Aucott and Redman discuss this in their letter in The Lancet published March 5th 2021. 

115 million people worldwide have been infected with SARS-CoV-2 during the COVID-19 pandemic, with extensive implications for morbidity and mortality.  

Description of the long term effects of COVID-19 are appearing regularly in literature. 

The first large cohort study with six months follow-up has been published and more data is going to follow. 

A small number of studies point not only to persistent imaging and testing abnormalities across several organ systems in the post-acute period but also to a high frequency of patient reported symptoms such as fatigue, insomnia, anxiety and depression, autonomic disturbances, cognitive difficulties, pain and others.  

The presence of patient support groups, and the rapid expansion of clinics to manage or treat the symptoms validate further their existence and support. 

Although the frequency, severity and potentially the aetiology of persistent symptoms can vary, sequelae after COVID-19 appears poised to join the range of other post infection syndromes described in the field of infectious diseases.  

These often share a common symptom phenotype, which might also meet case definitions for myalgic encephalomyelitis – chronic fatigue syndrome, fibromyalgia, or post treatment Lyme disease. 

The authors hope that researchers and clinicians will draw on these conditions as they continue to advance scientific understanding of the so called long haul or persistent COVID-19. 

They also argue that there are important lessons to learn and pitfalls to avoid as they have been researching in this area with post-treatment Lyme disease for more than 30 years. 

They discuss that in patient reported symptoms, this is more difficult to quantify severity and measure improvements than in objective abnormalities. 

They also suggest that scientific knowledge surrounding the cause of persistent symptoms after acute infections such as fatigue is unclear.  

Both these factors contribute to the risk of dismissing patient reported complaints, particularly when they appear vague, difficult to explain, multifactorial, or unexpected.

It is clear that although peer reviewed research is needed, patients with persistent symptoms after COVID-19 face illness invalidation and disbelief from some healthcare providers, family and friends. 

When listening to patients, it is important to understand their symptoms for example fatigue and the implications these symptoms have on the quality of the patient’s life. 

Post-infectious syndromes, including persistent symptoms after COVID-19, present a considerable challenge to clinicians and researchers. 

However, they do present the opportunity for novel, scientifically rigorous, inclusive, open minded research with the sole aim of helping patients with these poorly understood conditions to recover their health. 

The London General Practice has set up a long COVID service with the help of clinicians, therapists and testing as appropriate to ensure that a multidisciplinary approach is utilised to help all patients suffering with long COVID.

Dr Paul Ettlinger

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