Post-COVID-19, also known as long COVID, describes the symptoms that arise in some people in the weeks or months following a SARS-CoV-2 infection. A range of symptoms have been reported in both adults and children, with variation in the duration of symptoms and clinical history. Post-COVID-19 symptoms may be experienced by people who had either mild, moderate or severe COVID-19. Some symptoms subside gradually with self-directed care alone, while other symptoms may require care from a health professional, and new symptoms may arise over time.
The term ‘Post-COVID-19’ can be used to describe two things:
AND/OR
The most commonly used clinical definitions were developed by the WHO and the National Institute of Health Care and Excellence (NICE UK) and the Taskforce supports both these definitions of post-COVID-19.
Post-COVID-19 can feature differently in different people. It can include one symptom, or clusters of symptoms. More than 200 symptoms have been described in the literature. The most common are:
There are also secondary symptoms such as anxiety, which may arise as a result of the primary symptoms. Symptoms may fluctuate or relapse over time. The following groups of symptoms have been reported commonly by people with post-COVID-19:
Respiratory symptoms
Cardiovascular symptoms
Generalised symptoms
Neurological symptoms
Gastrointestinal symptoms
Musculoskeletal symptoms
Ear, nose and throat symptoms
Dermatological symptoms
Psychological symptoms (indicating depression, anxiety or posttraumatic stress disorder)
Patients who received care for COVID-19 in ICU may also experience symptoms of post-intensive care syndrome. Post-intensive care syndrome refers to one or more of the following symptoms that people experience following care in ICU:
Post-COVID-19 symptoms are reported more frequently in:
There are a number of theories and emerging data about what may cause post-COVID-19. For instance:
While there is research describing post-COVID symptoms, we do not have good evidence about what works to improve symptoms in people with long-COVID.
In the absence of this evidence, the Taskforce has developed the following key principles of care:
For some patients, clinicians may wish to highlight that the recovery journey may take months or longer but that the GP can provide them with the care and coordination that they might require.
For many patients, the impact of post-COVID-19 on their ability to work and earn a living or go to school is significant. Some patients may benefit from their GP’s advocacy with their patient’s workplace to find adjusted duties that can help the person recover and stay at work.
Currently there is no specific test or tool to diagnose post-COVID-19. However, there are three essential elements to consider:
COVID-19 vaccination may offer some protection against Post-COVID-19 as described below:
We await further data to demonstrate the influence of vaccination on post-COVID-19.
Recent data from the UK (Office of National statistics) indicate that about 30% of people who had the omicron variant also report post-COVID-19 symptoms. This is very early data.
There is no good data at this stage to determine if people are more or less likely to get post-COVID with repeat infections, or if the symptoms are better or worse.
Children can get post-COVID-19 but are less likely to do so than adults. The most frequently reported symptoms in children are tiredness and headaches.
Although there are some similarities in the presentation of post-COVID-19 and ME/CFS, further research is required to understand the underlying disease mechanisms of both conditions.
Both conditions are complex and not well understood, with the treatment guided by the predominant symptoms displayed.
Currently, there is very limited evidence to provide recommendations for the treatment of post-COVID-19. The next steps for evidence in the post-COVID-19 space include understanding:
Post-COVID-19 clinics are not widely available in Australia. Existing post-COVID-19 clinics are often associated with a hospital and consist of multidisciplinary care providers, including rehabilitation and some provide mental health care. Your Primary Health Network can identify post-COVID-19 clinics that may be suitable for patient referral. The RACGP website provides a list of current post-COVID-19 clinics in Victoria here.
To support clinicians around clinical decision making on the use of tocilizumab and baricitinib we have developed some responses to frequently asked questions:
Current evidence does not clarify whether an inability to switch to tocilizumab after commencing baricitinib will disadvantage patients who deteriorate with what mimics a cytokine release syndrome.
Current evidence suggests that baricitinib is effective at treating cytokine release syndrome in deteriorating patients with COVID-19. Evidence is not yet available to determine which of the two treatments is the most effective. In the absence of direct comparative data, the use of one treatment over the other cannot be supported; i.e although there is no evidence suggesting that baricitinib is as effective as tocilizumab, there is also no evidence suggesting that tocilizumab is as effective as baricitinib.
No clinical evidence of potential complications resulting from the use of tocilizumab following baricitinib in patients with COVID-19 has been identified. Investigators within the RECOVERY trial added baricitinib to their list of experimental treatments in February 2021. As part of their study design, they have not excluded the previous or concomitant use of tocilizumab in patients receiving baricitinib. It is unclear when results from this study will be published, however these data may clarify the safety and effectiveness following sequential and/or concomitant therapy.
At present, there is no standard clinical decision pathway regarding the management of patients who are commenced on baricitinib and continue to deteriorate. Discussions around optimal strategies should be conducted on a case by case basis and involve both infectious disease experts and intensivists.
The Taskforce has issued a strong recommendation against the use of hydroxycholorquine:
Do not use hydroxychloroquine for the treatment of COVID-19.
This recommendation applies to adults, children and adolescents, pregnant and breastfeeding women, older people living with frailty and those receiving palliative care.
For more information refer to the full hydroxychloroquine recommendation with evidence profiles and references.
Twenty two randomised trials which compared hydroxychloroquine with standard care in over 10,600 patients.
The Taskforce uses only the best available evidence when developing recommendations. For drug treatments, this means randomised controlled trials conducted in humans, with comparison to placebo or standard treatment. There are currently 22 randomised trials available which meet these criteria. The evidence team continues to perform daily searches as new studies emerge.
The Taskforce has issued a strong recommendation against the use of ivermectin (v56.0 8/4/2022):
Do not use ivermectin for the treatment of COVID-19.
This recommendation applies to adults, children and adolescents, pregnant and breastfeeding women, older people living with frailty and those receiving palliative care.
Use of ivermectin may still be considered in the context of randomised trials with appropriate ethical approval, such as combination therapies that include ivermectin.
For more information, view the full ivermectin recommendation with evidence profiles and references.
The Taskforce uses a living evidence approach to all its treatment recommendations. Ivermectin remains a high priority topic and any new relevant high-quality studies will be incorporated into the evidence underpinning the recommendation.
The available research evidence suggests that ivermectin does not decrease mortality, the need for mechanical ventilation or the need for hospitalisation in people with COVID-19.
In addition, ivermectin has not been shown to accelerate time to recovery or reduce duration of hospitalisation however it probably increases the incidence of adverse events. Common side effects and harms associated with ivermectin include diarrhoea, nausea and dizziness.
The certainty of the remaining outcomes varies from low to very low depending on which outcome is being measured; as a result of serious risk of bias and serious imprecision.
Given the lack of benefit, and concerns of harms; the Taskforce recommends against using ivermectin to treat COVID-19.
Evidence underpinning the current recommendation comes from 17 randomised trials that compared ivermectin with standard care in 3700 adults with COVID-19.
The Taskforce previously recommended that ivermectin only be used in the context of randomised controlled trials, as the effectiveness of ivermectin was uncertain, however the results of the TOGETHER trial provide increased certainty that ivermectin is not effective as a treatment for COVID-19.
The Taskforce considers trials of treatment conducted anywhere in the world, regardless of healthcare setting or phase of treatment.
We only include studies conducted in humans, where participants are randomised to receive ivermectin or standard treatment/placebo.
View our Taskforce search methods for further detail.
The Taskforce uses only the best available evidence when developing recommendations. For drug treatments, this means randomised controlled trials conducted in humans, with comparison to placebo or standard treatment. There are currently 17 randomised trials available which meet these criteria and evaluate the effectiveness of ivermectin for treatment of COVID-19.
While some websites appear to list dozens of ivermectin studies, many of these are not conducted in humans, are not randomised, do not compare to standard treatment or placebo, or combine ivermectin with another treatment (e.g. ivermectin plus doxycycline); making these studies significantly less reliable in evaluating the effectiveness of ivermectin.
In addition, a number of trials have been discredited, retracted or found to be inconsistent and subsequently removed from our analysis.
Yes, we are aware of the ivermectin arm of the Oxford PRINCIPLE Trial however we are unsure when results will be made available.
In the meantime, the Taskforce continues to undertake daily evidence surveillance and will incorporate all reliable research into our evidence profile for ivermectin as it emerges. We are also in frequent communication with international expert guideline groups.
The Taskforce and its 35-member organisations unanimously support vaccination as the best protection against serious illness or death from COVID-19.
Please refer to the Australian Technical Advisory Group on Immunisation (ATAGI) for specific vaccination advice.
For further information you can also go to the Commonwealth Department of Health website or refer to the National Centre for Immunisation Research and Surveillance (NCIRS) COVID-19 resources.
Taskforce partner NPS MedicineWise have developed a COVID-19 glossary to help consumers understand terms often used only by health professionals and other types of researchers.
Please send your question to [email protected]