The Cheshire and Merseyside Long COVID Assessment Hub

The NHS has invested £10 million to meet the additional demand created by ongoing COVID-19 symptoms in a proportion of the population. This investment will help local services in every part of the country bring together the right professionals to provide physical, cognitive and psychological assessments for those experiencing suspected post-COVID syndrome (Long COVID), so that they can be referred to the right support.

Long COVID, or post-COVID syndrome is not one condition. The term Long COVID is commonly used to describe signs and symptoms that continue or develop after acute COVID‑19. It includes both ongoing symptomatic COVID‑19 and post‑COVID‑19 syndrome (defined below).

It is estimated that 1 in 10 people with COVID will develop long COVID symptoms.

The Cheshire and Merseyside Long COVID Service is a virtual assessment hub for adults 18 years and older who have had COVID (clinical or laboratory diagnosis) with symptoms persisting for more than 10 weeks.

It is a NHS England commissioned regional service provided by Liverpool University Hospitals NHS Foundation Trust and is based at the Aintree Hospital site. The service is led by three respiratory consultants; Dr Gurinder Tack, Dr Laura Watkins and Dr Nneka Nwosu with a team of clinical fellows, physicians associates and administrative support.

The service has been operation since January 2021 and currently receives 15-20 referrals a day.

We offer onward referrals for community therapies to address; anxiety, breathlessness, mood disturbance, memory and cognition (problem solving) changes.

After assessment onward community referrals options are;

Pulmonary rehab –specifically designed for patients with long COVID symptoms
Psychology support – talking therapies ( IAPT )or psychology virtual appointment
Community therapies – speech and language therapies (SALT), occupational therapists (OT) and dietetics
English National Opera Breathe Programme - breathing and wellbeing programme.

We are working with different providers to expand our onward referral options.

We do not:

Assess patients with COVID symptoms present for less than 10 weeks
Act as routine follow-up post hospital admission
Assess patients with single organ disease secondary to COVID
Operate as a diagnostic service
Offer any X-ray, blood or breathing tests
Manage loss of smell or taste
Assess patients coughing up blood.

Assess patients with abnormal chest X-rays or CT scans
Manage rashes, earache or diarrhoea due to Long COVID
See patients outside of Cheshire and Merseyside
Accept patient self-referrals.

NICE COVID-19 definitions 2020

Signs and symptoms of COVID-19 for up to four weeks.

Signs and symptoms of COVID-19 from four to twelve weeks.

Signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than twelve weeks and are not explained by an alternative diagnosis.

Common Long COVID symptoms

Extreme tiredness (fatigue)
shortness of breath
chest pain or tightness
problems with memory and concentration ("brain fog")
difficulty sleeping (insomnia)
heart palpitations
dizziness
pins and needles
joint pain
depression and anxiety
tinnitus, earaches
feeling sick, diarrhoea, stomach aches, loss of appetite
a high temperature, cough, headaches, sore throat, changes to sense of smell or taste
rashes.

Service Pathway

Step 1: Patient self-management

COVID symptoms for less than 10 weeks.

Please access: www.yourcovidrecovery.nhs.uk

A NHS England website providing general information on all aspects of recovering from COVID-19 including physical, emotional and psychological wellbeing, advice on recovery and information for families and carers.

Step 2: GP review

COVID symptoms for 10 weeks or longer.

Patients to see their own GP to ensure there is not an alternative diagnosis for your symptoms.

The GP will be required to:

Perform a face to face review and examination
Request investigations (blood tests, heart tracing and chest Xray).

Step 3: Long COVID Assessment Hub 1^st Virtual appointment

Virtual (telephone or video) 45 minute appointment speaking to one of our clinical team members.

Soon to be supported by a phone based app.

Decision made about referral to appropriate onward community based services or patient is discharged.

Step 4: Onward community referrals

Virtual or face to face reviews in patient’s local area by the relevant teams.

If Long COVID symptoms resolve the community team can discharge the patient from the Cheshire and Merseyside Long COVID Assessment Hub.

Step 5: Long COVID assessment hub 2nd Virtual appointment

Virtual 30 minute appointment to assess improvement of symptoms.

All patients will be discharged at this point:

Symptoms fully resolved discharge back to GP
symptoms ongoing we will give recommendations to the patient’s GP for referral to their local relevant hospital specialist.

Important points

If you were admitted to hospital with COVID-19 please await your local hospital follow up before requesting to be referred to into The Cheshire and Merseyside Long COVID Assessment Hub
A hospital consultant specialist can refer you into our service.

Further help

Loss of smell and taste

The loss of smell and taste is one of the recognised symptoms of COVID-19

Just over half of patients with the virus will lose their sense of smell, but most will recover smell and taste after two or three weeks.

Unfortunately, one in ten people who lose their sense of smell will have persistent smell loss which can last at least eight weeks, but commonly lasts for many months.

We do not manage loss of smell or taste within the Long COVID Assessment Hub.

Patients can be directed to:

https://www.yourcovidrecovery.nhs.uk/ to access information about smell training
abscent.org this website aims to “help people experiencing sense of smell loss (anosmia) to understand the condition, find support, and retrain their smelling (olfactory sense). It is supported by ENT UK and British Rhinological Society.