PRACTICE

1 Nuffield Department of Primary Care PRACTICE POINTER B

Health Sciences, University of Oxford,
Oxford OX2 6GG, UK M

2 West Hertfordshire Hospitals NHS

Management of post-acute covid-19 in primary care J:
fir
Trust, Watford, UK
Trisha Greenhalgh, 1 Matthew Knight, 2 Christine A’Court, 1 Maria Buxton, 3 Laiba Husain1 st
3 West Hertfordshire Respiratory pu
Service – Central London Community What you need to know Box 1: A patient’s account bli
Healthcare, London, UK
My wife, kids, and I all had symptoms of sh
• Management of COVID-19 after the first
Correspondence to: T Greenhalgh presumed COVID-19 in early April 2020. ed
trish.greenhalgh@phc.ox.ac.uk three weeks is currently based on
They were soon fine, but I was more unwell as
Cite this as: BMJ 2020;370:m3026 • limited evidence and ended up in bed extremely fatigued, 10
http://dx.doi.org/10.1136/bmj.m3026 Approximately 10% of people experience lethargic, and without appetite for four .1
• prolonged illness after COVID-19
Published: 11 August 2020 days. 13
Many such patients recover The only person whose symptoms 6/
persisted was myself, and the fatigue
• spontaneously (if slowly) with holistic b
support, rest, symptomatic treatment, which I had experienced was still lingering mj
and gradual increase in activity in the background. From this point .m
• onwards, it became difficult to engage fully
Home pulse oximetry can be helpful in 30
in day to day activities with my normal
monitoring breathlessness 26
energy levels. Exercise, of which I do a fair
Indications for specialist assessment
on
amount, was not at all possible.
include clinical concern along with 11
I continued to feel like this for another
respiratory,
COVID-19 cardiac,
pasca-akut or neurological
("Long Covid") tampaknya Au
three weeks, before finally feeling
symptoms that are new, persistent, or gu
merupakan penyakit multisistem, kadang-kadang completely overwhelmed. This happened
progressive
terjadi setelah penyakit akut yang relatif ringan. 1 very quickly and without warning, resulting st
Penatalaksanaan klinis memerlukan perspektif seluruh in me heading for bed immediately as I felt 20
pasien.2 Artikel ini, ditujukan untuk dokter perawatan so bad. For the next 72 hours, I felt unwell 20
primer, berkaitan dengan pasien yang mengalami in a way that was bordering on not coping. .
pemulihan tertunda dari episode COVID-19 yang I was feverish, soaked with sweat to the D
point of having to regularly towel myself o
dikelola di komunitas atau di bangsal rumah sakit
down, and with a persistent headache that w
standar. Secara luas, pasien tersebut dapat dibagi had no relief in spite of increased doses of nl
menjadi mereka yang mungkin memiliki gejala sisa paracetamol or ibuprofen.
yang serius (seperti komplikasi tromboemboli) dan oa
My chest was painfully tight, and my de
mereka dengan gambaran klinis yang tidak spesifik, breathing was slightly erratic; I began to
seringkali didominasi oleh kelelahan dan sesak napas. d
experience a shortness of breath in random fro
Kebutuhan rehabilitasi spesialis kelompok ketiga, waves that didn’t leave me gasping for air
pasien COVID-19 yang penyakit akutnya m
but certainly made me uncomfortable and htt
membutuhkan perawatan intensif, telah ditanggung di very worried. My glands were swollen to
p:/
tempat lain.3 the point that it was physically challenging
to swallow, and this was only possible with
/w
Mendefinisikan covid-19 pasca akut severe discomfort. I felt physically w
exhausted, mentally drained, and, for the w.
Dengan tidak adanya definisi yang disepakati, first time in my life, began to consider b
untuk tujuan artikel ini kami mendefinisikan asking for additional help. mj
COVID-19 pasca akut sebagai melampaui tiga It was at this point that I noticed I had also .c
minggu sejak timbulnya gejala pertama dan not had any sense of smell for the past o
COVID-19 kronis sebagai melampaui 12 minggu. week, and this has continued to be the m/
Karena banyak orang tidak dites, dan tes negatif case since. on
palsu biasa terjadi,4 kami menyarankan bahwa tes Overall, I spent seven days feeling like I 11
positif untuk COVID-19 bukanlah prasyarat untuk had been knocked sideways. I rarely get Au
diagnosis unwell, and if I do it’s a fleeting fling with gu
something that is usually seasonal and st
Seberapa umum itu? easily self medicated. This felt very 20
Sekitar 10% pasien yang dites positif SARS-COV-2 different and was particularly challenging 20
VIRUS tetap tidak sehat setelah tiga minggu, dan as there were points during my sickness by
that I was completely overwhelmed. gu
proporsi yang lebih kecil selama berbulan-bulan
(lihat kotak 1).7 Ini didasarkan pada Studi Gejala As far as recovery goes, it has now taken a es
•full40seven
year old
toman, who
eight was previously
weeks to start feeling
COVID Inggris, di mana orang memasukkan gejala fit to my normal self again. In the t.
close
We also recommend recent articles by a Pr
yang sedang berlangsung pada aplikasi smartphone.
aftermath of this,
social scientist andI have continued
clinical to
academicwith
Persentase ini lebih rendah daripada yang dikutip ot
experience the following:
prolonged COVID-19 fatigued to the
symptoms.
dalam banyak penelitian observasi yang point of having to sleep in the day, inability
ec
dipublikasikan,8,9 yang populasi penyebutnya to exercise, continued shortness of breath te
adalah mereka yang dirawat di rumah sakit atau both motionless and when exerting, small
mengunjungi klinik spesialis. Sebuah penelitian di waves of anxiety, considerable depression,
AS baru-baru ini menemukan bahwa hanya 65% continued loss of smell. These are all post-
orang yang kembali ke tingkat kesehatan symptoms that I have had no experience or
medical history with, and so it has been
the bmj | BMJ 2020;370:m3026 | doi: difficult to wrestle with the 1
10.1136/bmj.m3026 unexpectedness of them.
 very difficult 12 WEEK cycle from start to
end.

PRACTICE

sebelumnya 14-21 hari setelah tes positif.10

2 the bmj | BMJ 2020;370:m3026 | doi:

10.1136/bmj.m3026
Mengapa beberapa orang bisa terjadi? Apa tes yang dibutuhkan?
Tidak diketahui mengapa pemulihan beberapa orang berlangsung Tes darah harus dilakukan secara selektif dan untuk indikasi
lama. Viremia persisten karena respons antibodi yang lemah atau B
klinis spesifik setelah anamnesis dan pemeriksaan yang cermat M
tidak ada,11 kambuh atau infeksi ulang,12 reaksi inflamasi dan reaksi (lihat infografis); pasien mungkin tidak membutuhkannya.
imun lainnya,13,14 dekondisi, dan faktor mental seperti stres pasca- J:
Anemia harus disingkirkan pada pasien sesak napas. fir
trauma15,16 semuanya dapat berkontribusi. Gejala sisa pernapasan,
Limfopenia adalah ciri COVID-19 akut yang parah. st
muskuloskeletal, dan neuropsikiatri jangka panjang telah dijelaskan
untuk virus korona lain (SARS dan MERS), 17-22 dan ini memiliki Peningkatan biomarker mungkin termasuk protein C reaktif pu
(misalnya, infeksi akut), jumlah sel darah putih (infeksi atau bli
kesamaan patofisiologis dengan COVID-19 pasca akut..23
respon inflamasi), peptida natriuretik (misalnya, gagal jantung), sh
Apa gejalanya? feritin (inflamasi dan status prothrombotik berkelanjutan), ed
troponin (sindrom koroner akut atau miokarditis) dan D-dimer as
Gejala COVID-19 pasca akut sangat bervariasi. Bahkan yang
(penyakit tromboemboli). Tes troponin dan D-dimer mungkin 10
disebut COVID-19 ringan dapat dikaitkan dengan gejala jangka
salah positif, tetapi hasil negatif dapat mengurangi .1
panjang, paling sering batuk, demam ringan, dan kelelahan, yang
ketidakpastian klinis. Penelitian lebih lanjut kemungkinan akan 13
semuanya dapat kambuh dan sembuh. 4,7 Gejala lain yang
menyempurnakan indikasi, dan interpretasi, tes diagnostik dan 6/
dilaporkan termasuk sesak napas, nyeri dada, sakit kepala,
kesulitan neurokognitif, nyeri otot dan kelemahan, gangguan pemantauan dalam tindak lanjut COVID-19. b
Untuk pasien yang tidak dirawat di perawatan intensif, panduan mj
pencernaan, ruam, gangguan metabolisme (seperti kontrol
diabetes yang buruk), kondisi tromboemboli, dan depresi dan British Thoracic Society tentang tindak lanjut pasien COVID- .m
19 yang memiliki penyakit pernapasan signifikan mengusulkan 30
kondisi kesehatan mental lainnya. 4,24 Ruam kulit dapat terjadi
dalam berbagai bentuk termasuk vesikuler, makulopapular, tindak lanjut komunitas dengan rontgen dada pada 12 minggu 26
dan rujukan untuk yang baru, persisten, atau gejala progresif. 26 on
urtikaria, atau lesi seperti chilblain pada ekstremitas (disebut
covid toe).25 Tampaknya tidak perlu merujuk atau menyelidiki hal 11
Bagi mereka dengan bukti kerusakan paru-paru (seperti
Au
ini jika pasien dalam keadaan sehat. pembacaan sinar X dan oksimeter dada abnormal yang
gu
persisten), rujukan ke layanan pernapasan direkomendasikan;
st
rujukan awal selanjutnya ke rehabilitasi paru mungkin
20
membantu pemulihan.recovery.
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Mendukung pemulihan dari covid-19 penyelidikan berlebihan. Demam, misalnya, dapat diobati sesuai ec
Setelah penagnagan komplikasi serius atau komorbiditas yang gejalanya dengan parasetamol atau non steroid te
sedang berlangsung, dan sampai hasil studi lanjutan jangka obat anti inflamasi. Pemantauan status fungsional pada pasien
panjang tersedia, pasien harus ditangani secara pragmatis dan COIVD-19 pasca akut belum merupakan ilmu pasti. Skala status
simtomatik dengan penekanan pada dukungan holistik sambil fungsional pasca-COVID-19 telah dikembangkan secara pragmatis
menghindari tetapi tidak
secara formal27 — versi yang disederhanakan direproduksi
dalam materi tambahan. saturations are normal and no other cause for dyspnoea is found
on thorough evaluation. An exertional desaturation test should be
B
Rujukan ke layanan rehabilitasi spesialis tampaknya tidak performed as part of baseline assessment for patients whose resting
diperlukan untuk kebanyakan pasien, yang dapat mengharapkan pulse oximeter reading is 96% or above but whose symptoms
M
peningkatan tingkat energi dan sesak napas secara bertahap, jika suggest exertional desaturation (such as light-headedness or J:
kadang-kadang berlarut-larut, dibantu dengan pengaturan waktu severe breathlessness on exercise). In the absence of fir
yang cermat, penentuan prioritas, dan penetapan tujuan yang contraindications, such patients should be invited to repeat the st
sederhana. Dalam pengalaman kami, sebagian besar tetapi tidak oximeter reading after 40 steps on a flat surface (if self testing pu
semua pasien yang tidak dirawat di rumah sakit pulih dengan remotely) and then after spending one minute doing bli
baik dengan empat hingga enam minggu latihan aerobik ringan 33 sh
sit-to-stand as fast as they can (if supervised on site). A fall of
(seperti berjalan atau Pilates), secara bertahap meningkatkan 3% in the saturation reading on mild exertion is abnormal and ed
intensitasnya sesuai toleransi. Mereka yang kembali bekerja 33 as
requires investigation.
mungkin memerlukan dukungan untuk menegosiasikan 10
Patients should be provided with a pulse oximeter and an
pengembalian bertahap. Kotak 5 tautan ke sumber daya pasien, 34 .1
termasuk panduan pasien komprehensif dari Rumah Sakit observations diary and given instructions for how to self monitor.
13
Universitas Homerton.28 Typically, this would be a daily reading taken on a clean, warm finger
6/
without nail polish, after resting for 20 minutes; the device should be
b
Gejala pernapasan dan dukungan left to stabilise and the highest reading obtained should be recorded.
While the range of commercially available oxygen saturation probes mj
Batuk from healthcare suppliers and pharmacies seem to work within .m
The British Thoracic Society mendefinisikan batuk kronis sebagai normal ranges (92% and above), smartphone apps that purport to 30
batuk yang berlangsung lebih dari delapan minggu.26 Hingga saat measure oxygen saturations using the phone camera and torch 26
35 on
itu, dan kecuali ada tanda-tanda infeksi super atau komplikasi lain should not be used.
seperti radang pleura yang menyakitkan, batuk tampaknya paling British Thoracic Society guidelines define the target range for oxygen
11
baik ditangani dengan latihan kontrol pernapasan sederhana 28 (lihat saturation as 94-98% and a level of 92% or below as requiring Au
kotak 2) dan pengobatan jika diindikasikan (seperti inhibitor supplementary oxygen (unless the patient is in chronic respiratory gu
pompa proton jika dicurigai refluks). 36
failure). In the context of a normal assessment (history, st
examination, and appropriate investigations) without red flags, an 20
Box 2: Breathing techniques oxygen saturation of 96% or above and the absence of desaturation 20
on exertional tests is very reassuring. Further investigation or referral .
About 80% of the work of breathing is done by the D
in the first six weeks after COVID-19 in such patients is rarely
diaphragm. After illness or general deconditioning, the
indicated, though regular support by telephone or video is likely to o
breathing pattern may be altered, with reduced
be appreciated. Oximeter readings persistently in the 94-95% range or w
diaphragmatic movement and greater use of neck and
below (indicating substantially farther down the oxygen-haemoglobin nl
shoulder accessory muscles. This results in shallow 37
breathing, increasing fatigue and breathlessness, and desaturation curve ) require assessment and investigation. The oa
higher energy expenditure. The “breathing control” patient should be provided with safety-netting advice (such as de
technique is aimed at normalising breathing patterns and contacting their general practice or NHS111) in the event of recurrent d
increasing the efficiency of the respiratory muscles low saturation readings. Appropriate adjustments should be made for fro
(including the diaphragm) resulting in less energy m
expenditure, less airway irritation, reduced fatigue, and htt
improvement in breathlessness. p:/
The patient should sit in a supported position and breathe B ox 3: Use of pulse oximetry in post-acute COVID-19 /w
in and out slowly, preferably in through the nose and out w
Hypoxia may reflect impaired oxygen diffusion and is a recognised
through the mouth, while relaxing the chest and w.
feature of COVID-19. It may be asymptomatic (so called silent
shoulders and allowing the tummy to rise. They should 29 b
aim for an inspiration to expiration ratio of 1:2. This hypoxia ) or symptomatic (reflecting increased work of breathing, or
mj
technique can be used frequently throughout the day, in secondary pathology such as a bacterial pneumonia or
thromboembolism). Oxygen saturation probes (pulse oximeters) have .c
5-10 minute bursts (or longer if helpful).
been used as part of a package of care for patients with COVID-19 and o
Other breathing techniques—such as diaphragmatic m/
breathing, slow deep breathing, pursed lip breathing, yoga are recommended as part of the assessment of acute COVID-19 in
national and local guidelines.
30 -32 on
techniques,
Sesak napasButeyko—are used in strategies to manage Pe 11
patients’ breathing patterns and breathlessness but Self monitoring of oxygen saturations over three to five days may
yang mulihan setelah penyakit parah yang melemahkan dapat berlangsung Au
require specialist
Tingkat sesak advice
napas sering terjadito identify
setelah which
COVID-19 technique
akut. Sesak napasbest
suits each patient. lama.38 Orang yang selamat dari sindrom gangguan pernapasan akut gu
parah, yang jarang terjadi pada pasien yang tidak dirawat di rumah sakit,
COVID-19 berisiko mengalami penurunan fungsi paru-paru dalam st
mungkin memerlukan rujukan segera. Sesak napas cenderung membaik
jangka panjang. 39-41 Penyakit paru-paru interstisial yang serius 20
dengan latihan pernapasan (kotak 2). Oksimeter denyut mungkin sangat
tampaknya jarang terjadi pada pasien yang tidak hipoksia, meskipun 20
berguna untuk menilai dan memantau gejala pernapasan setelah COVID-19,
data tentang hasil jangka panjang belum tersedia.42 by
dan kami tidak dapat menemukan bukti bahwa penggunaannya di rumah dapat
gu
meningkatkan kecemasan (kotak 3) Rehabilitasi Paru
es
Banyak pasien yang masih pulih secara spontan dalam enam t.
minggu pertama setelah COVID-19 akut dan umumnya tidak Pr
memerlukan jalur cepat untuk masuk ke program rehabilitasi ot
paru. Mereka yang memiliki penyakit pernafasan yang ec
signifikan dapat memperoleh manfaat dari rehabilitasi paru, te
yang didefinisikan sebagai “intervensi multidisiplin
berdasarkan evaluasi dan pengobatan yang dipersonalisasi
yang mencakup, tetapi tidak terbatas pada, pelatihan olahraga,
pendidikan, dan modifikasi perilaku yang dirancang untuk
meningkatkan kondisi fisik dan psikologis orang dengan
penyakit pernapasan. ”43 Dalam konteks COVID-19,
rehabilitasi dilakukan dengan berbagai model virtual,
termasuk kelas yang terhubung dengan video dan buklet
pendidikan rumah dengan dukungan telepon tambahan. Kami
menjelaskan salah satu program tersebut dalam materi
tambahan di bmj.com.
Kelelahan
Sifat kelelahan yang mendalam dan berkepanjangan pada beberapa
pasien pasca-akut COVID-19 berbagi fitur dengan sindrom
kelelahan kronis yang dijelaskan setelah infeksi serius lainnya
termasuk SARS, MERS, dan pneumonia yang didapat dari
komunitas.19 20 22 44 Kami tidak menemukan bukti penelitian yang
dipublikasikan tentang kemanjuran intervensi farmakologis atau
non-farmakologis pada kelelahan setelah COVID-19. Sumber daya
pasien tentang manajemen kelelahan 45 dan panduan untuk dokte
rkembali berolahraga 43 dan peningkatan kinerja atlet (kotak 4) 46 untuk antikoagulasi setelah keluar dari rumah sakit bervariasi,
pada COVID-19 saat ini semuanya didasarkan pada bukti tidak tetapi pasien dengan risiko lebih tinggi biasanya dipulangkan dari
langsung rumah sakit dengan tromboprofilaksis yang diperpanjang selama B
10 hari.57 Jika pasien telah didiagnosis dengan episode trombotik, M
Box 4: The sportsperson returning to exercise (summarised from Stanford-
antikoagulasi dan penyelidikan dan pemantauan lebih lanjut harus J:
Hall statement)
mengikuti pedoman standar.58 Tidak diketahui berapa lama pasien fir
• After recovery from mild illness: 1 WEEK of low level
tetap hiperkoagulasi setelah COVID-19 akut. st
stretching and strengthening before targeted
pu
Disfungsi ventrikel bli
• cardiovascular sessions Disfungsi sistolik ventrikel kiri dan gagal jantung setelah COVID- sh
Very mild symptoms: limit activity to slow walking or ed
19 dapat ditangani sesuai dengan pedoman standar.59 Latihan
• equivalent. Increase rest periods if symptoms kardiovaskular yang intensif harus dihindari selama tiga bulan as
worsen. Avoid high-intensity training
pada semua pasien setelah miokarditis atau perikarditis; atlet 10
• Persistent symptoms (such as fatigue, cough, disarankan untuk mengambil tiga sampai enam bulan istirahat total .1
breathlessness, fever): limit activity to 60% dari pelatihan kardiovaskular diikuti oleh tindak lanjut spesialis, 13
maximum heart rate until 2-3 weeks after symptoms dengan kembali ke olahraga dipandu oleh status fungsional, 6/
• resolve
biomarker, tidak adanya disritmia, dan bukti fungsi sistolik b
Patients who had lymphopenia or required oxygen ventrikel kiri normal.60 mj
need respiratory assessment before resuming .m
exercise Gejala sisa neurologis 30
Ada banyak perdebatan dan kontroversi tentang peran latihan
Patients who had cardiac involvement need cardiac Stroke iskemik, kejang, ensefalitis, dan neuropati kranial telah 26
bertahap dalam kelelahan kronis secara umum (lihat tanggapan
assessment before resuming dijelaskan setelah COVID-19, tetapi ini semua tampaknya jarang on
pasien terhadap ulasan Cochrane baru-baru ini 47) dan pada
terjadi.61 Pasien yang dicurigai mengalami komplikasi serius ini 11
COVID-19 khususnya (lihat pernyataan terbaru dari National
harus dirujuk ke ahli saraf. Gejala neurologis non-spesifik yang Au
Institute for Health and Care Excellence (NICE) 48). Menunggu
umum, yang tampaknya terjadi bersamaan dengan kelelahan dan gu
bukti langsung dari studi penelitian, kami menyarankan bahwa st
olahraga pada pasien tersebut harus dilakukan dengan hati-hati sesak napas, termasuk sakit kepala, pusing, dan kognitif tumpul
20
dan dikurangi jika pasien mengalami demam, sesak napas, ("kabut otak").4 Sampai panduan berbasis bukti muncul tentang
20
kelelahan parah, atau nyeri otot. Pemahaman, dukungan, dan bagaimana mengelola atau kapan merujuk gejala tersebut, kami
.
kepastian dari dokter perawatan primer merupakan komponen merekomendasikan manajemen suportif dan pemantauan gejala D
penting dari manajemen. dalam perawatan primer. o
Komplikasi kardiopulmoner, penilaian dan manajemen Pasien Lansia w
Mungkin 20% dari pasien yang dirawat dengan COVID-19 nl
COVID-19 cenderung mempengaruhi pasien yang lebih tua oa
memiliki keterlibatan jantung yang signifikan secara klinis 49 50; lebih parah.62 Mereka yang bertahan hidup berisiko tinggi
keterlibatan okultisme mungkin lebih umum. 51,52 Komplikasi de
mengalami sarcopenia, malnutrisi, depresi, dan delirium.2 d
kardiopulmonal termasuk miokarditis, perikarditis, infark Nyeri kronis pasca-COVID-19 dapat memengaruhi pasien dari
miokard, disritmia, dan emboli paru; mereka mungkin muncul fro
segala usia tetapi tampaknya lebih umum pada lansia pasien.63 m
beberapa minggu setelah COVID-19 akut. Mereka lebih umum Gejala fisik menambah dampak psikososial dari gangguan
pada pasien dengan penyakit kardiovaskular yang sudah ada htt
akses ke perawatan kesehatan (seperti pengaturan untuk p:/
sebelumnya, 49 tetapi mereka juga telah dijelaskan pada pasien mendapatkan pengobatan rutin), rutinitas pribadi CORE
muda yang sebelumnya aktif.43 53 54 Berbagai mekanisme /w
(seperti berjalan ke toko-toko lokal), interaksi sosial (seperti w
patofisiologis telah diusulkan, termasuk infiltrasi virus, bertemu teman), dan berbaring dan jaringan dukungan
peradangan dan mikrotrombi, dan penurunan regulasi ACE -2 w.
profesional.64 Dukungan harus dipersonalisasi dengan b
reseptor. 51 53 54 masukan dari tim multi-profesional (misalnya, dokter umum, mj
perawat distrik, pekerja sosial, tim rehabilitasi, dan terapis
Nyeri dada .c
okupasi sesuai kebutuhan) o
Nyeri dada sering terjadi pada COVID-19 pasca akut. Prioritas
Kesehatan mental m/
klinis adalah untuk memisahkan nyeri muskuloskeletal dan
on
nyeri dada non-spesifik lainnya (misalnya, gejala yang Sebagian besar publikasi tentang COVID-19 dan kesehatan mental 11
dijelaskan oleh survei besar yang dipimpin pasien sebagai telah menekankan reaksi individu terhadap pandemi seperti kumpulan, Au
"luka bakar paru" 4) dari kondisi kardiovaskular yang serius. stres, dan kondisi yang terkait dengan rutinitas yang rusak, kesepian, gu
Penilaian klinis pasien COVID-19 pasca akut dengan nyeri dan isolasi sosial pada individu yang tidak terinfeksi65 66; Organisasi st
dada harus mengikuti prinsip yang serupa dengan nyeri dada: Kesehatan Dunia telah mengeluarkan panduan tentang hal ini.67 20
riwayat yang cermat, dengan mempertimbangkan riwayat Akun awam menunjukkan bahwa COVID-19 pasca akut syringe 20
medis masa lalu dan faktor risiko, pemeriksaan fisik, didukung dengan suasana hati yang rendah, keputusasaan, yang meningkat, dan by
seperti yang ditunjukkan oleh penyelidikan ( infografik). 43 Jika kesulitan tidur.6 gu
diagnosis tidak pasti, atau pasien benar-benar tidak sehat, es
rujukan kardiologi mendesak mungkin diperlukan untuk Gangguan stres pasca trauma dapat terjadi, terutama pada petugas t.
penilaian dan penyelidikan spesialis (termasuk ekokardiografi, kesehatan dan orang lain yang memiliki tanggung jawab kepedulian. Pr
computed tomography dada, atau pencitraan resonansi 15 16 43 ot
magnetik jantung). Meskipun sebagian kecil pasien dapat memperoleh manfaat dari ec
rujukan ke layanan kesehatan mental, penting untuk tidak membuat te
Tromboemboli
sebagian besar pasien patologis. Manifestasi fisik COVID-19 dapat
COVID-19 adalah keadaan inflamasi dan hiperkoagulasi, 50 dengan mengubah respons terhadap alat pengiriman yang dirancang untuk
peningkatan risiko kejadian tromboemboli. 55,56 Banyak pasien mengukur dan depresi pada populasi yang sehat secara fisik,
rawat inap menerima antikoagulasi profilaksis. Rekomendasi. meskipun komplikasi ini dapat terjadi. Organisasi pasien
kesejahteraan, perhatian, hubungan sosial, perawatan diri (termasuk
diet dan hidrasi), dukungan teman sebaya, gejala pengendalian.
Penyakit mental sangat terkait dengan faktor penentu sosial seperti
kemiskinan, kewarganegaraan, dan pengucilan sosial; kesehatan
mental dan kesejahteraan ditingkatkan dengan peningkatan
solidaritas sosial, dukungan sosial informal, gotong royong, dan
tindakan berbasis komunitas dan kolektif lainnya. 68,69 Mengingat
betapa luasnya dan tidak setara dampak COVID-19, 70,71 tingkat
masyarakat, lintas sektor kolaborasi yang mungkin diperlukan untuk
mengembangkan solusi yang relevan secara lokal. Laporan terbarut
dari praktik umum di daerah tertinggal di Glasgow menjelaskan ‐ Sikh Helpline. Coronavirus update.
pentingnya perawatan berbasis hubungan yang dapat diakses
untuk pasien dengan kebutuhan kompleks, dan intervensi Jewish Care. Online and local resource library. B
‐
tingkat sistem seperti penasihat keuangan terlampir dan Muslim Council of Britain. COVID-19 guidance for M
penjangkauan layanan kesehatan mental.69 ‐ Muslim communities. J:
fir
Pertimbangan sosial dan budaya st
COVID-19 COVID-19 lebih umum dan memiliki prognosis yang pu
• Ethnic
lebih buruk pada fase akut pada orang yang miskin, lanjut usia, bli
‐organisations:
Ubele. COVID-19 resource page for African sh
dan dari kelompok etnis minoritas tertentu (terutama kulit hitam,
diaspora communities. ed
Asia Selatan, dan Yahudi 70). Masih terlalu dini untuk mengatakan ‐
Greater Manchester Centre for Voluntary as
apakah pola sosiodemografi ini tetap ada pada COVID-19 pasca
Organisation. Support and resources for BAME 10
akut. Pengalaman kami sendiri menunjukkan bahwa pasien
Communities. .1
dengan COVID-19 pasca akut berasal dari latar belakang sosial
13
dan budaya yang berbeda. Banyak yang memiliki penyakit Professional guidelines and resources
6/
penyerta termasuk diabetes, hipertensi, penyakit ginjal, atau • European Respiratory Society. ERS COVID-19 b
penyakit jantung iskemik. Beberapa telah mengalami kehilangan resource centre. mj
keluarga serta kehilangan pekerjaan dan akibat dari tekanan .m
• European Cardiology Society. COVID-19 and
finansial dan kemiskinan makanan. Ketegangan pada banyak cardiology. Cardiology Society 30
pengasuh tinggi. Untuk beberapa orang penting, penguncian telah 26
• Diabetes UK. Advice for healthcare professionals on
memperburuk masalah perlindungan seperti risiko pelecehan anak on
coronavirus (COVID-19) and diabetes.
atau pasangan intim. Diskusi mendetail tentang semua masalah ini 11
berada di luar cakupan artikel ini, tetapi ada argumen kuat untuk • Renal Association. COVID-19: Information and
Au
bekerja dengan lembaga lain guna mengembangkan solusi tingkat guidance for renal professionals. gu
sistem lokal. Kotak 5 memberikan beberapa tautan ke saran • Royal College of Psychiatrists. COVID-19: Guidance st
COVID-19 dari perawatan sosial spesialis, perawatan awam, dan for clinicians. 20
organisasi • British Geriatric Association: 20
.
Box 5: Additional resources for patients and professionals D
Advice for patients o
w
• Homerton University Hospital. ACERS: Post COVID-19
‐ Coronavirus and older people. 2020 nl
patient information pack.
oa
• Royal College of Occupational Therapists. How to COVID-19: Managing the COVID-19 pandemic in
‐ de
conserve your energy: Practical advice for people care homes for older people.
d
• during and after having COVID-19. fro
Chartered Society of Physiotherapy. COVID-19: The m
road to recovery activity planner. htt
• Mental Health Foundation. How to look after your p:/
mental health during the coronavirus outbreak. /w
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• Mind. Coronavirus and your mental health.
w.
Asthma UK and British Lung Foundation. Post-COVID b
• HUB. implikasi untuk tim perawatan primer mj
Facebook. Long Covid Support Group. Dari bukti yang terbatas saat ini, kami mengantisipasi bahwa .c
• banyak pasien dengan penyakit COVID-19 yang o
berkepanjangan akan pulih tanpa masukan spesialis melalui m/
pendekatan holistik dan cepat. Banyak yang dapat dicapai on
melalui layanan rehabilitasi interprofesional yang berhadapan 11
dengan komunitas yang mencakup manajemen diri pasien dan Au
dukungan sebaya serta memanfaatkan potensi video dan gu
Social, financial, and cultural support st
teknologi jarak jauh lainnya. Sebuah platform informasi untuk
• Citizens Advice Bureau. Helping people through the publik baru-baru ini diluncurkan, dan platform rehabilitasi 20
COVID-19 pandemic. virtual direncanakan untuk akhir tahun 2020.72 20
Penatalaksanaan COVID-19 pasca akut harus terjadi dalam by
Advisory Conciliation and Arbitration Service (ACAS).
hubungannya dengan pengelolaan penyakit penyerta yang sudah gu
Coronavirus (COVID-19): advice for employers and
es
• employees. ada atau yang baru (lihat sumber daya profesional di kotak 5 ).
t.
Social Care Institute for Excellence. Supporting Riwayat alami COVID-19 pasca akut dan kronis dalam populasi Pr
• people who are isolated or at risk during the COVID- komunitas tidak diketahui pada saat penulisan. Hasil studi ot
19 crisis. penelitian yang sedang berlangsung73,74 sangat ditunggu. Jika ec
Carers UK. Coronavirus guidance. 10% penyintas COVID-19 mengalami penyakit pasca-akut, dan te
• Faith organisations: kami berasumsi (secara konservatif) bahwa setengah dari semua
kasus tidak didiagnosis secara resmi, ini berarti sekitar 60.000
• orang di Inggris dengan COVID-19 pasca-akut (sekitar enam
per Latihan umum). Pasien, banyak di antaranya masih muda
dan bugar sebelum sakit, telah dideskripsikan diberhentikan
atau dirawat sebagai hipokondriak oleh para profesional
kesehatan.4 Mereka dengan tepat memperebutkan klasifikasi
tidak dirawat di rumah sakit. d COVID-19 sebagai "ringan." 5
Dalam masa-masa yang tidak pasti ini, satu peran kunci yang
dapat dimainkan oleh praktisi perawatan primer adalah sebagai
saksi, "menghormati
ceritanya ”tentang pasien yang pemulihannya berlarut-larut
tidak terduga, mengkhawatirkan, dan tidak masuk akal. 75 11 Wu F, Wang A, Liu M, et al. Neutralizing antibody responses to SARS-CoV-2 in a COVID-19 recovered
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