were still more at risk of psychiatric sequelae compared to people not requiring hospitalisation for other illnesses (influenza, other respiratory infections, skin infections, cholelithiasis, urolithiasis and fracture of a large bone; all p values <0.001).</p><p><a class="bibr" href="#niceng188er2.app5.ref16" rid="niceng188er2.app5.ref16">Poyraz 2020</a> assessed psychological wellbeing of people with probable or confirmed COVID-19. They reported that 72/284 (25.4%) had moderate to severe PTSD symptoms at a mean of 48.7 days since diagnosis of COVID-19 illness.</p></div><div id="niceng188er2.s3.2.2.2"><h5>Outcomes: Carrying out usual activities (including work, education and leisure)</h5><p><a class="bibr" href="#niceng188er2.app5.ref16" rid="niceng188er2.app5.ref16">Poyraz 2020</a> assessed psychological wellbeing of patients with probable or confirmed COVID-19. They reported that 19/202 (9.4%) of working people were still on temporary disability leave at a mean of 48.7 days since diagnosis of COVID-19 illness.</p></div></div></div><div id="niceng188er2.s3.3"><h3>Real world evidence studies</h3><p>Evidence from 2 real world data studies provided analyses on social media posts (via Twitter) that contained information on symptoms reported as ongoing or new after acute COVID-19. Prevalence of these symptoms were wide ranging. The most common symptoms reported across the studies are reported in <a href="/books/NBK567266/table/niceng188er2.tab6/?report=objectonly" target="object" rid-ob="figobniceng188er2tab6">Table 5</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng188er2tab6"><a href="/books/NBK567266/table/niceng188er2.tab6/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img" rid-ob="figobniceng188er2tab6"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng188er2.tab6"><a href="/books/NBK567266/table/niceng188er2.tab6/?report=objectonly" target="object" rid-ob="figobniceng188er2tab6">Table 5</a></h4><p class="float-caption no_bottom_margin">Common symptoms reported in real world evidence studies. </p></div></div></div><div id="niceng188er2.s3.4"><h3>Strengths and limitations</h3><p>Although these prevalence outcomes have been identified in cohort or cross-sectional studies, the primary aim of the studies was not necessarily to measure prevalence of symptoms. People were recruited to the studies in different ways, some of which were through self-selection and are subsequently less likely to be representative of the population. The sample sizes of the studies were also relatively small (majority with n <500) so may not be reliable to measure prevalence. Many studies were unable to obtain information of symptom history prior to initial COVID-19 illness. All studies were considered to be at high or moderate risk of bias (See evidence tables in <a href="#niceng188er2.app6">appendix 6</a>).</p><p>The real world evidence studies also had their own limitations. As this data came from social media, it is often incomplete, requires self-selection of users with a lack of objective validations of reported symptoms. The reporting of sociodemographic information and symptomatology were often vague or non-exact. Both studies included analysed data from the same social media platform so have potentially missed data from other platforms. These studies did not report the time since acute COVID-19 that the symptoms were being experienced so it is not possible to relate specifically to the case definition of post-COVID-19 syndrome.</p></div></div><div id="niceng188er2.s4"><h2 id="_niceng188er2_s4_">Review question 3 (published evidence)</h2><p>What is the prevalence of symptoms or clusters of symptoms (physical and mental health) and problems carrying out usual activities, including work and leisure, among people who have symptoms of COVID-19 beyond 12 weeks?</p><p>The review protocol is shown in <a href="#niceng188er2.app1">appendix 1</a>.</p><div id="niceng188er2.s4.1"><h3>Included studies</h3><p>In total, 4,104 references were identified through the searches. Of these, 505 were included and ordered for full text assessment. A total of 58 references were included for the whole guideline, 3 of which were included for this review. Of these 3, one was a cohort study and 2 were cross-sectional studies.</p><p>See <a href="/books/NBK567266/table/niceng188er2.tab7/?report=objectonly" target="object" rid-ob="figobniceng188er2tab7">table 6</a> and <a href="/books/NBK567266/table/niceng188er2.tab8/?report=objectonly" target="object" rid-ob="figobniceng188er2tab8">table 7</a>.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng188er2tab7"><a href="/books/NBK567266/table/niceng188er2.tab7/?report=objectonly" target="object" title="Table 6" class="img_link icnblk_img" rid-ob="figobniceng188er2tab7"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng188er2.tab7"><a href="/books/NBK567266/table/niceng188er2.tab7/?report=objectonly" target="object" rid-ob="figobniceng188er2tab7">Table 6</a></h4><p class="float-caption no_bottom_margin">Included studies for review question 3: hospitalised people. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng188er2tab8"><a href="/books/NBK567266/table/niceng188er2.tab8/?report=objectonly" target="object" title="Table 7" class="img_link icnblk_img" rid-ob="figobniceng188er2tab8"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng188er2.tab8"><a href="/books/NBK567266/table/niceng188er2.tab8/?report=objectonly" target="object" rid-ob="figobniceng188er2tab8">Table 7</a></h4><p class="float-caption no_bottom_margin">Included studies for review question 3: non-hospitalised people. </p></div></div></div><div id="niceng188er2.s4.2"><h3>Key results</h3><div id="niceng188er2.s4.2.1"><h4>Hospitalised people</h4><div id="niceng188er2.s4.2.1.1"><h5>Outcomes: Symptoms and conditions</h5><p>Very low-quality evidence from 2 studies recorded various symptoms reported at 12+ weeks from onset of acute COVID-19 by participants who were previously hospitalised. Prevalence of these symptoms were wide ranging. The symptoms most commonly reported across both studies were breathlessness (6.7% and 94.6%) and pain (10.5% and 45.9%).</p><p><a class="bibr" href="#niceng188er2.app5.ref22" rid="niceng188er2.app5.ref22">Dennis 2020</a> reported that 164 (100%) of hospitalised people were experiencing fatigue at 3 to 5 months from initial illness. The majority of this cohort also reported cough, fever, myalgia headache joint pain, chest pain, wheezing and worsened mobility.</p><p>Tomasoni 2020 assessed their cohort with a HADS questionnaire (n=100). They found that 29% had abnormal results for anxiety and 11% were abnormal or depression. 33% had abnormal results for both anxiety and depression. Patients with abnormal HADS showed a higher proportion (77% vs 43%; P = 0.002) of physical symptoms persistence, compared to subjects displaying normal HADS.</p></div></div><div id="niceng188er2.s4.2.2"><h4>Outcomes: Carrying out usual activities (including work, education and leisure)</h4><p>No evidence was identified.</p></div><div id="niceng188er2.s4.2.3"><h4>Non-hospitalised people</h4><div id="niceng188er2.s4.2.3.1"><h5>Outcomes: Symptoms and conditions</h5><p>Very low-quality evidence from 2 studies recorded various symptoms at 12+ weeks from onset of acute COVID-19 reported by participants who had not previously been hospitalised for COVID-19. Prevalence of these symptoms varied across the studies. The symptoms most commonly reported across both studies were breathlessness (8.9% and 87.1%), fatigue (20.5% and 97.6%), myalgia (7.1% and 87.6%) and headache (3.6% and 87.1%).</p><p>Klein 2020 noted that fatigue, breathing difficulty, memory disorders and hair loss, were not typically reported during the 6-weeks follow-ups and were therefore new symptoms. Other symptoms such as muscle aches, headache and chemosensory changes were usually reported at earlier timepoints.</p></div><div id="niceng188er2.s4.2.3.2"><h5>Outcomes: Carrying out usual activities (including work, education and leisure)</h5><p>No evidence was identified.</p></div></div></div><div id="niceng188er2.s4.3"><h3>Strengths and limitations</h3><p>Although these prevalence outcomes have been identified in cohort or cross-sectional studies, the primary aim of the studies was not necessarily to measure prevalence of symptoms. People were recruited to the studies in different ways, some of which were only those active on social media and are less likely to be representative of the whole population. Only 3 studies were identified and the sample sizes of the studies were relatively small (all n<200) so may not be reliable to measure prevalence. The studies were unable to obtain information of symptom history prior to initial COVID-19 illness. All studies were considered to be at high or moderate risk of bias (See evidence tables in <a href="#niceng188er2.app6">appendix 6</a>).</p></div></div><div id="niceng188er2.s5"><h2 id="_niceng188er2_s5_">Expert panel discussion (for both review questions 2 and 3)</h2><p>This section describes how the expert panel considered the evidence in relation to the recommendations within the guidance.</p><div id="niceng188er2.s5.1"><h3>Relative value of different outcomes</h3><p>The outcomes the expert panel expected to see in the evidence were prevalence of symptoms or clusters of symptoms experienced by people at 4-12 weeks and 12+ weeks from acute COVID-19 onset. By identifying the most common symptoms experienced after acute COVID-19, it might be possible to use these to help differentially diagnose ongoing and post-COVID-19 syndrome, particularly if there are symptoms prevalent after 12 weeks or more.</p><p>The panel also wanted to consider how these symptoms impact on usual activities (including both work and leisure activities) in order to understand the wider implications of the long-term effects of COVID-19 such as loss of identity or sense of self.</p></div><div id="niceng188er2.s5.2"><h3>Quality of the evidence</h3><p>Whilst there was evidence of prevalence reported in the studies, the range of symptoms reported across the studies was very broad and there was a lack of clear evidence for differences in symptoms at the 4 to 12 week and 12+ weeks timepoints. Therefore, the panel could not draw strong conclusions from the data. There was high prevalence of some symptoms reported in individual studies and some evidence of association, but most studies did not identify many confounders or adjust for any that they did find so this data is unreliable. However, the published evidence and real world evidence analysis was consistent with the patient lived experience evidence and the panel’s own experience in terms of which symptoms were the most common amongst those people with new and ongoing symptoms after COVID-19. These symptoms, for example included fatigue and breathlessness. The patient lived experience evidence supports the panel’s experience of people reporting many symptoms that can fluctuate and affect them differently at different times. While the panel were unable to identify an exhaustive list of symptoms, due to the uncertainty in the evidence, they were able to recommend people are made aware of what they might expect in the time following their acute illness. The panel thought that it would be helpful to have a list of the most common symptoms, so these were drawn from the studies and the patient experience. There was no evidence identified that reported outcomes on clustering of symptoms so the panel considered making a research recommendation which is outlined in the guideline.</p><p>Whilst there was some quantitative evidence on the impact of symptoms on returning to work and other activities, it was very limited, and the panel could not draw firm conclusions in order to extrapolate to the wider population from this data. The panel thought that these outcomes will be affected by individual needs and characteristics so any support or advice given should be given based on holistic approach to assessment.</p><p>The overall certainty in the evidence was low to very low. People were recruited to the studies in different ways, some of which were through self-selection and are less likely to be representative of the population. The evidence showed a consistent pattern of people who were predominantly female and most likely middle-aged and of white ethnicity. The panel did not consider the evidence to be generalisable to the whole UK population. It highlighted expected over-representation in demographics for those more likely to seek help and those who use social media. The sample sizes of the studies were also relatively small so may not be reliable to measure prevalence. Most studies did not report symptoms prior to onset of acute COVID-19 and adjust for confounders or include a control group who had not had COVID-19. The panel would have liked to have had a better understanding of symptom history prior-to COVID-19 to determine the significance of these ongoing symptoms. Only one study compared reported symptoms to a COVID-19 free control group so the panel could not be confident in the findings.</p></div><div id="niceng188er2.s5.3"><h3>Trade-off between benefits and harms</h3><p>Although the panel acknowledged that new, ongoing or recurring symptoms 12 weeks or more from acute illness onset might be more indicative of post-COVID-19 syndrome, they also thought it important to consider symptoms presenting earlier. This is to ensure symptoms that could indicate an acute complication are assessed as early as possible.</p><div id="niceng188er2.s5.3.1"><h4>Implementation and resource considerations</h4><p>Resource impact in relation to symptoms is covered in the <a href="https://www.nice.org.uk/guidance/ng188/evidence" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">evidence review on investigations</a>.</p></div><div id="niceng188er2.s5.3.2"><h4>Other considerations</h4><p>The panel discussed that some reported symptoms, including dizziness, light-headedness and ‘brain-fog’, were not well reported in the published quantitative literature, despite it being reported in the patient lived experience evidence and the panel seeing these commonly in practice. However, they acknowledged that people may describe these symptoms in different ways and there could be limited ways in which data is recorded in the literature.</p><p>The patient lived experience data supported the panel’s experience of people feeling dismissed when seeking help for their symptoms, and symptoms being mis-attributed to psychological causes. The panel discussed that this could increase anxiety levels.</p><p>The panel noted that there was no evidence identified for long term effects of COVID-19 in children and older people. They discussed that older people and children may present with atypical symptoms that could be overlooked. For example, older people can present with gradual decline, deconditioning, worsening frailty or dementia and may not be eating and drinking which can have a variety of causes. It would be reasonable to consider post-COVID-19 syndrome as a cause of these symptoms.</p></div></div></div><div id="niceng188er2.app1"><h2 id="_niceng188er2_app1_">Appendix 1. Methods used to develop the guidance</h2><p>Please see the <a href="/books/NBK567266/bin/niceng188er2_bm1.pdf">methods chapter</a> for details of how this guidance was developed.</p></div><div id="niceng188er2.app2"><h2 id="_niceng188er2_app2_">Appendix 2. Review protocols</h2><div id="niceng188er2.app2.s1"><h3>RQ 2: What is the prevalence of symptoms or clusters of symptoms (physical and mental health) and problems carrying out usual activities, including work, education and leisure, among people who have symptoms of COVID-19 for a duration of 4 to 12 weeks?</h3><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng188er2app2tab1"><a href="/books/NBK567266/table/niceng188er2.app2.tab1/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobniceng188er2app2tab1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng188er2.app2.tab1"><a href="/books/NBK567266/table/niceng188er2.app2.tab1/?report=objectonly" target="object" rid-ob="figobniceng188er2app2tab1">Table</a></h4><p class="float-caption no_bottom_margin">Prevalence of symptoms or clusters of symptoms (ongoing physical and mental health) reported 4-12 weeks following onset of acute COVID-19 including, but not limited to: Signs and symptoms:
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respiratory symptoms such as chronic cough, shortness of breath, <a href="/books/NBK567266/table/niceng188er2.app2.tab1/?report=objectonly" target="object" rid-ob="figobniceng188er2app2tab1">(more...)</a></p></div></div></div><div id="niceng188er2.app2.s2"><h3>RQ 3: What is the prevalence of symptoms or clusters of symptoms (physical and mental health) and problems carrying out usual activities, including work and leisure, among people who have symptoms of COVID-19 beyond 12 weeks?</h3><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng188er2app2tab2"><a href="/books/NBK567266/table/niceng188er2.app2.tab2/?report=objectonly" target="object" title="Table" class="img_link icnblk_img" rid-ob="figobniceng188er2app2tab2"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng188er2.app2.tab2"><a href="/books/NBK567266/table/niceng188er2.app2.tab2/?report=objectonly" target="object" rid-ob="figobniceng188er2app2tab2">Table</a></h4><p class="float-caption no_bottom_margin">Prevalence of symptoms or clusters of symptoms (ongoing physical and mental health) reported 12+ weeks following onset of acute COVID-19 including, but not limited to: Signs and symptoms:
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Respiratory symptoms such as chronic cough, shortness of breath, <a href="/books/NBK567266/table/niceng188er2.app2.tab2/?report=objectonly" target="object" rid-ob="figobniceng188er2app2tab2">(more...)</a></p></div></div></div></div><div id="niceng188er2.app3"><h2 id="_niceng188er2_app3_">Appendix 3. Literature search strategy</h2><div id="niceng188er2.app3.s1"><h3>Database strategies</h3><p>Please refer to the <a href="/books/NBK567266/bin/niceng188er2_bm2.pdf">search history record</a> for full details of the search.</p></div></div><div id="niceng188er2.app4"><h2 id="_niceng188er2_app4_">Appendix 4. Study flow diagram</h2><div id="niceng188er2.app4.fig1" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20niceng188er2app4f1&p=BOOKS&id=567266_niceng188er2app4f1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK567266/bin/niceng188er2app4f1.jpg" alt="Image niceng188er2app4f1" class="tileshop" title="Click on image to zoom" /></a></div></div></div><div id="niceng188er2.app5"><h2 id="_niceng188er2_app5_">Appendix 5. Included studies</h2><div id="niceng188er2.app5.s1"><h3>Review question 2: Symptom prevalence for people with ongoing symptoms in 4 to 12-week period post-acute Covid-19</h3><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref1">Arnold, David T., Hamilton, Fergus W., Milne, Alice
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et al (2020) Patient outcomes after hospitalisation with COVID-19 and implications for follow-up; results from a prospective UK cohort. medRxiv: 2020081220173526 [<a href="/pmc/articles/PMC7716340/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7716340</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33273026" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33273026</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref2">Assaf, G., Davis, H.
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et al (2020): An Analysis of the Prolonged COVID-19 Symptoms Survey by Patient-Led Research Team. <a href="https://patientresearchcovid19.com/research/report-1/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https:<wbr style="display:inline-block"></wbr>​//patientresearchcovid19<wbr style="display:inline-block"></wbr>​.com/research/report-1/</a></div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref3">Boscolo-Rizzo, Paolo, Borsetto, Daniele, Fabbris, Cristoforo
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et al (2020) Evolution of Altered Sense of Smell or Taste in Patients With Mildly Symptomatic COVID-19. JAMA Otolaryngology-Head & Neck Surgery
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146(8): 729 to 732
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[<a href="/pmc/articles/PMC7333173/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7333173</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32614442" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32614442</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref4">Carvalho-Schneider, Claudia, Laurent, Emeline, Lemaignen, Adrien
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et al (2020) Follow-up of adults with non-critical COVID-19 two months after symptoms’ onset. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases [<a href="/pmc/articles/PMC7534895/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7534895</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33031948" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33031948</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref5">Cirulli, Elizabeth T., Barrett, Kelly M. Schiabor, Riffle, Stephen
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et al (2020) Long-term COVID-19 symptoms in a large unselected population. medRxiv: 2020100720208702#</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref6">D’Cruz, Rebecca F., Waller, Michael D., Perrin, Felicity
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et al (2020) Chest radiography is a poor predictor of respiratory symptoms and functional impairment in survivors of severe COVID-19 pneumonia. ERJ Open Research [<a href="/pmc/articles/PMC7585700/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7585700</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33575312" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33575312</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref7">Daher, Ayham, Balfanz, Paul, Cornelissen, Christian
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et al (2020) Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae. Respiratory Medicine: 106197 to 106197 [<a href="/pmc/articles/PMC7573668/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7573668</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33120193" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33120193</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref8">Eiros, Rocio, Perez Manuel, Barreiro-Perez, Garcia Ana, Martin-Garcia
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et al
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Pericarditis and myocarditis long after SARS-CoV-2 infection: a cross-sectional descriptive study in health-care workers. medrxiv preprint</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref9">Fjaeldstad, Alexander Wieck (2020) Prolonged complaints of chemosensory loss after COVID-19. Danish medical journal
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67(8) [<a href="https://pubmed.ncbi.nlm.nih.gov/32741438" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32741438</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref10">Goërtz, Yvonne M. J., Herck, Maarten Van, Delbressine, Jeannet M.
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et al (2020) Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?
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ERJ Open Research [<a href="/pmc/articles/PMC7491255/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7491255</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33257910" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33257910</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref11">Halpin, Stephen J, McIvor, Claire, Whyatt, Gemma
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et al (2020) Post-discharge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation. Journal of medical virology [<a href="https://pubmed.ncbi.nlm.nih.gov/32729939" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32729939</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref12">Kamal, M., Omirah, M.
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et al (2020): Assessment and characterisation of post-COVID-19 manifestations. Int J Clin Pract. 2020;00: e13746. 10.1111/ijcp.13746 [<a href="/pmc/articles/PMC7536922/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7536922</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32991035" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32991035</span></a>] [<a href="http://dx.crossref.org/10.1111/ijcp.13746" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref13">Landi, Francesco, Carfi, Angelo, Benvenuto, Francesca
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et al (2020) Predictive Factors for a New Positive Nasopharyngeal Swab Among Patients Recovered From COVID-19. American journal of preventive medicine [<a href="/pmc/articles/PMC7500946/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7500946</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33041095" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33041095</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref14">Mazza, Mario Gennaro, De Lorenzo, Rebecca, Conte, Caterina
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et al (2020) Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain, behavior, and immunity
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89: 594 to 600
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[<a href="/pmc/articles/PMC7390748/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7390748</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32738287" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32738287</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref15">Paderno, Alberto, Mattavelli, Davide, Rampinelli, Vittorio
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et al (2020) Olfactory and Gustatory Outcomes in COVID-19: A Prospective Evaluation in Nonhospitalized Subjects. Otolaryngology--Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery: 194599820939538 [<a href="/pmc/articles/PMC7331108/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7331108</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32600175" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32600175</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref16">Poyraz, B., Poyraz, C.
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et al (2020): Psychiatric morbidity and protracted symptoms in recovered COVID-19 patients. medRxiv preprint doi: 10.1101/2020.10.07.20208249 [<a href="http://dx.crossref.org/10.1101/2020.10.07.20208249" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref17">Taquet, M., Luciano, S.
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et al (2020): Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry
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2020. Published Online November
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9, 2020 10.1016/S2215-0366(20)30462-4 [<a href="/pmc/articles/PMC7820108/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7820108</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33181098" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33181098</span></a>] [<a href="http://dx.crossref.org/10.1016/S2215-0366(20)30462-4" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref18">Lucia Valiente-De, Santis, Ines, Perez-Camacho, Beatriz, Sobrino
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et al (2020) Clinical and immunoserological status 12 weeks after infection with COVID-19: prospective observational study. medRxiv</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref19">Vaira, L.A., Hopkins, C.
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et al (2020): Smell and taste recovery in coronavirus disease 2019 patients: a 60-day objective and prospective study. J Laryngol Otol
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2020;1 to 7. 10.1017/S0022215120001826 [<a href="/pmc/articles/PMC7471571/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7471571</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32782030" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32782030</span></a>] [<a href="http://dx.crossref.org/10.1017/S0022215120001826" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref20">Weerahandi, H., Hochman, K.
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et al (2020): Post-discharge health status and symptoms in patients with severe COVID-19. medRxiv preprint doi: 10.1101/2020.08.11.20172742 [<a href="/pmc/articles/PMC7808113/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7808113</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33443703" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33443703</span></a>] [<a href="http://dx.crossref.org/10.1101/2020.08.11.20172742" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">CrossRef</a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref21">Xiong, Qiutang, Xu, Ming, Li, Jiao
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et al (2020) Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study. Clinical microbiology and infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases [<a href="/pmc/articles/PMC7510771/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7510771</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32979574" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32979574</span></a>]</div></p></li></ul></div><div id="niceng188er2.app5.s2"><h3>Review question 3: Symptom prevalence for people with ongoing symptoms in 12 week-plus period post-acute Covid-19</h3><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref22">Dennis, Andrea, Wamil, Malgorzata, Kapur, Sandeep
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et al (2020) Multi-organ impairment in low-risk individuals with long COVID. medRxiv: 2020101420212555</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref23">Klein, Hadar, Asseo, Kim, Karni, Noam
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et al
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Onset, duration, and persistence of taste and smell changes and other COVID-19 symptoms: longitudinal study in Israeli patients. medrxiv preprint</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng188er2.app5.ref24">Tomasoni, Daniele, Bai, Francesca, Castoldi, Roberto
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et al
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Anxiety and depression symptoms after virological clearance of COVID-19: A cross-sectional study in Milan, Italy. Journal of Medical Virology na(na) [<a href="/pmc/articles/PMC7461061/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7461061</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32841387" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32841387</span></a>]</div></p></li></ul></div></div><div id="niceng188er2.app6"><h2 id="_niceng188er2_app6_">Appendix 6. Evidence tables</h2><div id="niceng188er2.app6.s1"><h3>Review question 2 (4 to 12-week period)</h3><p id="niceng188er2.app6.et1"><a href="/books/NBK567266/bin/niceng188er2-app6-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Arnold 2020
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</a><span class="small"> (PDF, 222K)</span></p><p id="niceng188er2.app6.et2"><a href="/books/NBK567266/bin/niceng188er2-app6-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Patient-Led Research Team (Assaf et al, 2020)</a><span class="small"> (PDF, 167K)</span></p><p id="niceng188er2.app6.et3"><a href="/books/NBK567266/bin/niceng188er2-app6-et3.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Boscolo-Rizzo 2020
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</a><span class="small"> (PDF, 200K)</span></p><p id="niceng188er2.app6.et4"><a href="/books/NBK567266/bin/niceng188er2-app6-et4.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Carvalho-Schneider 2020
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</a><span class="small"> (PDF, 235K)</span></p><p id="niceng188er2.app6.et5"><a href="/books/NBK567266/bin/niceng188er2-app6-et5.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Cirulli 2020
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</a><span class="small"> (PDF, 192K)</span></p><p id="niceng188er2.app6.et6"><a href="/books/NBK567266/bin/niceng188er2-app6-et6.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Daher 2020
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</a><span class="small"> (PDF, 198K)</span></p><p id="niceng188er2.app6.et7"><a href="/books/NBK567266/bin/niceng188er2-app6-et7.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Eiros 2020</a><span class="small"> (PDF, 247K)</span></p><p id="niceng188er2.app6.et8"><a href="/books/NBK567266/bin/niceng188er2-app6-et8.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Fjaeldstad 2020
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</a><span class="small"> (PDF, 226K)</span></p><p id="niceng188er2.app6.et9"><a href="/books/NBK567266/bin/niceng188er2-app6-et9.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Goërtz 2020
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</a><span class="small"> (PDF, 227K)</span></p><p id="niceng188er2.app6.et10"><a href="/books/NBK567266/bin/niceng188er2-app6-et10.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Halpin 2020
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</a><span class="small"> (PDF, 368K)</span></p><p id="niceng188er2.app6.et11"><a href="/books/NBK567266/bin/niceng188er2-app6-et11.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Kamal 2020
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</a><span class="small"> (PDF, 216K)</span></p><p id="niceng188er2.app6.et12"><a href="/books/NBK567266/bin/niceng188er2-app6-et12.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Landi 2020
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</a><span class="small"> (PDF, 207K)</span></p><p id="niceng188er2.app6.et13"><a href="/books/NBK567266/bin/niceng188er2-app6-et13.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Mazza 2020
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</a><span class="small"> (PDF, 208K)</span></p><p id="niceng188er2.app6.et14"><a href="/books/NBK567266/bin/niceng188er2-app6-et14.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Paderno 2020
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</a><span class="small"> (PDF, 235K)</span></p><p id="niceng188er2.app6.et15"><a href="/books/NBK567266/bin/niceng188er2-app6-et15.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Poyraz 2020
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</a><span class="small"> (PDF, 177K)</span></p><p id="niceng188er2.app6.et16"><a href="/books/NBK567266/bin/niceng188er2-app6-et16.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Taquet 2020
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</a><span class="small"> (PDF, 156K)</span></p><p id="niceng188er2.app6.et17"><a href="/books/NBK567266/bin/niceng188er2-app6-et17.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Vaira 2020
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</a><span class="small"> (PDF, 151K)</span></p><p id="niceng188er2.app6.et18"><a href="/books/NBK567266/bin/niceng188er2-app6-et18.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Valiente-De Santis 2020
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</a><span class="small"> (PDF, 223K)</span></p><p id="niceng188er2.app6.et19"><a href="/books/NBK567266/bin/niceng188er2-app6-et19.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Weerahandi 2020
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</a><span class="small"> (PDF, 174K)</span></p><p id="niceng188er2.app6.et20"><a href="/books/NBK567266/bin/niceng188er2-app6-et20.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Xiong 2020
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</a><span class="small"> (PDF, 255K)</span></p></div><div id="niceng188er2.app6.s2"><h3>Review question 2 (12 week-plus period)</h3><p id="niceng188er2.app6.et21"><a href="/books/NBK567266/bin/niceng188er2-app6-et21.pdf" class="bk_dwnld_icn bk_dwnld_pdf">
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Dennis 2020
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</a><span class="small"> (PDF, 264K)</span></p><p id="niceng188er2.app6.et22"><a href="/books/NBK567266/bin/niceng188er2-app6-et22.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Klein 2020</a><span class="small"> (PDF, 169K)</span></p><p id="niceng188er2.app6.et23"><a href="/books/NBK567266/bin/niceng188er2-app6-et23.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Tomasoni 2020</a><span class="small"> (PDF, 250K)</span></p></div><div id="niceng188er2.app6.s3"><h3>Real world data studies</h3><p id="niceng188er2.app6.et24"><a href="/books/NBK567266/bin/niceng188er2-app6-et24.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Banda 2020</a><span class="small"> (PDF, 195K)</span></p><p id="niceng188er2.app6.et25"><a href="/books/NBK567266/bin/niceng188er2-app6-et25.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Singh 2020</a><span class="small"> (PDF, 157K)</span></p></div></div><div id="niceng188er2.app7"><h2 id="_niceng188er2_app7_">Appendix 7. Excluded studies</h2><p>Please refer to the full list of <a href="/books/NBK567266/bin/niceng188er2_bm3.pdf">excluded studies</a> for this guideline.</p></div></div><div class="fm-sec"><div><p>Please note that this is a revised version from that originally published</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2020.</div><div class="small"><span class="label">Bookshelf ID: NBK567266</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/33555766" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">33555766</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng188er2tab1"><div id="niceng188er2.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">Included studies for review question 2: hospitalised people</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK567266/table/niceng188er2.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng188er2.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng188er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng188er2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Country, study design, dates</th><th id="hd_h_niceng188er2.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population (n)</th><th id="hd_h_niceng188er2.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">COVID-19 disease severity</th><th id="hd_h_niceng188er2.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Time since acute COVID-19 illness</th><th id="hd_h_niceng188er2.tab1_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Main symptoms/conditions reported</th></tr></thead><tbody><tr><td headers="hd_h_niceng188er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref1" rid="niceng188er2.app5.ref1">Arnold 2020</a>
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</td><td headers="hd_h_niceng188er2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">UK, prospective cohort, 30<sup>th</sup> March to 3<sup>rd</sup> June 2020</td><td headers="hd_h_niceng188er2.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">110 people hospitalised with COVID-19 (median age 60 years)</td><td headers="hd_h_niceng188er2.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mild, moderate and severe</td><td headers="hd_h_niceng188er2.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 to 12 weeks from admission</td><td headers="hd_h_niceng188er2.tab1_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Breathlessness (39%)</p>
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<p>Excessive fatigue (39%)</p>
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<p>Insomnia (24%)</p>
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</td></tr><tr><td headers="hd_h_niceng188er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref6" rid="niceng188er2.app5.ref6">D’Cruz 2020</a>
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</td><td headers="hd_h_niceng188er2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">UK, prospective cohort, June to July 2020</td><td headers="hd_h_niceng188er2.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">119 COVID-19 survivors who had been hospitalised with PCRconfirmed severe COVID-19 pneumonia (mean age 58.7)</td><td headers="hd_h_niceng188er2.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severe</td><td headers="hd_h_niceng188er2.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 to 6 weeks from discharge</td><td headers="hd_h_niceng188er2.tab1_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Fatigue (67.8%)</p>
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<p>Sleep disturbance (56.5%)</p>
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<p>Pain (49.6%)</p>
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<p>Breathlessness (46.2%)</p>
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<p>Cough (42.6%)</p>
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</td></tr><tr><td headers="hd_h_niceng188er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref7" rid="niceng188er2.app5.ref7">Daher 2020</a>
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</td><td headers="hd_h_niceng188er2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Germany, retrospective cohort, February to May 2020</td><td headers="hd_h_niceng188er2.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33 people with COVID-19 who were discharged from the isolation ward (mean age 64 years)</td><td headers="hd_h_niceng188er2.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severe</td><td headers="hd_h_niceng188er2.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 weeks from discharge</td><td headers="hd_h_niceng188er2.tab1_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Fatigue (45%)</p>
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<p>Tiredness (45%)</p>
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<p>Dyspnoea (33%)</p>
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<p>Cough (33%)</p>
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</td></tr><tr><td headers="hd_h_niceng188er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref11" rid="niceng188er2.app5.ref11">Halpin 2020</a>
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</td><td headers="hd_h_niceng188er2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">UK, retrospective cohort, May to June 2020</td><td headers="hd_h_niceng188er2.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">100 hospitalised people diagnosed with COVID-19 (median age 70.5 years ward people; 58.5 years ICU people)</td><td headers="hd_h_niceng188er2.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate to severe</td><td headers="hd_h_niceng188er2.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4-8 weeks from discharge</td><td headers="hd_h_niceng188er2.tab1_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Fatigue (64%)</p>
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<p>Breathlessness (50%)</p>
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<p>PTSD (31%)</p>
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</td></tr><tr><td headers="hd_h_niceng188er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref13" rid="niceng188er2.app5.ref13">Landi 2020</a>
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</td><td headers="hd_h_niceng188er2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Italy, prospective cohort, 21<sup>st</sup> April to 21<sup>st</sup> May 2020</td><td headers="hd_h_niceng188er2.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">109 people recovered from COVID-19 (mean age 55.8 years)</td><td headers="hd_h_niceng188er2.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate to severe</td><td headers="hd_h_niceng188er2.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8 weeks from COVID-19 onset</td><td headers="hd_h_niceng188er2.tab1_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Fatigue (51.3%)</p>
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<p>Short of breath (45.8%)</p>
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<p>Joint pain (25.6%)</p>
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</td></tr><tr><td headers="hd_h_niceng188er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref14" rid="niceng188er2.app5.ref14">Mazza 2020</a>
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</td><td headers="hd_h_niceng188er2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Italy, crosssectional, 6 April to 9 June 2020</td><td headers="hd_h_niceng188er2.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">402 people surviving COVID-19 who had previously been hospitalised (mean age 57.8 years)</td><td headers="hd_h_niceng188er2.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severe</td><td headers="hd_h_niceng188er2.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31 days after discharge</td><td headers="hd_h_niceng188er2.tab1_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Psychiatric symptoms:</p>
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<p>55.7% scored in the clinical range in at least one psychopathological dimension, 36.8% in two, 20.6% in three, and 10% in four</p>
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</td></tr><tr><td headers="hd_h_niceng188er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref20" rid="niceng188er2.app5.ref20">Weerahandi 2020</a>
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</td><td headers="hd_h_niceng188er2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">USA, prospective cohort, from 15 April 2020</td><td headers="hd_h_niceng188er2.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">152 people recovering from severe COVID-19 (median age 62 years)</td><td headers="hd_h_niceng188er2.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Severe</td><td headers="hd_h_niceng188er2.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30 to 40 days after discharge</td><td headers="hd_h_niceng188er2.tab1_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dyspnoea (74.3%)</td></tr><tr><td headers="hd_h_niceng188er2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref21" rid="niceng188er2.app5.ref21">Xiong 2020</a>
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</td><td headers="hd_h_niceng188er2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">China, retrospective cohort, up to 1 March 2020</td><td headers="hd_h_niceng188er2.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">538 COVID-19 survivors who were discharged from hospital (median age 52 years)</td><td headers="hd_h_niceng188er2.tab1_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Moderate</td><td headers="hd_h_niceng188er2.tab1_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 months after discharge</td><td headers="hd_h_niceng188er2.tab1_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>General symptoms (49.6%)</p>
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<p>Respiratory symptoms (39%)</p>
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<p>CVD symptoms (13%)</p>
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<p>Psychosocial symptoms (22.7%)</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng188er2tab2"><div id="niceng188er2.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Included studies for review question 2: Non-hospitalised people</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK567266/table/niceng188er2.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng188er2.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Country, study design, dates</th><th id="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population (n)</th><th id="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">COVID-19 disease severity</th><th id="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Time since COVID-19 illness</th><th id="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Main symptoms/conditions reported</th></tr></thead><tbody><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref2" rid="niceng188er2.app5.ref2">Assaf 2020</a>
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</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">International, Patient-led research, Survey,</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">640 self-selected people (age range 30 to 49, 62.7%)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Limited to evidence from weeks 1 to 8 from COVID-19 illness</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The vast majority of participants with symptoms experienced fluctuations both in the type (70% reporting) and intensity (89% reporting) of symptoms over the course of being symptomatic.</td></tr><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref3" rid="niceng188er2.app5.ref3">Boscolo-Rizzo 2020</a>
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</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Italy, cross sectional, 19 March to 22 March</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">202 people who were mildly symptomatic of COVID-19 (median age 56 years)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mild</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4 weeks after positive test</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Altered sense of smell/taste (51.3%)</p>
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<p>Dry cough (39.7%)</p>
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<p>Problems breathing (39%)</p>
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<p>Headache (23.7%)</p>
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</td></tr><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref4" rid="niceng188er2.app5.ref4">Carvalho-Schneider 2020</a>
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</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">France, prospective cohort, March 17 to June 3 2020</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">150 people with non-critical COVID-19</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Non-critical</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30 to 60 days from symptom onset</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Chest pain (13.1%)</p>
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<p>Dyspnoea (7.7%)</p>
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<p>Flu-like symptoms (21.5%)</p>
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<p>Anosmia/Ageusia (22.7%)</p>
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<p>Arthralgia (16.3%)</p>
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<p>Palpitations (10.9%)</p>
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</td></tr><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref5" rid="niceng188er2.app5.ref5">Cirulli 2020</a>
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</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">USA, cross-sectional, April 2020 to September 2020</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">233 with positive COVID-19 test (out of a sample of 21,359, median age 58 years)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mild</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30, 60 and 90 days from symptom onset</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Anosmia, ageusia, difficulty concentrating, dyspnoea, memory loss, headache, heart palpitations were significant after 30 days and 60 days in COVID-19+ cases.</p>
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<p>Tachycardia was significant at 60 days</p>
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<p>All symptoms except memory loss were significant at 90 days</p>
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</td></tr><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref8" rid="niceng188er2.app5.ref8">Eiros 2020</a>
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</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spain, cross-sectional, 25 May 2020 to 12 June 2020</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">139 health-care workers with confirmed past SARS-CoV-2 infection (median age 52 years)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 weeks after infection onset</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Cardiac symptoms (42%)</p>
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<p>Dyspnoea (26%)</p>
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<p>Fatigue (27%)</p>
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<p>Chest pain (19%)</p>
|
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</td></tr><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref9" rid="niceng188er2.app5.ref9">Fjaelstad 2020</a>
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</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Denmark, cross-sectional, 22 April to 4 May 2020</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">109 non-hospitalised people experiencing a sudden chemosensory loss (mean age 39 years)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mild</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.5 days after symptom onset</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>Anosmia (28%)</p>
|
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<p>Ageusia (20%)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref10" rid="niceng188er2.app5.ref10">Goertz 2020</a>
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</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Netherlands and Belgium, Cross sectional, 4 to 11 June 2020</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2113 Facebook group members, Lung Foundation Netherlands website (median age 47 years)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mild</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">79 days since onset of first symptoms</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Fatigue (87%)</p>
|
|
<p>Dyspnoea (71%)</p>
|
|
<p>Headache (38%)</p>
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<p>Chest tightness (44%)</p>
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|
<p>Palpitations (32%)</p>
|
|
<p>Cough (29%)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref12" rid="niceng188er2.app5.ref12">Kamal 2020</a>
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</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Egypt, Cross-sectional (date not reported)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">287 COVID-19 survivors (mean age 32.3 years)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mild</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">More than 20 days since last negative PCR</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Fatigue (72.8%)</p>
|
|
<p>Dyspnoea (28.2%)</p>
|
|
<p>Depression (28.6%)</p>
|
|
<p>Anxiety (38%)</p>
|
|
<p>Cognitive impairment (28.6%)</p>
|
|
<p>Headache (28.9%)</p>
|
|
<p>Joint pain (31.4%)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<a class="bibr" href="#niceng188er2.app5.ref15" rid="niceng188er2.app5.ref15">Paderno 2020</a>
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</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Italy, prospective cohort, April 27 to May 5, 2020</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">151 home-quarantined SARS-CoV-2–positive people (mean 45 years)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Most likely mild</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45 days since symptom onset</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<p>Olfactory dysfunction (16%)</p>
|
|
<p>Gustatory dysfunction (12%)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bibr" href="#niceng188er2.app5.ref16" rid="niceng188er2.app5.ref16">Poyraz 2020</a>
|
|
</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Turkey, cross-sectional, March 15 and May 15, 2020</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">284 adults who had received care (mean age 39.7 years)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mild to moderate</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.7 days since COVID-19 diagnosis</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Fatigue (40%)</p>
|
|
<p>Muscle aches (22%)</p>
|
|
<p>Alteration of taste (18%)</p>
|
|
<p>Headache (17%)</p>
|
|
<p>Alteration of smell (17%)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<a class="bibr" href="#niceng188er2.app5.ref17" rid="niceng188er2.app5.ref17">Taquet 2020</a>
|
|
</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">USA, prospective cohort</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44,779 COVID-19 survivors with no prior psychiatric history (mean age 49.3 years)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14 to 90 days from illness</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>At 3 months a diagnosis of COVID-19 led to significantly more first diagnoses of psychiatric illness vs six other health events (HR 1.58 to 2.24, all P values <0.0001).</p>
|
|
<p>The most frequent diagnosis was anxiety disorder, and the other most common disorders were adjustment disorder, generalised anxiety disorder and PTSD to a lesser extent.</p>
|
|
</td></tr><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bibr" href="#niceng188er2.app5.ref18" rid="niceng188er2.app5.ref18">Valiente-De Santis 2020</a>
|
|
</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Spain, prospective cohort, 14<sup>th</sup> March to 15<sup>th</sup> April</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">108 people with previous acute SARS-CoV-2 infection (age >65 years 26.9%)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Mild to severe</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12 weeks after acute phase</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Dyspnoea (55.6%)</p>
|
|
<p>Asthenia (44.9%)</p>
|
|
<p>Cough (25.9%)</p>
|
|
<p>Chest pain (25.9%)</p>
|
|
<p>Palpitations (22.2%)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng188er2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<a class="bibr" href="#niceng188er2.app5.ref19" rid="niceng188er2.app5.ref19">Vaira 2020</a>
|
|
</td><td headers="hd_h_niceng188er2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Italy, prospective cohort, (date not reported)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">138 people with COVID-19 (mean age 51.2 years)</td><td headers="hd_h_niceng188er2.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Most likely mild</td><td headers="hd_h_niceng188er2.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Up to 60 days from COVID-19 diagnosis</td><td headers="hd_h_niceng188er2.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anosmia/ageusia (7.2%)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng188er2tab3"><div id="niceng188er2.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Included studies for review question 2: Real world evidence</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK567266/table/niceng188er2.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng188er2.tab3_lrgtbl__"><table><thead><tr><th id="hd_h_niceng188er2.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng188er2.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Country, study design, dates</th><th id="hd_h_niceng188er2.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population (n)</th><th id="hd_h_niceng188er2.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">COVID-19 disease severity</th><th id="hd_h_niceng188er2.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Time since COVID-19 illness</th><th id="hd_h_niceng188er2.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Main symptoms/conditions reported</th></tr></thead><tbody><tr><td headers="hd_h_niceng188er2.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Banda 2020</td><td headers="hd_h_niceng188er2.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Country not reported, real world data,21 May 2020 to 10 July 2020</td><td headers="hd_h_niceng188er2.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">150 tweets from 107 users in the largest publicly available COVID-19 Twitter chatter dataset.</td><td headers="hd_h_niceng188er2.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_niceng188er2.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_niceng188er2.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>malaise and fatigue (62%)</p>
|
|
<p>dyspnoea (19%)</p>
|
|
<p>tachycardia/palpitations (13%)</p>
|
|
<p>chest pain (13%),</p>
|
|
<p>insomnia/sleep disorders (10%)</p>
|
|
<p>cough (9%) headache (7%)</p>
|
|
</td></tr><tr><td headers="hd_h_niceng188er2.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Singh 2020</td><td headers="hd_h_niceng188er2.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Country not reported, real world data 20 July 2020 to 29th July 2020</td><td headers="hd_h_niceng188er2.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">165 tweets from 89 users were included in the final analysis</td><td headers="hd_h_niceng188er2.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_niceng188er2.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_niceng188er2.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Fatigue 42 (47%)</p>
|
|
<p>Shortness of breath (26%)</p>
|
|
<p>Brain fog 15 (17%)</p>
|
|
<p>Exercise intolerance (15%)</p>
|
|
<p>Pain in the whole body (10%)</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng188er2tab4"><div id="niceng188er2.tab4" class="table"><h3><span class="label">Table 3</span><span class="title">Common symptoms reported across studies in hospitalised people</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK567266/table/niceng188er2.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng188er2.tab4_lrgtbl__"><table><thead><tr><th id="hd_h_niceng188er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Symptom</th><th id="hd_h_niceng188er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of studies</th><th id="hd_h_niceng188er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of people (n)</th><th id="hd_h_niceng188er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prevalence (range, %)</th></tr></thead><tbody><tr><td headers="hd_h_niceng188er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shortness of breath</td><td headers="hd_h_niceng188er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_niceng188er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">619</td><td headers="hd_h_niceng188er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32% to 74%</td></tr><tr><td headers="hd_h_niceng188er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fatigue</td><td headers="hd_h_niceng188er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_niceng188er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">950</td><td headers="hd_h_niceng188er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28% to 68%</td></tr><tr><td headers="hd_h_niceng188er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cough</td><td headers="hd_h_niceng188er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_niceng188er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">795</td><td headers="hd_h_niceng188er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.% to 43%</td></tr><tr><td headers="hd_h_niceng188er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sleep disturbance</td><td headers="hd_h_niceng188er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_niceng188er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">659</td><td headers="hd_h_niceng188er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18% to 57%</td></tr><tr><td headers="hd_h_niceng188er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cognitive impairment</td><td headers="hd_h_niceng188er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_niceng188er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">248</td><td headers="hd_h_niceng188er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18% to 22%</td></tr><tr><td headers="hd_h_niceng188er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sore throat</td><td headers="hd_h_niceng188er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_niceng188er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">680</td><td headers="hd_h_niceng188er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3% to 9%</td></tr><tr><td headers="hd_h_niceng188er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Loss of smell</td><td headers="hd_h_niceng188er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_niceng188er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">142</td><td headers="hd_h_niceng188er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12% to 15%</td></tr><tr><td headers="hd_h_niceng188er2.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Loss of taste</td><td headers="hd_h_niceng188er2.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_niceng188er2.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">142</td><td headers="hd_h_niceng188er2.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9% to 10%</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng188er2tab5"><div id="niceng188er2.tab5" class="table"><h3><span class="label">Table 4</span><span class="title">Common symptoms reported across studies in non-hospitalised people</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK567266/table/niceng188er2.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng188er2.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_niceng188er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Symptom</th><th id="hd_h_niceng188er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of studies</th><th id="hd_h_niceng188er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Number of people (n)</th><th id="hd_h_niceng188er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Prevalence (range, %)</th></tr></thead><tbody><tr><td headers="hd_h_niceng188er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Loss of smell</td><td headers="hd_h_niceng188er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_niceng188er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3110</td><td headers="hd_h_niceng188er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7% to 51%</td></tr><tr><td headers="hd_h_niceng188er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Loss of taste</td><td headers="hd_h_niceng188er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_niceng188er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2960</td><td headers="hd_h_niceng188er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5% to 51%</td></tr><tr><td headers="hd_h_niceng188er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shortness of breath</td><td headers="hd_h_niceng188er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_niceng188er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2999</td><td headers="hd_h_niceng188er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8% to 71%</td></tr><tr><td headers="hd_h_niceng188er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chest pain</td><td headers="hd_h_niceng188er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_niceng188er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2999</td><td headers="hd_h_niceng188er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.9% to 44%</td></tr><tr><td headers="hd_h_niceng188er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Joint pain</td><td headers="hd_h_niceng188er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_niceng188er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2999</td><td headers="hd_h_niceng188er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2% to 31%</td></tr><tr><td headers="hd_h_niceng188er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Headache</td><td headers="hd_h_niceng188er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_niceng188er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2849</td><td headers="hd_h_niceng188er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5% to 38%</td></tr><tr><td headers="hd_h_niceng188er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fatigue</td><td headers="hd_h_niceng188er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_niceng188er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2823</td><td headers="hd_h_niceng188er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27% to 87%</td></tr><tr><td headers="hd_h_niceng188er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Palpitations</td><td headers="hd_h_niceng188er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_niceng188er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2510</td><td headers="hd_h_niceng188er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10% to 32%</td></tr><tr><td headers="hd_h_niceng188er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fever</td><td headers="hd_h_niceng188er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_niceng188er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2710</td><td headers="hd_h_niceng188er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2% to 11%</td></tr><tr><td headers="hd_h_niceng188er2.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cognitive impairment</td><td headers="hd_h_niceng188er2.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_niceng188er2.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">679</td><td headers="hd_h_niceng188er2.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2% to 29%</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng188er2tab6"><div id="niceng188er2.tab6" class="table"><h3><span class="label">Table 5</span><span class="title">Common symptoms reported in real world evidence studies</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK567266/table/niceng188er2.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng188er2.tab6_lrgtbl__"><table><thead><tr><th id="hd_h_niceng188er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rank</th><th id="hd_h_niceng188er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Banda (n=107)</th><th id="hd_h_niceng188er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Singh (n=89)</th></tr></thead><tbody><tr><td headers="hd_h_niceng188er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng188er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Malaise and fatigue (62%)</td><td headers="hd_h_niceng188er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fatigue (47.19%)</td></tr><tr><td headers="hd_h_niceng188er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2</td><td headers="hd_h_niceng188er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dyspnoea (19%)</td><td headers="hd_h_niceng188er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">SOB (25.8%)</td></tr><tr><td headers="hd_h_niceng188er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3</td><td headers="hd_h_niceng188er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Chest pain (unspecified) (13%)</td><td headers="hd_h_niceng188er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Brain fog (16.85%)</td></tr><tr><td headers="hd_h_niceng188er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4</td><td headers="hd_h_niceng188er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tachycardia (unspecified) (13%)</td><td headers="hd_h_niceng188er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Exercise intolerance (14.6%)</td></tr><tr><td headers="hd_h_niceng188er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5</td><td headers="hd_h_niceng188er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Insomnia (10%)</td><td headers="hd_h_niceng188er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pain in the whole body (10.11%)</td></tr><tr><td headers="hd_h_niceng188er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6</td><td headers="hd_h_niceng188er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cough (9%)</td><td headers="hd_h_niceng188er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Altered smell (7.86%)</td></tr><tr><td headers="hd_h_niceng188er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7</td><td headers="hd_h_niceng188er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Headache (7%)</td><td headers="hd_h_niceng188er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Headache (7.86%)</td></tr><tr><td headers="hd_h_niceng188er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8</td><td headers="hd_h_niceng188er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Fever (unspecified) (6%)</td><td headers="hd_h_niceng188er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tachycardia (6.74%)</td></tr><tr><td headers="hd_h_niceng188er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9</td><td headers="hd_h_niceng188er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pain (unspecified) (6%)</td><td headers="hd_h_niceng188er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Altered taste (6.74%)</td></tr><tr><td headers="hd_h_niceng188er2.tab6_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10</td><td headers="hd_h_niceng188er2.tab6_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pain in joint (6%)</td><td headers="hd_h_niceng188er2.tab6_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pain in chest (5.61%)</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng188er2tab7"><div id="niceng188er2.tab7" class="table"><h3><span class="label">Table 6</span><span class="title">Included studies for review question 3: hospitalised people</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK567266/table/niceng188er2.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng188er2.tab7_lrgtbl__"><table><thead><tr><th id="hd_h_niceng188er2.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng188er2.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Country, study design, dates</th><th id="hd_h_niceng188er2.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population (n)</th><th id="hd_h_niceng188er2.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">COVID-19 disease severity</th><th id="hd_h_niceng188er2.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Time since COVID-19 illness</th><th id="hd_h_niceng188er2.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Main symptoms/conditions reported</th></tr></thead><tbody><tr><td headers="hd_h_niceng188er2.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref22" rid="niceng188er2.app5.ref22">Dennis 2020</a>
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</td><td headers="hd_h_niceng188er2.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">UK, prospective cohort, April to August 2020</td><td headers="hd_h_niceng188er2.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">164 people with previous SARS-COV-2 infection who had been hospitalised (mean age 50 years)</td><td headers="hd_h_niceng188er2.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_niceng188er2.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 to 5 months after initial illness</td><td headers="hd_h_niceng188er2.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Fatigue (97.6%)</p>
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<p>Muscle ache (87.6%)</p>
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<p>Shortness of breath (85.4%)</p>
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<p>Headache (84.8%)</p>
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<p>Joint pain (78%)</p>
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</td></tr><tr><td headers="hd_h_niceng188er2.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Tomasoni 2020</td><td headers="hd_h_niceng188er2.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Italy, cross-sectional, April to June 2020</td><td headers="hd_h_niceng188er2.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">105 people clinically and virologically recovered from COVID-19 (mean age 55 years)</td><td headers="hd_h_niceng188er2.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_niceng188er2.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">>3 months from virological clearance</td><td headers="hd_h_niceng188er2.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Asthenia (31.4%)</p>
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<p>Breathlessness (6.7%)</p>
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<p>Pain (10.5%)</p>
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<p>Cognitive impairment (17.1%)</p>
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<p>Loss of smell/taste (5.7%)</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng188er2tab8"><div id="niceng188er2.tab8" class="table"><h3><span class="label">Table 7</span><span class="title">Included studies for review question 3: non-hospitalised people</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK567266/table/niceng188er2.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng188er2.tab8_lrgtbl__"><table><thead><tr><th id="hd_h_niceng188er2.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng188er2.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Country, study design, dates</th><th id="hd_h_niceng188er2.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population (n)</th><th id="hd_h_niceng188er2.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">COVID-19 disease severity</th><th id="hd_h_niceng188er2.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Time since COVID-19 illness</th><th id="hd_h_niceng188er2.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Main symptoms/conditions reported</th></tr></thead><tbody><tr><td headers="hd_h_niceng188er2.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a class="bibr" href="#niceng188er2.app5.ref22" rid="niceng188er2.app5.ref22">Dennis 2020</a>
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</td><td headers="hd_h_niceng188er2.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">UK, prospective cohort, April to August 2020</td><td headers="hd_h_niceng188er2.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">164 people with previous SARS-COV-2 infection who had been hospitalised (mean age 50 years)</td><td headers="hd_h_niceng188er2.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not reported</td><td headers="hd_h_niceng188er2.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3 to 5 months after initial illness</td><td headers="hd_h_niceng188er2.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Fatigue (87.1%)</p>
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<p>Muscle ache (87.6%)</p>
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<p>Shortness of breath (87.1%)</p>
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<p>Headache (87.1%)</p>
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<p>Joint pain (78.1%)</p>
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</td></tr><tr><td headers="hd_h_niceng188er2.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Klein 2020</td><td headers="hd_h_niceng188er2.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Israel, cross-sectional, April 2020 to October 2020</td><td headers="hd_h_niceng188er2.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">112 Israeli residents with positive COVID-19 RT-PCR recruited via social media (mean age 35 years)</td><td headers="hd_h_niceng188er2.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Most likely mild</td><td headers="hd_h_niceng188er2.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Around 6 months after initial illness</td><td headers="hd_h_niceng188er2.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Fatigue (20.5%)</p>
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<p>Loss of smell (13.4%)</p>
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<p>Breathlessness (8.9%)</p>
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<p>Myalgia (7.41%)</p>
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</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng188er2app2tab1"><div id="niceng188er2.app2.tab1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK567266/table/niceng188er2.app2.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng188er2.app2.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng188er2.app2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Criteria</th><th id="hd_h_niceng188er2.app2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Notes</th></tr></thead><tbody><tr><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</td><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People experiencing symptoms or clusters of symptoms (ongoing physical and mental health) from 4 to 12 weeks after the onset of acute COVID-19.</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions/service configuration/information and support [delete/amend as appropriate]</td><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparators</td><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</td><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Prevalence of symptoms or clusters of symptoms (ongoing physical and mental health) reported 4-12 weeks following onset of acute COVID-19 including, but not limited to:</p>
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<p>Signs and symptoms:
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<ul><li class="half_rhythm"><div>respiratory symptoms such as chronic cough, shortness of breath, cardiovascular symptoms, and disease such as chest tightness, tachycardia, palpitations, protracted loss or change of smell and taste</div></li><li class="half_rhythm"><div>mental health problems including but not limited to depression, anxiety and PTSD symptoms and cognitive difficulties</div></li><li class="half_rhythm"><div>Neuropsychiatric or psychiatric symptoms</div></li><li class="half_rhythm"><div>Neurological symptoms including weakness, numbness, continuing headaches, seizures, cognitive symptoms visual loss, autonomic symptoms, vestibular symptoms</div></li><li class="half_rhythm"><div>Myalgia or joint pain</div></li><li class="half_rhythm"><div>Evidence of end organ damage across a range of organs</div></li><li class="half_rhythm"><div>Gastrointestinal disturbance with diarrhoea</div></li><li class="half_rhythm"><div>Fatigue, weakness and sleeplessness</div></li><li class="half_rhythm"><div>Skin rashes</div></li><li class="half_rhythm"><div>Evidence of systemic inflammation</div></li><li class="half_rhythm"><div>Conditions</div></li><li class="half_rhythm"><div>Autonomic conditions</div></li><li class="half_rhythm"><div>Respiratory conditions such as lung inflammation and fibrosis</div></li><li class="half_rhythm"><div>Cardiovascular conditions such as myocarditis and heart failure</div></li><li class="half_rhythm"><div>Liver and kidney dysfunction</div></li><li class="half_rhythm"><div>Clotting disorders and thrombosis</div></li><li class="half_rhythm"><div>Lymphadenopathy</div></li><li class="half_rhythm"><div>Neurological disorders including neuropathy</div></li></ul>
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</p>
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</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Settings</td><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Subgroups</td><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<ul><li class="half_rhythm"><div>Groups as defined in the EIA for example, age, sex, ethnicity</div></li><li class="half_rhythm"><div>Diagnosis of COVID-19 (e.g. confirmed or high clinical suspicion)</div></li><li class="half_rhythm"><div>Duration of symptoms</div></li></ul></td></tr><tr><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study types</td><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Any</p>
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<p>The following study design types for this question are preferred. Where these studies are not identified, other study designs will be considered.
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<ul><li class="half_rhythm"><div>Systematic reviews of observational studies</div></li><li class="half_rhythm"><div>Prospective and retrospective observational studies</div></li><li class="half_rhythm"><div>Descriptive studies; case series, case reports</div></li><li class="half_rhythm"><div>Mixed method study designs</div></li></ul></p>
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</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Countries</td><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Timepoints</td><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other exclusions</td><td headers="hd_h_niceng188er2.app2.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng188er2app2tab2"><div id="niceng188er2.app2.tab2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK567266/table/niceng188er2.app2.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng188er2.app2.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng188er2.app2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Criteria</th><th id="hd_h_niceng188er2.app2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Notes</th></tr></thead><tbody><tr><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</td><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">People experiencing symptoms or clusters of symptoms (ongoing physical and mental health) continuing after 12 weeks from the onset of acute COVID-19</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interventions/service configuration/information and support [delete/amend as appropriate]</td><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparators</td><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</td><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Prevalence of symptoms or clusters of symptoms (ongoing physical and mental health) reported 12+ weeks following onset of acute COVID-19 including, but not limited to:</p>
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<p>Signs and symptoms:
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<ul><li class="half_rhythm"><div>Respiratory symptoms such as chronic cough, shortness of breath, cardiovascular symptoms, and disease such as chest tightness, tachycardia, palpitations, protracted loss or change of smell and taste</div></li><li class="half_rhythm"><div>Mental health problems including but not limited to depression, anxiety and PTSD symptoms and cognitive difficulties</div></li><li class="half_rhythm"><div>Neuropsychiatric or psychiatric symptoms</div></li><li class="half_rhythm"><div>Neurological symptoms including weakness, numbness, continuing headaches, seizures, cognitive symptoms visual loss, autonomic symptoms, vestibular symptoms</div></li><li class="half_rhythm"><div>Myalgia or joint pain</div></li><li class="half_rhythm"><div>Evidence of end organ damage across a range of organs</div></li><li class="half_rhythm"><div>Gastrointestinal disturbance with diarrhoea</div></li><li class="half_rhythm"><div>Fatigue, weakness and sleeplessness</div></li><li class="half_rhythm"><div>Skin rashes</div></li><li class="half_rhythm"><div>Evidence of systemic inflammation conditions</div></li><li class="half_rhythm"><div>Autonomic conditions</div></li><li class="half_rhythm"><div>Respiratory conditions such as lung inflammation and fibrosis</div></li><li class="half_rhythm"><div>Cardiovascular conditions such as myocarditis and heart failure</div></li><li class="half_rhythm"><div>Liver and kidney dysfunction</div></li><li class="half_rhythm"><div>Clotting disorders and thrombosis</div></li><li class="half_rhythm"><div>Lymphadenopathy</div></li><li class="half_rhythm"><div>Neurological disorders including neuropathy</div></li></ul></p>
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</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Settings</td><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Subgroups</td><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
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<ul><li class="half_rhythm"><div>Groups as defined in the EIA for example, age, sex, ethnicity</div></li><li class="half_rhythm"><div>Diagnosis of COVID-19 (e.g. confirmed or high clinical suspicion)</div></li><li class="half_rhythm"><div>Duration of symptoms</div></li></ul></td></tr><tr><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study types</td><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<p>Any</p>
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<p>The following study design types for this question are preferred. Where these studies are not identified, other study designs will be considered.
|
|
<ul><li class="half_rhythm"><div>Systematic reviews of observational studies</div></li><li class="half_rhythm"><div>Prospective and retrospective observational studies</div></li><li class="half_rhythm"><div>Descriptive studies; case series, case reports</div></li><li class="half_rhythm"><div>Mixed method study designs</div></li></ul></p>
|
|
</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Countries</td><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Timepoints</td><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Any</td></tr><tr><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other exclusions</td><td headers="hd_h_niceng188er2.app2.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div></article><article data-type="fig" id="figobniceng188er2app4fig1"><div id="niceng188er2.app4.fig1" class="figure"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Image%20niceng188er2app4f1&p=BOOKS&id=567266_niceng188er2app4f1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img data-src="/books/NBK567266/bin/niceng188er2app4f1.jpg" alt="Image niceng188er2app4f1" class="tileshop" title="Click on image to zoom" /></a></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
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