COVID-19 has mostly been discussed in the context of severe or fatal cases, however, recent investigations reveal that a growing number of patients with initially mild COVID-19 may develop long-term symptoms. During the onset of the pandemic, patients recognised themselves as “Long-Haulers” and the prolonged health concerns as “Long COVID”. There have been limited findings on Long COVID due to a lack of systematic studies, and according to a study published by The Lancet, information is scarce on “the symptom profile and severity, projected clinical course, impact on daily functioning, and expected recovery to baseline health.”
However, new research is surfacing to help healthcare professionals better understand Long COVID to implement specialised treatments that can alleviate symptoms. Dr. Brian O'Connor, Consultant in Respiratory Medicine at Cromwell Hospital discusses findings that led to the initiation of its Long COVID Clinic, and how a multi-disciplinary approach to treatment is ensuring positive patient outcomes.
Source: Cromwell Hospital, https://www.cromwellhospital.com/
COVID-19 compromises the immune system significantly. What percentage of patients experience long-term effects after being tested negative?
The current statistics in the UK indicate that around 15% of people who have had an acute COVID infection, even if it's a mild infection, go on to develop what we call Long COVID. Patients experiencing Long COVID can still have symptoms that relate to the original COVID infection, 12 weeks after they first test positive.
Long COVID symptoms vary for each individual, they range from being related to the heart or the lungs. Many patients suffer from breathlessness, and chest pain, palpitations, dizziness, and they continue with the sensation of not being able to take a deep breath. The other constant symptom is profound fatigue. In addition, they have problems with what we call brain fog, or poor concentration, where they are unable to focus or get tired very easily. They are unable to complete mental tasks and to process complex information, particularly when back at work. Significant joint pains are also a symptom many patients continue to experience.
As well as physical symptoms, mental health is also impacted by Long COVID, for example, sleep patterns become poor or irregular, with some patients sleeping more hours or others have insomnia. We also have seen a lot of patients reporting anxiety and depression since having the virus.
What are physicians doing to accurately diagnose Long Covid symptoms?
By definition, a patient can be only diagnosed with Long COVID when other illnesses have been excluded. There can be an instance when a patient comes back for a checkup after three months of recovering from COVID or even longer. If they have the mentioned symptoms, we need to rule out that they don’t have any other underlying problems unrelated to COVID-19. These can be autoimmune diseases, lung abnormalities, neurological conditions, or heart disease issues. Every patient undergoes a very extensive range of investigations before you can conclude that they have Long COVID.
How does long covid impact patients and what are the ramifications of these symptoms being misdiagnosed?
Initially, healthcare professionals did not expect patients to suffer from the long-lasting effects of COVID-19. In the first wave, between March and September of last year, there was an attitude among the healthcare community, and doctors, that this was a virus from which you recover and can continue with your normal lifestyle. Patients were being poorly advised to resume full activity too quickly. We didn’t realise the devastating impact of COVID-19 on the immune system.
Patients have been frustrated that they’re not recovering from the virus as quickly as they originally thought. We’re tending to see people presenting with Long COVID who have tried to return to a busy lifestyle too quickly. These patients tend to work full time, exercise regularly, and have childcare responsibilities.
Can you tell us about the Long Covid Clinic at Cromwell Hospital?
15 percent of patients who had COVID-19, have developed Long COVID. Therefore, a staggering number of the UK population are suffering from the long last effects of COVID-19. In the private sector, Cromwell Hospital is one of the UK’s leading private hospitals that receive a huge range of inquiries from people with symptoms. In our clinic, these patients undergo a series of tests, inclusive of various blood tests to exclude autoimmune disease, lung function tests, echocardiogram, ECG, seven-day ECG monitoring, heart monitoring, a CT scan to analyse their lung functions depending on their case, a brain MRI, tests on muscle function, and nerve conduction studies. As well as a huge range of blood tests. From our findings, we’ve also noticed several patients who suffer from Long COVID have a Vitamin D deficiency.
When specialists are concerned about the cardiac status of a patient, particularly the palpitations, lightheadedness, and ongoing chest pain, even in the instance of a normal echo, patients undergo a cardiac MRI. A cardiac MRI is a much more sophisticated test to identify abnormalities. The multidisciplinary team at Cromwell Hospital encompasses of consultants from different specialties, including hospital consultants in respiratory medicine, neurology, and cardiology. In addition, we have and physiotherapists, psychiatrists as well as access when necessary to a rheumatologist.
Do genetics, immunity, and pre-existing conditions play a role in patients being more susceptible to experiencing Long Covid?
One of the striking aspects about Long COVID has been the majority of patients we’ve diagnosed with it tend to be individuals from their late 20s to their early 50s, 75 percent of them being female. Several of them are very high achieving with extremely busy lives pre-COVID-19. They can be successful entrepreneurs or those with incredibly stressful family lives. These are caretakers, who also have multiple projects in their personal lives, outside work. These patients tend to be extremely busy people who find it very difficult to cope with being ill with COVID-19, and they don't give themselves enough time for their bodies to recover.
Our findings related to Long Covid ever-changing and how will this impact patient care in the future?
One of the key factors in Long COVID patient care is reassurance. Telling our patients that they will recover, and encouraging them is crucial. Testing them to ensure that results indicate their heart and brain functionality is normal is important. They require as much support as possible and need to have access to not just physical therapists, but also psychologists or psychiatrists to help with the mental health implications of the virus.
The most critical aspect of recovery from Long COVID is physiotherapy and rehabilitation. Patients should not try and rush back to doing full activity. Patients who suffer the most from Long COVID are those who try and do too much, too soon without allocating enough time to recover from the initial infection