Post COVID-19 condition

WHO developed a clinical case definition of post COVID-19 condition by Delphi methodology that includes 12 domains, available for use in all settings. This first version was developed by patients, researchers, and others, representing all WHO regions, with the understanding that the definition may change as new evidence emerges and our understanding of the consequences of COVID-19 continues to evolve. 

Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS- CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others which generally have an impact on everyday functioning. Symptoms may be new onset, following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.

A separate clinical case definition for children and adolescents has also been produced, through a process of expert consensus, which recognizes the unique health needs and challenges of this group of people. 

The WHO COVID-19 Clinical management: living guidance contains the Organization’s most up-to-date recommendations for the clinical management of people with COVID-19. Providing guidance that is comprehensive and holistic for the optimal care of COVID-19 patients throughout their entire illness is important. The latest version of this living guideline is available in pdf format (via the ‘Download’ button) and via an online platform, and is updated regularly as new evidence emerges. No further updates to the previous existing recommendations were made in this latest version.

This updated (fifth) version contains 16 new recommendations for the rehabilitation of adults with post COVID-19 condition (see Chapter 24), which includes: 

• strong recommendation that exertional desaturation and cardiac impairment following COVID-19 should be ruled out and managed before consideration of physical exercise training; and 

• conditional recommendations for

• support for the delivery of rehabilitation services;
• early referral for appropriate rehabilitation services;
• rehabilitation service delivery using a hybrid approach of in-person and remote models which are integrated across all levels of health care; 
• a rehabilitation workforce that includes physiotherapists, occupational therapists, nurses, psychologists, speech and language therapists, physicians, social workers, and (based on local needs) community health care workers;
• use of education and skills training on energy conservation techniques, such as pacing approaches, for the clinical rehabilitation management of post-exertional symptom exacerbation (PESE); 
• use of a combination of pain education, skills training on self-management strategies, prescription of short-term anti-inflammatory drugs and, in the absence of PESE, physical exercise training for the clinical rehabilitation management of arthralgia; 
• use of a combination of education and skills training on self-management strategies, such as nasal breathing and pacing approaches and, in the absence of PESE, physical exercise training for the clinical rehabilitation management of breathing impairment;
• use of a combination of education, skills training on self-management strategies and cognitive exercises for the clinical rehabilitation management of cognitive impairment;
• use of a combination of education, skills training on energy conservation techniques such as pacing approaches and, in the absence of PESE, a cautious return to symptom titrated physical exercise training for the clinical rehabilitation management of fatigue;
• use of psychological support and, in the absence of PESE, physical exercise training, mindfulness-based approaches and peer support groups for the clinical rehabilitation management of anxiety and depression;
• use of education and skills training for olfactory training for the clinical rehabilitation management of olfactory impairment;
• use of a combination of education and skills training on self-management strategies and, in the absence of PESE, physical exercise training for the clinical rehabilitation management of orthostatic intolerance. Environmental modifications may be useful to support activities of daily living for people experiencing difficulties with upright positions or standing. 
• use of a combination of education and skills training on positioning, maneuvers and dietary modifications, and swallowing exercises for the clinical rehabilitation management of swallowing impairment;
• use of education and skills training about voice rest and vocal behaviours for the clinical rehabilitation management of voice impairment;
• rehabilitation interventions for a return to everyday activities that could include education and skills training on energy conservation techniques, the provision and training in the use of assistive products to those who need further assistance with activity management and mobility, and a return-to-work action plan that supports a prolonged and flexible phased return. Environmental modifications at work may be needed based on an individualized workplace risk assessment of personal capabilities matched to work requirements.

Guidelines regarding the use of drugs to treat COVID-19 are included in a separate WHO document, Therapeutics and COVID-19: living guideline, that can via an online platform and in  pdf format (or click ‘PDF’ in top right corner of online platform).

Guidelines regarding the use of drugs to prevent COVID-19 are included in a separate document, WHO Living guideline: Drugs to prevent COVID-19, that can be accessed via an online platform and in  pdf format (or click ‘PDF’ in top right corner of online platform).

To view previous (now outdated) versions of this guideline, please see the links below:

• First version, published 27 May 2020 (accessible as pdf only), was originally published under the title "Clinical management of COVID-19: interim guidance, 27 May 2020".
• Second version, published 25 January 2021 (access via an online platform or as pdf).
• Third version, published 23 November 2021 (access via an online platform or as a pdf)
• Fourth version, published 23 June 2022 (access via an online platform or as a pdf)