GP EDUCATION

Long COVID in 10 minutes

Practical management for busy GPs

SAFETY PHENOTYPE FUNCTION ACTION CONTINUITY

Dr Jenny C M Huang
Co-Director, Geelong Long COVID Clinic. Deputy Chair, RACGP ELPIC SIG
17 September 2026

Immunology: A Space Opera Beneath the Skin, an illustrated comic strip mapping body systems to a war narrative

Illustration by A/Prof Bernard Shiu with AI, concept by Dr Jenny C M Huang

AUDIENCE POLL

Start with the consult you find hardest

A

Is this Long COVID, or something else?

B

What activity advice is safe?

C

What can I actually offer?

D

When and where should I refer?

COMPOSITE CASE · ALEX, 42, TEACHER

One patient. Ten symptoms. Ten minutes.

"Since COVID six months ago, I'm exhausted, foggy, dizzy standing, breathless on stairs, and I crash after trying to catch up."

What must you establish today?

What can safely wait?

What would change your advice?

Pair discussion, 60 seconds. Your first move?

THE 10-MINUTE RULE

A short consult needs a repeatable sequence

1

Safety

Anything dangerous today?

2

Phenotype

What drives disability?

3

Function

What is sustainably possible?

4

Action

One useful intervention.

5

Continuity

What happens next?

The goal is structured longitudinal care, not solving the syndrome today.

VISIT ONE

Consult 1: safety, pattern and a plan

0 TO 2 MIN

Red flags

Do not attribute acute danger to Long COVID.

2 TO 5 MIN

Two priorities

"Which two symptoms interfere most?"

5 TO 7 MIN

Function

Compare pre-COVID with sustainable function now.

7 TO 9 MIN

Targeted tests

Exclude plausible alternatives, follow symptoms.

9 TO 10 MIN

One action

Name the next step and book continuity.

"We'll work through this systematically."

SAFETY FIRST

Red flags: when this is not routine Long COVID

Name a finding that would change today's pathway.

SAFETY FIRST · PROMPTS

Red flags: when this is not routine Long COVID

Severe or new chest pain

Worsening dyspnoea or hypoxaemia

Syncope or new focal neurology

Marked tachycardia or arrhythmia

Thromboembolic features

Severe psychiatric risk

Not an exhaustive list. Investigate or refer according to the presenting problem.

PATTERN RECOGNITION

Two questions can change management

PESE / PEM

"After more physical or mental activity than usual, are you significantly worse later that day, or over the next day or two?"

Orthostatic intolerance

"Are you worse upright, dizzy, weak, shaky, breathless, palpitations or foggy in the head, and better lying down?"

Either answer can change assessment, rehabilitation and work advice.

THE QUESTION THAT CHANGES MANAGEMENT

PESE changes the activity prescription

During activity

Fine during activity.

Delay

12 to 72 hours later.

Then

Worse, disproportionately.

Ask: "What happens the next day?"

Look for disproportionate, delayed symptom worsening and prolonged recovery, not just tiredness during exertion.

EXERCISE IS NOT ONE-SIZE-FITS-ALL

Screen before prescribing activity

PESE present

Prioritise pacing and energy conservation. Reduce repeated crashes. Avoid fixed incremental graded exercise.

PESE absent

After excluding exertional desaturation and cardiac impairment, consider cautious symptom-titrated rehabilitation appropriate to the presentation.

Vote: which side does Alex belong on, and what evidence do you need?

PRACTICAL PHENOTYPING · CONSULT 2

Treat the dominant pattern

1

Energy-limiting

PESE, crashes, unrefreshing sleep.

2

Autonomic

Upright symptoms, palpitations, presyncope.

3

Cardiorespiratory

Dyspnoea, chest pain, desaturation.

4

Cognitive / neuro

Brain fog, headache, sensory symptoms.

5

Sleep / pain / mood

Treatable comorbid drivers and amplifiers.

Most patients occupy more than one row. Start with what drives disability.

ORTHOSTATIC INTOLERANCE · CASE TURN

Symptoms spike on standing

Alex's pulse is 74 lying down. After standing, symptoms reproduce and the pulse rises substantially.

A

Reassure: deconditioning explains it.

B

Document HR and BP and symptoms over time.

C

Start vigorous recumbent training today.

D

Explore medication, hydration and differentials.

Choose two actions.

TESTING

Use targeted investigations, not a blanket panel

Core referral data

FBE, U&E, LFT, medication history, pre-morbid and current function.

Symptom-directed

Fatigue: iron, ferritin, TSH, B12, folate. Cognition: TSH, B12, folate plus baseline. Cardiorespiratory: appropriate ECG, imaging, testing.

Pause before ordering

Will this test identify a plausible alternative, comorbidity or complication, and change management?

Normal conventional tests do not make disability trivial or psychological.

MANAGEMENT

'No cure' is not the same as 'nothing to offer'

1

Validate

Name the illness and acknowledge functional impact.

2

Target

Treat sleep, pain, migraine, asthma, reflux and mood when present.

3

Adapt

Pacing, cognitive strategies, orthostatic supports and work modification.

4

Coordinate

Use appropriate allied health and specialist input.

For off-label or online treatments: separate biological plausibility, early signals and routine-practice evidence.

LONGITUDINAL CARE

Build a 90-day plan across short visits

Today · Consult 1

Safe? Two priorities. Functional baseline. Targeted tests. One action.

Next · Consult 2

Review results. Confirm dominant patterns. Add symptom treatment. Work and ADL adjustments.

Ongoing · Reviews

Track sustainable function. Reduce crashes. Escalate or refer. Reconsider atypical course.

REFERRAL AND ALLIED HEALTH

Refer for the problem that needs help

Specialist / multidisciplinary

Persistent multi-system symptoms with significant functional impact. Worsening or unresponsive to management. Diagnostic uncertainty or significant organ-specific symptoms.

Dominant problem pathway

A single dominant symptom may fit the relevant specialty or rehabilitation service.

Refer with the patient's goal, infection timeline, pre-morbid and current function, medication list and relevant results. Ask: "What outcome are we seeking from this referral?"

RETURN TO WORK

Work plans need adjustable load

Move beyond "fit" or "unfit"

Hours

Cognitive load

Rest breaks

Location

Task complexity

Review date

Write restrictions in terms of sustainable capacity, not motivation.

DISCUSSION ROUND

Practise the answer before the patient asks

"Is this all anxiety?"

"Why are all my tests normal?"

"Should I push through?"

"Will I recover?"

"What about LDN, antihistamines or supplements?"

"Will another infection make me worse?"

Choose one. Let's practice answering together.

BEFORE YOU GO

What will you do differently in your next consult?

SAFETY → PHENOTYPE → FUNCTION → ONE ACTION → CONTINUITY

A question you will ask

A phrase you will use

A habit you will stop

Write one change. Share with a colleague. Then name the system change your practice needs: longer first visit, planned review, template, or referral map.

REVISIT THE OPENING POLL

Which problem now feels more manageable?

A

Is this Long COVID, or something else?

B

What activity advice is safe?

C

What can I actually offer?

D

When and where should I refer?

Continuity is an active part of care for this multi-systems condition.

REFERENCES

Clinical sources used in this session

Victoria

Statewide referral criteria: Advice on the management of Long COVID. Updated 26 May 2025.

WHO

Clinical management of COVID-19: living guideline, June 2025. Post-COVID condition rehabilitation recommendations.

Australia

National Post-Acute Sequelae of COVID-19 Plan, 15 February 2024.

NICE

NG188: Managing the long-term effects of COVID-19.

Educational material only. Apply clinical judgment, current guidance and local pathways to each patient.