The Health Information and Quality Authority (HIQA) in Ireland has published its international review of clinical guidelines and models of care for the diagnosis and management of long Covid.

HIQA carried out this review at the request of the Health Service Executive (HSE) to inform the HSE’s interim model of care for long Covid.

The World Health Organization (WHO) defines long Covid as the continuation or development of new symptoms three months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least two months with no other explanation.


Long Covid symptoms, which may be quite debilitating, vary greatly from person to person. The range of symptoms can include breathlessness, cough, brain fog, headache, sleep disturbance, pins and needles, numbness, dizziness, fatigue, abdominal pain, nausea and vomiting, diarrhoea, weight loss, reduced appetite, chest pain, chest tightness and palpitations, among others.

In some individuals symptoms respond spontaneously; in others symptoms persist. Long Covid has affected many people; the UK estimated that, in October 2022, 3.5% (approximately 2.3 million individuals) of the population were living with long Covid, with about one in five having symptoms for over two years.

HIQA reviewed 24 guidelines and two models of care from international, national and regional authorities. These documents highlight that the evidence base on how to diagnose and or treat long Covid is as yet only developing. As a result, countries differ in how they define long Covid with most guideline recommendations noted to be conditional or based on expert opinion. As more evidence is published, the approaches to treatment and management may change. The dynamic nature of this area can be seen from the many updates to guidelines that are occurring.

In Ireland, the HSE’s interim model of care for long Covid has proposed a three-pillar approach: patient-led rehabilitation and recovery; general assessment, support and rehabilitation; and specialist assessment, support and rehabilitation.

Máirín Ryan, HIQA’s director of health technology assessment, said: “We found that most guidelines are recommending a holistic, person-centred approach to diagnosis, management and treatment, with an emphasis on shared decision-making, which is consistent with the HSE’s interim model of care. It’s clear from this international review that we are at an early stage of understanding long Covid and that the recommendations will change as more evidence becomes available particularly in relation to safe and effective treatments.”

Ryan continued “Long Covid can affect a person’s ability to carry on with their normal daily activities. Currently long Covid guidelines focus on management of the wide array of symptoms. The best way to avoid long Covid is to avoid SARS-CoV-2 infection.”

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