LongCOVID – Where Are We Now?

Dr Deepak Ravindran is a long covid expert and the author of bestselling book ‘The Pain-Free mindset’

WHAT IS IT?
Long COVID is a new long-term health condition causing multiple symptoms affecting multiple organ systems. Afteracute Covid-19, many people make a full recovery within a month. If Symptoms last 4 weeks or more after suspected or known Covid-19 then it may be Long Covid according to the new guidelines.

Symptoms can affect any part of the body and can fluctuate, or new ones may appear many weeks later. People of all ages and previous levels of health and fitness are at risk of experiencing the life-changing effects of Long Covid – including children and adolescents.

There is no association with the severity of the initial infection. In fact most patients presenting to a long Covidclinic may very well have had mild symptoms that did not need any admission to the hospital or intensive care unit. Therefore, this is a brand new medical condition for which healthcare professionals do not know the natural history so it is difficult to give a prognosis and when symptoms might resolve.

HOW BIG IS THE PROBLEM?
The Office of National Statistics (ONS) note that there are more than two million UK patients affected with this condition after an acute episode. That is almost 3% of the UK population and there are more than 1.2 million who have had the symptoms for more than 12 months. what we understand from this data is that it did not count those from care homes,prisons, hospitals, university halls of residence and therefore when these are factored in it is possible the number impactedis much larger. There are right now more than 200,000 healthcare and key workers such as carers also suffering and off work due to Longcovid.

WHAT ARE THE SYMPTOMS?
A study published in 2021 look at the kind of symptoms people have been reporting and this study looked at 3700 participants from more than 56 countries and they documented more than 200 different symptoms from the 10 organ systems in our body. The same study found that, after seven months of illness, 45% of respondents reported requiring a reduced work schedule and 22% were not working due to their health. The most common symptoms can be grouped into
Physical: fatigue, shortness of breath, Palpitations, bloating and stomach problems, loss of taste and smell and pain
Cognitive: memory issues and concentration problems popularly called Brain Fog
Mental: new onset anxiety and depression and PTSD like symptoms in people with severe infections needing intensive care.

HOW DO WE DIAGNOSE IT?
At the time of writing this article, there is no single blood test or scan that has been validated for diagnosing long COVID so this is still very much a clinical diagnosis. If you have had a history of probable or confirmed COVID like infection and the symptoms are lasting beyond four weeks and there is no other alternative problem then we can diagnose it as LongCOVID. It is important to do a series of investigations to ensure that we’re not missing anything sinister.

WHAT ARE THE CAUSES?
There is a lot of active research going on to find out the causes for the occurrence of long covid but at this time we do not as yet have a clear answer. 4 theories are right now predominent.
1. An overactivity in the immune cells system as a whole including the discovery of autoantibodies which may be causing some of the symptoms
2. Due to the close connections / links between the nervous and immune system, many parts of the nervous system especially the autonomic nervous system which controls breathing, heart rate and digestion can also be abnormal after the COVID infection
3. Inflammation within the small blood vessels and micro clots that could be reducing the circulation to some organs causing the symptoms.
4. Lastly it is thought that in some patients the virus or its fragment’s remain present and repeated exposures can activate the immune system causing it to show symptoms.
there are some patients who are at higher risk of long COVID.These include people who are having coexisting medical problems like diabetes, asthma and mental health issues. It tends to be more common in women and those with autoantibodies or those coming from a deprived area, If you have had lots of initial symptoms or being severely unwell then that is also a risk of being left with long Covid.

HOW DO WE TREAT IT?

As I mentioned earlier this is a new long-term condition and at this time there is no cure or quick fix for the problem. Thereare several treatment options however available with your GP or specialist LC clinic based on your symptoms. The NHS in England have provided funding for 90 specialist multi-disciplinary long COVID clinics to be established throughout the country and 15 dedicated hubs for paediatric long COVID. These clinics can be in the primary care or secondary care. NICE (National Institute of Health Care and excellence) and BMJ (British Medical Journal) have provided severalguidelines and review articles on managing and supporting people with long COVID. They recommend that GPs should offer an assessment if symptoms are present for more than four weeks and investigate accordingly. It is important to provide a personalised service as each patient may have a different set of symptoms which they need help. The guidelines provide a wide variety of self-management resources and provide GPs with the guidance on when to refer for more specialised investigations and support.

IMPLICATIONS FOR THE CARE PROFESSION
Like most key worker professions, you may very well be aware of a close friend, family member or co-worker or patient impacted with a number of symptoms after the COVID infection. The following points could be used as pointers and provide support to our patients and colleagues left impacted.
1. It is best to contact your GP if symptoms have gone on beyond four weeks.

2. It does not matter if you have tested positive or negative according to the COVID test. Indeed, for most of 2020,the public did not have access to testing and a number ofpatients were left with symptoms which are likely to have been due to COVID.

3. The wait times for accessing the specialist LC clinics are long so it is best to start with self-management resources while you are waiting. These include the NHS approved Your COVID Recovery, Long Covid SOS and Long Covid Support, support and advocacy groups for LC and finallyLongcovid Physio to understand more about the condition and find excellent resources.

4. The Society for Occupational Medicine (SOM) has produced a new guideline supporting people on their return to work. Link can be found here

5. Vaccines have been quite useful in reducing the severity of the infections but do not prevent transmission nor do they seem to prevent Longcovid from happening in the at risk patient.

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