An interesting article by Goff and others published in the Journal of the American Medical  Association October 2021 reviewed this issue.  

Short term and long term persistent post acute sequelae of COVID-19 have not been  systematically evaluated. The incidence and evolution of post acute sequelae are dependent  on time from infection, organ systems and tissues affected, vaccination status, variant of the  virus and geographic region. This study tried to estimate the organ system specific frequency  and the evolution of post acute sequelae of COVID-19 infection. From a total of 2,100 studies  identified, 57 studies with 250,351 survivors of COVID-19 met the inclusion criteria. The mean  age of the survivors was 54.4 years, 140196 were male that is 56% and 19777 that is 79% of  hospitalised during acute COVID-19. 

High income countries contributed 45 studies, that was 79%. The median proportion of  COVID-19 survivors experiencing at least one post acute sequelae of COVID-19 was 54% at  one month, 55% at two to five months intermediate term and 54% at six or more months. 

Most prevalent: pulmonary sequelae, neurological disorders, mental health disorders, functional mobility impairments and general and constitutional symptoms were chest imaging  abnormality 62.2%, difficulty concentrating 23.8% generalised anxiety disorder 26.9%, general  functional impairments 44% and fatigue or muscle weakness 37.5% respectively. Other  frequently reported symptoms included cardiac, dermatologic, digestive and ear, nose and  throat disorders.  

This systematic review showed that more than half of COVID-19 survivors experienced post  acute sequelae some six months after recovery. The most common involved functional  mobility impairments, pulmonary abnormalities and mental health disorders. The study  suggests that the long term post acute sequelae effects could occur on a scale that would  overwhelm existing health care capacity, particularly in low and middle income countries.  

The London General Practice, the leading London doctors’ clinic in Harley Street offers a long COVID service and has put together a multidisciplinary team to help rehabilitate and review all  symptoms. 

Dr Paul Ettlinger 
BM, DRCOG, MRCGP, FRIPH, DOccMed 

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