Useful information for doctors and those treating patients

You will find a range of clinics with a specialisation for Long COVID in the Service area, where you can search for offers in your neighbourhood for your patients.

Last update: June 2023

Guidelines, consensus papers

The S1 guideline Long/Post-COVID offers detailed information on diagnostics and treatment of Long COVID patients. The guideline also illuminates on the aspects of rehabilitation. It is what is called as a living guideline, which is reviewed and updated annually. It was created in an interdisciplinary collaboration by multiple medical societies. The corresponding Patient guideline Long/Post-COVID syndrome can be issued as an information leaflet to long haulers and their relatives, loved ones and caregivers.

In November 2022, NICE, the National Institute for Health and Care Excellence in Great Britain published a revised guideline (Rapid Guideline) with recommendations for diagnosis, treatment, and multidisciplinary rehabilitation of Long COVID in adults, children, and adolescents.

A consensus paper was formulated for the standard basic care of children and adolescents in collaboration with multiple societies of pediatricians. An S2k guideline for diagnosis and therapy of Long COVID in childhood and adolescence is registered and shall be completed in December 2023.

The Deutschen Gesellschaft für Neurorehabilitation e. V. [German Society for Neuro-rehabilitation] (DGNR) has issued an S2k guideline SARS-CoV-2, COVID-19 and (Early-)Rehabilitation, which looks at aspects of rehabilitation in Long COVID patients.

The S2k guideline on Neurological Manifestations in COVID-19, which was issued by the German Society for Neurology (DGN), is specifically pursuing the treatment options for symptoms of the nervous system. This guideline also discusses the possibilities of neurological rehabilitation.

Other guidelines can also offer assistance. In the current revised S3 guideline Tiredness, the German Society for General Medicine and Family Medicine (DEGAM) Chapter 5.7 contains information on Myalgic Encephalomyelitis or Chronic Fatigue Syndrome (ME/CFS). The guideline is also available as a patient guideline.

Advanced multimedia training

Moreover, there are advanced training, which aid knowledge sharing on Long COVID in the medical circles. In this way, the Post-COVID Network of the Charité – Medical University of Berlin offers a monthly advanced training series on Long COVID. Every advanced training course consists of the presentation by an expert and a subsequent case study with all the participants. Interested parties also have the option to propose a case presentation at the time of registration. The records of previous events can be viewed in the archive.

The presentations from the 1st Congress of the Doctor’s Association on Long COVID from November 2022 were also recorded and are freely available.

Further information can also be found at the Robert Koch Institute. It provides scientifically substantiated information on Long COVID on its info portal. 

Long COVID guideline of the Federal Joint Committee

On 21 December 2023, the Federal Joint Committee (G-BA) adopted a new guideline for faster and more needs-based care for patients with suspected Long COVID. This Long COVID guideline defines requirements for care and describes so-called care pathways, i.e. the course of medical treatment.

A medical contact person is envisaged. This person will be responsible for the specific coordination required for diagnosis and treatment. In this way, the existing outpatient structures and services are utilised according to the severity and complexity of the illness and the right healthcare professionals are involved.

Overview of guidelines and training courses:

Guidelines

S1 guideline Long/Post COVID

Patient guideline Long/Post COVID Syndrome 

NICE: COVID-19 rapid guideline: managing the long-term effects of COVID-19

Consensus paper Standard basic cared of children and adolescents with Long COVID

S2k guideline SARS-CoV-2, COVID-19 and (Early-)Rehabilitation 

S2k guideline Neurological Manifestations in COVID-19

S3 guideline Tiredness by the German Society for General Medicine and Family Medicine (DEGAM)

Advanced multimedia training

Records of the events of Post COVID network of the Charité - Medical University of Berlin

Records of presentations from the 1st Congress of the Doctor’s Association on Long COVID

Also consider our information specifically for employees and employers. Under the heading “Things to know about Long COVID in professional context”, you will find information and points of contact on topics such as Long COVID as accident at work, loss of profession due to Long COVID, Long COVID in work routine and going back to work.

Long COVID guideline of the Federal Joint Committee

Decision text

Last update: February 2024

We still do not have answers to many of the questions on the cause and progression of Long COVID. There is no uniform treatment of Long COVID as yet. Among other things, this is due to the fact that the illness can be accompanied with many different symptoms. These symptoms can resemble one another in part. However, their progression and characteristic can greatly differ individually. Different healing professions have to collaborate to adequately treat Long COVID. Continuous care is necessary and the collaboration of various medical disciplines is needed for this purpose.

There have been no treatments until now, which counter the disease development (“causal therapy”). The treatment concepts until now aimed at alleviating the symptoms (“symptomatic therapy”). In many cases, the symptoms become weaker or disappear on their own over time. In other cases, they change, return or even become stronger. An early treatment can also be helpful so that long lasting symptoms do not develop.

The family doctor’s clinic is the first point of contact. The family doctor either treats the long haulers himself or refers them to a specialist practice. At present, various treatment approaches are used in Long COVID. These include:

• a breathing therapy, for example, for treating shortness of breath,
• a logaoedic treatment, which can be helpful in dealing with problems in swallowing and speech,
•  a sports therapy to train capacity and rebuild physical endurance (Attention: In case of a stress intolerance, the symptoms can become intensified by physical activity. For this purpose, also read the question “What about graded exercise therapy and ME/CFS?”), Pacing can be a helpful strategy if everyday activity deteriorates due to exercise intolerance: "What is pacing?"
• a physiotherapy or remedial gymnastics, which is useful in severely limited mobility,
• ergotheray (e.g. stress training or brain performance training),
• a psychotherapeutic or supplementary psychiatric treatment, which can support in psychological problems,
• nutritional therapy, if required,
• intake of specific medicinal products,
• regular check-ups to monitor the symptoms over time and adapt the treatment methods,
• various rehab offers for long haulers. 

Medications can also be used depending on the symptoms. These can help, for example, in alleviating severe circulatory disorders or sleep disturbances. In principle, the respective doctor shall agree upon the treatment options together with the patient. While doing so, healthcare professionals should always take into consideration the latest medical knowledge and obligation of medical due diligence. The treatment should also be done according to prudent discretion. Overall, further research is still needed to understand the exact cause of Long COVID and find out which treatments and medications are effective. Until then, the goal is to alleviate the individual symptoms.

Last update: October 2023

Post COVID (U09.9) is nationally recognised as a special prescription requirement in provision of remedies. This means that medically necessary physiotherapy or ergo-therapy can be prescribed by the attending doctor without the resulting prescription costs straining the practice’s budget. The required remedy can be prescribed for a period of 12 weeks depending on the prescription. The same applies for psychological symptoms due to long-term effects of Corona infection; a prescription can also be issued by the affiliated psychotherapists here. The National Association of Statutory Health Insurance Physicians (KBV) provides information on the performance audit and billing of diagnostics and therapy of Long COVID as well as administrative procedure.

The KBV has provided a common diagnosis list for long-term remedy and special prescription requirements on its website:

https://www.kbv.de/media/sp/Heilmittel_Diagnoseliste_Webversion.pdf

Last update: June 2023

The cause of Long COVID is not clear as yet. Different aspects appear to play a role, which need to be researched. These include biological factors and factors concerning the immune system as well as potential psychosomatic factors.

Psychosomatic interactions are interactions between the mind and the body. Psychological symptoms can lead to physical illnesses or favor them. For example, current or earlier stress factors can have an impact on the body. But your own personality, expectations as well as psychological illnesses such as depression or anxiety disorders can also have an effect on physical symptoms. It is a challenge in Long COVID also to gauge the interactions between physical and psychological processes.

For example, an article appeared in the journal Psychosomatic Medicine in April 2021. The article describes how psychological, social, and cultural factors as well as environmental influences can influence the progression of a COVID-19 illness. The article underlines the importance to regard the illness not just purely biologically, but also consider other factors.

But very little is known as yet about the role of psychosomatic aspects in Long COVID.

It is most important for medical practice to take the symptoms of long haulers seriously. It applies here to regard the patients from all points of views and treat them accordingly. Not only the biological aspects, but the psychological and social aspects also have to be considered. Independent of the causes of illness, a psychotherapy can have a positive impact on coping with Long COVID and its progression.

Last update: June 2023

The important focus points of the German and international research on Long COVID are currently on the following areas.

• potential risk and protection factors (prevention)
• The spread of Long COVID as well as specially affected population groups (epidemiology)
• individual and social impacts of Long COVID on the quality of life, functionality, incapacity of work, and healthcare requirements (healthcare research)
• Detection of a clinical pattern, causes of the disease and disease progression (pathogenesis)
• Indications and health problems (symptoms)
• Options for assessment of Long COVID (diagnostics)
• Options of therapeutic technique (clinical research on therapy options and rehabilitation research)
• uniform disease definition and case definition of Long COVID or Post COVID

As the pathology is still relatively new, research into it is still in its infancy. For example, attempts are being made to clarify the exact causes and risk factors of the disease and further treatment options are being researched. The Robert Koch-Institut (RKI) in its questions and answers provides information on a number of current research projects, among other things.

An overview of scientific publications can be found in our service area. The latest publications are added there every month.

Last update: October 2023