![]() ![]() By, there were over 4 million confirmed cases worldwide with over 280 000 deaths. 1 The highly transmittable virus spread rapidly and on 11 March 2020, coronavirus disease 2019 (COVID-19) was declared a global pandemic by the World Health Organisation. The first reports of a novel respiratory virus which was subsequently shown to be a coronavirus, severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), emerged from Wuhan, China in December 2019. For all patients, we suggest a holistic package of care to address breathlessness, anxiety, oxygen requirement, palliative care and rehabilitation. To mitigate NHS pressures, virtual solutions have been embedded within the pathway as has safety netting of patients whose clinical trajectory deviates from the pathway. We define two separate algorithms integrating disease severity, likelihood of long-term respiratory complications and functional capacity on discharge. In this guidance document, we provide a suggested structure for the respiratory follow-up of patients with clinicoradiological confirmation of COVID-19 pneumonia. There is a need for a unified pathway for the respiratory follow-up of patients with COVID-19 balancing the delivery of high-quality clinical care with stretched National Health Service (NHS) resources. With the pattern of thoracic imaging abnormalities and growing clinical experience, it is envisaged that interstitial lung disease and pulmonary vascular disease are likely to be the most important respiratory complications. The long-term complications of COVID-19 pneumonia are starting to emerge but data from previous coronavirus outbreaks such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) suggest that some patients will experience long-term respiratory complications of the infection. The overwhelming majority of patients admitted to hospital have respiratory failure and while most are managed on general wards, a sizeable proportion require intensive care support. COVID-19 is also associated with an increased risk of hypercoagulability and venous thromboembolism. The most severely affected patients are older men, individuals of black and Asian minority ethnicity and those with comorbidities. The COVID-19 pandemic has led to an unprecedented surge in hospitalised patients with viral pneumonia. 13 Aintree University Hospitals NHS Foundation Trust, Liverpool, UKĭr Peter M George, Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK p. ![]() 12 Department of Anaesthetics, Pain Medicine & Intensive Care, Imperial College London, London, UK.11 Intensive Care Unit, Queen's University Belfast, Belfast, UK.10 Centre for Respiratory Research, University of Nottingham, Nottingham, UK.9 Lane Fox Respiratory Service, Guy’s & St Thomas’ NHS Foundation Trust, London, UK.8 Department of Respiratory Medicine, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK.7 Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne, UK.6 Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.5 Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.
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