What causes Long Covid and how can it be treated?

    31 December 2020

    The announcement by the Secretary of State for Health Matt Hancock that the NHS is to set up more than 40 specialists clinics in England for those suffering with the long-term effects of coronavirus has brought into sharp relief the impact that the COVID-19 virus is having on people many months after their initial infection.

    Some estimates have 60,000 to 80,000 people in the UK now experiencing ‘long Covid’ symptoms such as fatigue, breathless ness, pain and brain fog, with NHS England providing £10 million to fund clinics that will treat patients who have been hospitalised with the virus, officially diagnosed after a test or reasonably believe they had Covid-19.

    At the start of the pandemic, Covid-19 was viewed as a viral respiratory illness from which the majority of people would recover in a few weeks at most and as a result, the Government adopted a flu pandemic model in its approach to it. However, from early April the longer term impact of the virus began to become noticed by sufferers and health professionals and although we know much more about the longer-term impact of the virus than earlier in the year, our current understanding of long Covid is constantly in flux so will continue to evolve in the coming months.

    According to a new definition by the National Institute of Health and Clinical Excellence (NICE), patients suffering the long-term effects of Covid-19 are those patients who are experiencing symptoms (usually appearing as ‘clusters’) that are ongoing for more than three months after their initial infection. These symptom clusters occur across all body systems and include psychiatric problems but to muddy the waters a little further, the NIHR (National Institute for Health Research) also say it may not be a single syndrome but rather split into four main subtypes – the after effects of intensive care, post viral fatigue, lasting organ damage and symptoms that move around the body.

    Patients presenting with what appears to be long Covid typically have one or more of the ‘big four’ symptoms of fatigue (which is often crippling), breathlessness on even mild exertion, joint and chest pains, and a persistent cough. Others include a persisting loss of taste or smell, headaches, a constantly running nose and red eyes but there are often also symptoms of insomnia, low mood, depression and anxiety (including post-traumatic stress disorder symptoms).

    The exact cause of long Covid remains unclear but current theories include an overactive immune response to the virus, ‘pockets’ of coronavirus that linger in the body long-term, fluctuations in blood sugar levels and inflammation of small blood vessels in the body along with abnormal clotting events. For many sufferers, their blood tests and oxygen levels are typically normal and few if any abnormalities are found on body scans.

    Managing the physical, psychological and social complications of long Covid will be tricky, which is why the specialist clinics have been set up. These will give patients access to a physical, cognitive and psychosocial assessment, following which onwards referral can be made into specialist services such as heart and lung disease, sleep clinics, rehabilitation centres and services providing evidence-based psychological therapies to people with anxiety disorders and depression. There will also be oversight by a new NHS England long Covid taskforce which will include medical specialists, researchers and long Covid patients.

    The news about possible highly effective vaccines being in the pipeline is obviously extremely encouraging and shines some light from the end of a dark tunnel, but it now appears that – even if an effective mass vaccination programme is successful over the next 18 months – Covid-19 will continue to throw a long and disabling shadow over many people it has infected.