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We’re finding out more and more about the long term effects of COVID-19, also known as ‘Long COVID’, as the pandemic goes on, and the Office for National Statistics (ONS) estimates that around 1 in 5 people who test positive for COVID-19 experience symptoms for 5 weeks or longer, and 1 in 10 for 12 weeks or longer.
The following clinical definitions explain the differences between the initial illness and Long COVID at different times:
- Acute COVID-19:
- Signs and symptoms of COVID-19 for up to 4 weeks
- Ongoing symptomatic COVID-19:
- Signs and symptoms of COVID-19 from 4 to 12 weeks
- Post-COVID-19 syndrome:
- Signs and symptoms that develop during or after an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis
We know many of the persistent health problems that are reported following acute COVID-19 disease; such as breathlessness, fatigue, chest tightness, headaches, weakness and sleeplessness, but research to evaluate the long-term health and psychosocial effects of COVID-19 is continuing.
Sir Simon Stevens, NHS chief executive, said: “The NHS is taking practical action to help patients suffering ongoing health issues as a result of coronavirus. Bringing expert clinicians together in these clinics will deliver an integrated approach to support patients access vital rehabilitation, as well as helping develop a greater understanding of Long COVID and its debilitating symptoms.”
It’s recognised that many people experiencing ongoing health effects following COVID-19 infection managed their condition themselves at home when they were acutely infected. It’s also known that not all patients seriously affected in the longer term were hospitalised or had a positive SARS-CoV-2 test. People with post-COVID syndrome have found that while some GPs have been sympathetic, some have been unsure how to refer into treatment services.
Patients can access services if they are referred by a GP or another healthcare professional, so that doctors can first rule out other possible underlying causes for symptoms. Healthcare providers can refer patients to the online COVID recovery programme – Your COVID Recovery (YCR), which has two phases:
- Phase 1: Is open access and provides patient-facing information to support people recovering from COVID-19
- Phase 2: The virtual rehabilitation aspect of the platform was launched in November 2020, which is available to people who have been assessed and referred by a health care professional
There will be over 80 post-COVID assessment clinics across England by the end of January offering offer physical, cognitive and psychological assessments, with the aim of
providing consistent post-COVID syndrome services for all who need them, whether they
were hospitalised or not and regardless of whether they were clinically diagnosed or as a result of a positive COVID-19 test.
NICE recently published official guidance on best practice for identifying, assessing investigating, referring, following up and monitoring of people with new or ongoing symptoms of COVID-19. NICE recommends that anyone who has new or ongoing symptoms 4 weeks or more after the start of acute COVID-19, should be referred to one of the COVID-19 assessment centres.
Dr Graham Burns, clinical lead at the Long COVID centre at the Royal Victoria Infirmary in Newcastle, said: ‘In the first wave of the pandemic many people did not recover as quickly as they’d expected. We had no idea what long COVID was – the world had never seen COVID-19 before. We set up the clinic in Newcastle to support patients, but it has also been invaluable in helping us understand what long COVID is.’
The RCGP has produced an e-learning module on Long COVID and an e-learning module on Recovery from COVID-19, which summarises current knowledge on the clinical effects of COVID-19. The Faculty of Occupational Medicine has also published a guidance sheet this month for healthcare professionals to assist them in facilitating the return to work of people who are unable to work due to Long COVID which is intended to complement and supplement the NICE guidance.