The editorial published in The Lancet August 28th 2021 reviews this.

As the COVID-19 pandemic continues, the need to understand and respond to long COVID is increasingly pressing. Symptoms such as persistent fatigue, breathlessness, brain fog and depression could debilitate millions of people globally. 

Yet very little is known about the condition.  The term long COVID is commonly used to describe signs and symptoms that continue or develop after acute COVID-19.  A NICE guideline, for example includes both ongoing symptomatic COVID-19 from 4 to 12 weeks and post COVID-19 syndrome greater than or equal to 12 weeks, but there is still no agreed definition.  

How distinct is long COVID from post-viral syndromes?  No clear biochemical or radiological features exist to aid diagnosis, and there are potentially several phenotypes with different presentations, prognosis and outcomes.  

With no proven treatments or even rehabilitation guidance, long COVID affects people’s ability to resume normal life and their capacity to do work.  The effect on society, from the increased healthcare burden and economic and productivity losses, is substantial. 

Long COVID is a modern medical challenge of the first order. 

Clearly, the condition is a public health concern, in the United Kingdom, for example an estimated 945,000 people that is 1.5% of the population had self-reported long COVID on July 4th 2021 according to the UK Office for National Statistics including 34,000 children aged 2 to 16 years. 

Prevalence was greatest in people aged 35 to 69 years, girls and women, people living in the most deprived areas, and those working in health or social care and those with another activity limiting health condition or disability. 

Most evidence about long COVID has been limited and based on small cohorts with short follow-up.  

However, in The Lancet Lixue Huang and colleagues report 12 month outcomes from the largest longitudinal cohort of hospitalised adult survivors of COVID-19 so far.  Including adult’s median age 59 years discharged from Jin Yin-tan hospital in Wuhan, China – this study advances our understanding of the nature and extent of long COVID.  

At one year COVID-19 survivors had more mobility problems, pain or discomfort and anxiety or depression than control participants (matched community dwelling adults without SARS-CoV-2 infection).  

Fatigue or muscle weakness was the most frequently reported symptom at both 

6 months and 12 months, almost half of patients reporting having at least one symptom, such as sleep difficulties, palpitations, joint pain or chest pain, at 

12 months.  The study showed that for many patients, full recovery from COVID-19 would take more than one year and raises important issues for health services and research. 

First, only 0.4% of patients with COVID-19 said that they had participated in a professional rehabilitation programme.  The reason for such low use of rehabilitation services is unclear, but poor recognition of long COVID and lack of clear referral pathways are becoming problems worldwide.  Second, the effect of long term on mental health warrants further and longer term investigation. 

The proportion of COVID-19 survivors who had anxiety or depression slightly increased between 6 months and 12 months and the proportion was much greater in COVID-19 survivors than in controls.  

Third, the outcomes for this cohort cannot be generalised to other populations for example, patients not admitted to hospital, younger people and those from racially minorities and other disadvantaged groups who have been disproportionately affected by the pandemic.  

Research in these populations needs to be prioritised urgently the editorial suggests.  Tedros Adhanom Ghebreyesus, the WHO’s Director General, has called on countries to prioritise recognition, rehabilitation and research for the long term consequences of COVID-19, as well as collect data for long COVID.  

A cohesive research agenda is needed to prevent research waste and improve outcomes for patients.  The scientific and medical communities must collaborate to explore the mechanism and pathogenesis of long COVID, estimate the global and regional disease burdens, better delineate who is most at risk, understand how vaccines might affect the condition and find effective treatments via randomised controlled trials.  

At the same time, healthcare providers must acknowledge and validate the toll of the persistent symptoms of long COVID on patients and health systems need to be prepared to meet individualised, patient-oriented goals, with an appropriately trained workforce involving physical, cognitive, social and occupational elements.  Answering these research questions while providing compassionate and multidisciplinary care will require the full breadth of scientific and medical ingenuity.  It is a challenge to which the whole health community must rise.

The London General Practice, the leading London doctors’ clinic in Harley Street provides a full multidisciplinary team approach to those patients suffering with long COVID symptoms.  If you feel that you may be suffering, please do not hesitate to book an appointment.

Dr Paul Ettlinger

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