Long covid: coding is caring

LETTERS SCALE AND SCOPE OF LONG COVID Guildford, UK 2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK nikhil.mayor@nhs.net Cite this as: BMJ 2021;373:n1262 http://dx.doi.org/10.1136/bmj.n1262 Published: 19 May 2021 Long covid: coding is caring Nikhil Mayor, 1 , 2 Ruby Tsang, 2 Mark Joy, 2 FD Richard Hobbs, 2 Simon de Lusignan2 Research, 24 April Sivan and colleagues1 and Ayoubkhani and colleagues2 describe the scale of adverse health outcomes for people admitted to hospital with covid-19. We agree that key questions of this complex, heterogeneous patient group are yet to be answered—such as whether particular symptom clusters exist, the impact on disparities, and whether young, fit people are disproportionately affected.3 For our health system to rise to the challenge of long covid we need systematically to record cases in primary care computerised medical record (CMR) systems. People with long covid are largely invisible to searches. There is the possibility that those who present and are prospectively flagged in record systems will be the more articulate and less deprived, further widening disparities. In England, we have been slow to provide clinical terms that enable those with long covid to be recorded in CMR systems. We now have, however, a schema for doing this, provided by the National Institute for Health and Care Excellence and included in the Systematized Nomenclature of Medicine Clinical Terms (SMOMED) clinical terms: • • • • Acute covid-19: signs and symptoms of covid-19: ≤4 weeks • Ongoing symptomatic covid-19: signs and symptoms of covid-19: 4-12 weeks • Post-covid-19 syndrome: signs and symptoms that develop during or after covid-19, lasting >12 weeks and not explained by another diagnosis4 Coding is caring—we need a means to flag those with long covid. We recommend people with long covid have this coded as a “problem” (diagnosis) in their CMR. In England, we recommend that GPs use the “post-covid-19 syndrome” SNOMED clinical term and record the start date as three months after that person’s positive test date. Please code correctly and caringly so we can collect the necessary real world evidence to manage covid-19 and its complicated sequelae. Competing interests: SdeL is director of the Oxford-RCGP RSC and involved in covid-19 research, including an AstraZeneca funded project (not related to long covid). 1 Sivan M, Rayner C, Delaney B. Fresh evidence of the scale and scope of long covid. BMJ 2021;373:n853. doi: 10.1136/bmj.n853 pmid: 33795224 2 Ayoubkhani D, Khunti K, Nafilyan V, et al. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. BMJ 2021;372:n693. doi: 10.1136/bmj.n693 pmid: 33789877 3 Sigfrid L, Drake TM, Pauley E, et al. Long covid in adults discharged from UK hospitals after covid-19: a prospective, multicentre cohort study using the ISARIC WHO Clinical Characterisation Protocol.medRxiv 2021.03.18.21253888v3 [Preprint]. 2021. www.medrxiv.org/content/10.1101/2021.03.18.21253888v3 4 National Institute for Health and Care Excellence. Covid-19 rapid guideline: managing the long-term effects of covid-19. 2020. www.nice.org.uk/guidance/ng188 This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained. the bmj | BMJ 2021;373:n1262 | doi: 10.1136/bmj.n1262 1 BMJ: first published as 10.1136/bmj.n1262 on 19 May 2021. Downloaded from http://www.bmj.com/ on 24 February 2022 by guest. Protected by copyright. 1 Royal Surrey NHS Foundation Trust,