Long Covid YP

 Below is a practical clinical management algorithm for Long COVID in children, adolescents, and young adults, aligned with guidance from World Health Organization and NICE, and adapted for real-world outpatient care.

Long COVID Management Algorithm (Young People)

1. 

Identify Possible Long COVID

Trigger:

• History of confirmed or probable SARS-CoV-2 infection
• Symptoms ≥ 4–12 weeks post-infection
• Symptoms impact daily functioning (school, social, physical)

Common symptoms in young people

• Fatigue / post-exertional symptom exacerbation (PESE)
• Brain fog, poor concentration
• Headache
• Breathlessness, chest pain
• Palpitations, dizziness (possible dysautonomia/POTS)
• Anxiety, low mood, sleep disturbance
• Abdominal pain, nausea

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2. 

Initial Clinical Assessment

A. Red flag screen (urgent referral if present)

• Persistent hypoxia, syncope
• Chest pain with exertion
• New focal neurological signs
• Significant weight loss
• Severe mental health risk

B. Baseline evaluation

• Full history (pre-COVID health, school attendance, activity tolerance)
• Physical exam (cardio-respiratory, neuro, orthostatic vitals)
• Consider baseline tests only if clinically indicated:
  
• FBC, CRP/ESR
• Ferritin, B12, folate
• TFTs
• Vitamin D
• ECG (if palpitations/chest pain)
• 
  

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3. 

Exclude Alternative or Contributing Diagnoses

• Anaemia
• Thyroid disease
• Asthma relapse
• Anxiety/depression as sole cause
• Deconditioning alone (important: may coexist but not primary)

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4. 

Confirm Long COVID (Working Diagnosis)

Diagnosis is clinical

→ No single confirmatory test

→ Symptoms may fluctuate and relapse

Provide validation:

“Your symptoms are real, recognised, and commonly improve over time.”

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5. 

Phenotype the Presentation

(Management is phenotype-led)

A. Fatigue-dominant ± PESE

B. Cognitive-dominant (brain fog)

C. Respiratory-dominant

D. Autonomic-dominant (POTS-like)

E. Mental health overlay

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6. 

Core Management (All Patients)

A. Education & Self-Management

• Explain energy envelope / pacing
• Avoid graded exercise therapy if PESE present
• Symptom diary
• Relapse prevention planning

B. School / College Support

• Reduced timetable
• Rest breaks
• Remote learning if needed
• Exam accommodations

C. Lifestyle

• Sleep regularity
• Nutrition and hydration
• Gentle, symptom-limited activity only

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7. 

Targeted Symptom Management

Fatigue / PESE

• Strict pacing
• Occupational therapy input
• Avoid “push through”

Cognitive symptoms

• Cognitive pacing
• Short focused tasks
• Screen breaks

Breathlessness

• Breathing pattern retraining
• Physiotherapy (NOT fitness-driven)

Autonomic symptoms (POTS-like)

• Fluids 2–3 L/day
• Salt increase (if appropriate)
• Compression garments
• Slow position changes
• Consider specialist referral if severe

Mental health symptoms

• Psychological support (CBT-informed, not curative)
• Treat anxiety/depression if present, but not as sole explanation

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8. 

Follow-Up & Monitoring

• Review every 6–12 weeks
• Track:
  
• Function (school attendance)
• Fatigue severity
• PESE frequency
• 
  
• Adjust plan based on relapses

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9. 

Specialist Referral (If Needed)

• Multidisciplinary Long COVID clinic
• Paediatric cardiology (persistent palpitations/syncope)
• Respiratory or neurology if focal signs
• Adolescent medicine / rehabilitation

Key Principles for Young People

• Recovery is often slow but positive
• Relapses are common and not failure
• Over-medicalisation should be avoided
• Function and quality of life matter more than test results

If you want, I can:

• Convert this into a one-page flowchart
• Adapt it for primary care vs specialist clinics
• Tailor it specifically for school-aged children vs adolescents
• Add a PESE-safe return-to-school plan

Just tell me how you plan to use it.