Long COVID
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Long COVID, also known as chronic COVID syndrome (CCS) and long-haul COVID,[1][2][3] is an informal name for the condition characterised by long-term sequelae—persisting after the typical convalescence period—of coronavirus disease 2019 (COVID-19). Persistent symptoms include fatigue, headaches, shortness of breath, anosmia (loss of smell), muscle weakness, low fever and cognitive dysfunction (brain fog).
About 10% of people who have tested positive for SARS-CoV-2 experience a range of symptoms that last longer than three weeks.[4][unreliable medical source?] About 2%[5][unreliable medical source?] of people report having symptoms which last longer than 12 weeks, which is called post-COVID-19 syndrome. Sufferers of long COVID are sometimes called long-haulers.
Studies are under way into various aspects of long COVID, but as of December 2020[update] it is too early to draw conclusions, although one study has suggested risk factors for developing the illness. Health systems in some countries or jurisdictions[which?] have been mobilised to deal with this group of patients by creating specialised clinics and providing advice.
Anyone infected with SARS-CoV-2 can suffer from "long COVID" after the infection is considered to have ended, including young, healthy people,[6][non-primary source needed] and even if the initial disease at its peak only caused minor symptoms. The risk of long COVID for patients of any age, in addition to the age-dependent risk of serious illness or death during the acute phase, makes it important to prevent coronavirus infection and master the pandemic through measures including social distancing, use of face masks, and of personal protective equipment by those working with patients,[7] hand cleaning, and vaccination.
While "Long COVID" is observed after acute COVID-19, it had not been reported after vaccination, with over 100,000 participants included in vaccine trials by December 2020.[8][9][10]
Terminology and definitions[edit]
Long COVID is a patient-created term which was reportedly first used in May 2020 as a hashtag on Twitter by Elisa Perego.[11][12]
Sufferers are often referred to as long-haulers.[13][14][15][16][17]
British definition[edit]
The British National Institute for Health and Care Excellence (NICE) divides COVID-19 into three clinical definitions:
- acute COVID-19 for signs and symptoms during the first 4 weeks after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),
- new or ongoing symptoms 4 weeks or more after the start of acute COVID-19, which is divided into:
- ongoing symptomatic COVID-19 for effects from 4 to 12 weeks after onset, and
- post-COVID-19 syndrome for effects that persist 12 or more weeks after onset.
NICE describes the term long COVID, which it uses "in addition to the clinical case definitions", as "commonly used to describe signs and symptoms that continue or develop after acute COVID-19. It includes both ongoing symptomatic COVID-19 (from 4 to 12 weeks) and post-COVID-19 syndrome (12 weeks or more)".[18]
NICE defines post-COVID-19 syndrome as "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. It usually presents with clusters of symptoms, often overlapping, which can fluctuate and change over time and can affect any system in the body. Post‑COVID‑19 syndrome may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed".[18]
Incidence[edit]
As time passed, from the first reports of the disease in December 2019 through the spread of the COVID-19 pandemic into 2020, it started becoming clear that COVID-19 was a long-term illness for many people,[19][13] seen in people who had a mild or moderate initial infection[20] as well as those who were admitted to hospital with more severe infection.[21][22][scientific citation needed]
Some early studies suggested that between 1 in 5 and 1 in 10 people with COVID-19 experienced symptoms lasting longer than a month.[19] Early studies usually tracked people who had been hospitalized for severe COVID, and whose recovery was longer.[4] Among the general population, about 90% of people stop reporting symptoms after about three weeks, and about 10% continue to report significant symptoms.[4] Different studies continue to report different rates.[4]
A case report and systematic review from Sweden has suggested that long COVID may also occur also in children.[23][24] Common symptoms in children were fatigue, dyspnoea, heart palpitations or chest pain, and there seemed to be a female predominance.[23]
A majority (up to 80%[25]) of those who were admitted to hospital with severe disease experience long-term problems including fatigue and shortness of breath (dyspnoea).[26][19][27] Patients with severe initial infection, particularly those who required mechanical ventilation to help breathing, are also likely to suffer from post-intensive care syndrome following recovery.[21]
A September 2020 study by King's College, London suggested the incidence in the UK was up to 60,000,[28] but statistics published in December by the Office of National Statistics suggest that as many as one in five patients are afflicted with long-term symptoms (although these statistics only report post-COVID and not pre-COVID incidence of those symptoms, which may have been pre-existent).[29][30]
Cause[edit]
No one knows why most people recover fully within two to three weeks and others experience symptoms for weeks or months longer.[4] An early analysis by the United Kingdom's National Institute for Health Research suggests that ongoing long COVID symptoms may be due to four syndromes:[19][31]
- permanent damage to the lungs and heart,
- post-intensive care syndrome,
- post-viral fatigue syndrome, and
- continuing COVID-19 symptoms.
Other situations that might cause new and ongoing symptoms include:
- the virus being present for a longer time than usual, due to an ineffective immune response;[4]
- reinfection (e.g., with another strain of the virus);[4]
- damage caused by inflammation and a strong immune response to the infection;[4]
- physical deconditioning due to a lack of exercise while ill;[4] and
- post-traumatic stress or other mental sequelae,[4] especially in people who had previously experienced anxiety, depression, insomnia, or other mental health difficulties.[32][non-primary source needed]
Risk factors[edit]
According to a King's College London study initially posted on 21 October 2020[5][unreliable medical source?] risk factors for long COVID may include:[33][34][non-primary source needed]
- Age – particularly those aged over 50
- Excess weight
- Asthma
- Reporting more than five symptoms (e.g. more than cough, fatigue, headache, diarrhoea, loss of sense of smell) in the first week of COVID-19 infection; five is the median number reported
Health system responses[edit]
Australia[edit]
In October 2020, a guide published by the Royal Australian College of General Practitioners (RACGP) says that ongoing post-COVID-19 infection symptoms such as fatigue, shortness of breath and chest pain will require management by GPs, in addition to the more severe conditions already documented.[25]
United Kingdom[edit]
In Britain, the National Health Service set up specialist clinics for the treatment of long COVID.[35] The four Chief Medical Officers of the UK were warned of academic concern over long COVID on 21 September 2020 in a letter written by Trisha Greenhalgh published in The BMJ[36] signed by academics including David Hunter, Martin McKee, Susan Michie, Melinda Mills, Christina Pagel, Stephen Reicher, Gabriel Scally, Devi Sridhar, Charles Tannock, Yee Whye Teh, and Harry Burns, former CMO for Scotland.[36] In October 2020, NHS England's head Simon Stevens announced the NHS had committed £10 million to be spent that year on setting up long COVID clinics to assess patients' physical, cognitive, and psychological conditions and to provide specialist treatment. Future clinical guidelines were announced, with further research on 10,000 patients planned and a designated task-force to be set up, along with an online rehabilitation service[37] – "Your Covid Recovery".[38] The clinics include a variety of medical professionals and therapists, with the aim of providing "joined-up care for physical and mental health”.[30]
The National Institute for Health Research has allocated funding for research into the mechanisms behind symptoms of Long COVID.[30]
In December 2020, University College London Hospitals (UCLH) opened a second Long Covid clinic at the National Hospital for Neurology and Neurosurgery for patients with post-Covid neurological issues. The first clinic had opened in May, primarily focused on respiratory problems, but both clinics refer patients to other specialists where needed, including cardiologists, physiotherapists and psychiatrists.[39]
On 18 December 2020, the National Institute for Health and Care Excellence (NICE), the Royal College of General Practitioners (RCGP) and the Scottish Intercollegiate Guidelines Network (SIGN) published a guide to the management of Long COVID.[40]
Public response[edit]
Multiple groups of long COVID sufferers have joined groups on social media sites that are either internationally based or on smaller geographical areas.[41][42] In many of these groups individuals post about frustrations with living with their symptoms and believed dismissal by medical professionals.[42]
List of symptoms[edit]
Symptoms reported by people with long COVID include:[43][15][16][non-primary source needed]
- Extreme fatigue
- Long lasting cough
- Muscle weakness
- Low grade fever
- Inability to concentrate (brain fog)
- Memory lapses
- Changes in mood, sometimes accompanied by depression and other mental health problems
- Sleep difficulties
- Headaches
- Joint pain
- Needle pains in arms and legs
- Diarrhoea and bouts of vomiting
- Loss of taste and smell
- Sore throat and difficulties to swallow
- New onset of diabetes and hypertension
- Skin rash
- Shortness of breath
- Chest pains
- Palpitations
See also[edit]
- Post viral cerebellar ataxia – clumsy movement appearing a few weeks after a viral infection
- Post-polio syndrome – delayed reaction appearing years after acute polio infection resolves
- Post-Ebola virus syndrome – symptoms that persist after recovering from Ebola
References[edit]
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i spoke to Professor Tim Spector of King's College London who developed the Covid-19 tracker app
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- ^ "Your COVID Recovery". Your COVID Recovery. Retrieved 19 October 2020.
- ^ "UCLH opens second 'long Covid' clinic for patients with neurological complications". University College London NHS Foundation Trust. Retrieved 19 December 2020.
- ^ "NICE, RCGP and SIGN publish guideline on managing the long-term effects of COVID-19". NICE. 18 December 2020. Retrieved 28 December 2020.
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Further reading[edit]
- Davis N (1 May 2020). "Lingering and painful: the long and unclear road to coronavirus recovery". The Guardian. ISSN 0261-3077. Retrieved 18 October 2020.
- Harding L (15 May 2020). "'Weird as hell': the Covid-19 patients who have symptoms for months". The Guardian. ISSN 0261-3077. Retrieved 18 October 2020.
- Tanner C (21 May 2020). "The people who can't shake off Covid-19 – 'Week nine and I'm back in bed'". i News. Retrieved 18 October 2020.
- "Major study into long-term health effects of COVID-19 launched in the UK". National Institute for Health Research. Retrieved 18 October 2020.
- Salisbury H (June 2020). "Helen Salisbury: When will we be well again?". BMJ. 369: m2490. doi:10.1136/bmj.m2490. PMID 32576550. S2CID 219983336.
- Keay L (25 June 2020). "Long-term COVID warning: ICU doctor reports having coronavirus symptoms for three months". Sky News. Retrieved 18 October 2020.
- Nordvig AS, Rimmer KT, Willey JZ, Thakur KT, Boehme AK, Vargas WS, Smith CJ, Elkind MS (29 June 2020). "Potential neurological manifestations of COVID-19". Neurology: Clinical Practice: 10.1212/CPJ.0000000000000897. doi:10.1212/CPJ.0000000000000897.
- "Scottish universities join Covid-19 long-term health impact study". BBC News. 5 July 2020. Retrieved 18 October 2020.
- "Major study will form basis for Covid-19 rehabilitation services, says DHSC". Pulse Today. 6 July 2020. Retrieved 18 October 2020.
- Wise J (July 2020). "GPs call for cut in red tape to manage aftermath of covid-19". BMJ. 370: m2729. doi:10.1136/bmj.m2729. PMID 32636191. S2CID 220383533.
- Kleinman Z (7 July 2020). "Coronavirus: Thousands say debilitating symptoms last 'for weeks'". BBC News. Retrieved 18 October 2020.
- Paterson RW, Brown RL, Benjamin L, Nortley R, Wiethoff S, Bharucha T, et al. (July 2020). "The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings". Brain. 143 (10): 3104–3120. doi:10.1093/brain/awaa240. PMC 7454352. PMID 32637987.
- Mahase E (July 2020). "Covid-19: What do we know about "long covid"?". BMJ. 370: m2815. doi:10.1136/bmj.m2815. PMID 32665317. S2CID 220497261.
- Prior R (19 July 2020). "Can't shake Covid-19: Warnings from young survivors still suffering". CNN. Retrieved 18 October 2020.
- Smith-Spark L, Shelley J, Borghese L (21 July 2020). "Brain fog, fatigue, breathlessness. Rehab centers set up across Europe to treat long-term effects of coronavirus". CNN. Retrieved 18 October 2020.
- Alwan NA (28 July 2020). "What exactly is mild covid-19?". The BMJ. Retrieved 18 October 2020.
- Davis H (5 August 2020). "Brain fog, phantom smells and tinnitus: my 4 months (and counting) of Covid-19". The Guardian. Retrieved 18 October 2020.
- "Can coronavirus damage 'last for life'?". The Week UK. 6 August 2020. Retrieved 18 October 2020.
- Alwan NA (August 2020). "Track COVID-19 sickness, not just positive tests and deaths". Nature. 584 (7820): 170. doi:10.1038/d41586-020-02335-z. PMID 32782377. S2CID 221107554.
- Tom B (13 August 2020). "Half of patients suffering with 'long Covid' and symptoms four months after leaving hospital". i News. Retrieved 18 October 2020.
- Morgan E (19 August 2020). "Coronavirus: How do you cure those suffering with long Covid?". ITV News. Retrieved 18 October 2020.
- Stamataki Z (19 August 2020). "Is anyone safe from Covid-19? This is what we know so far about immunity | Zania Stamataki". The Guardian. ISSN 0261-3077. Retrieved 18 October 2020.
- Knapton S (20 August 2020). "'Long Covid' is real and patients suffer debilitating symptoms for months, experts say". The Telegraph. ISSN 0307-1235. Retrieved 18 October 2020.
- Gallagher S (20 August 2020). "What is long Covid and why are people having symptoms for months?". The Independent. Retrieved 18 October 2020.
- Woodcock A (25 August 2020). "Boris Johnson denies claim he could quit as prime minister over coronavirus-related health issues". The Independent. Retrieved 18 October 2020.
- Lynch P, Manning J (27 August 2020). "UK flu jab rates prompt complacency warning". BBC News. Retrieved 18 October 2020.
- Nabavi N (September 2020). "Long covid: How to define it and how to manage it". BMJ. 370: m3489. doi:10.1136/bmj.m3489. PMID 32895219. S2CID 221520739.
- Clifton H, Deith J (8 September 2020). "Coronavirus: 'Long Covid' patients need treatment programme, doctors say". BBC News. Retrieved 18 October 2020.
- Wood V (8 September 2020). "60,000 ill with coronavirus for three months or more, professor says". The Independent. Retrieved 18 October 2020.
- Tapper J (13 September 2020). "I was infected with coronavirus in March, six months on I'm still unwell". The Observer. ISSN 0029-7712. Retrieved 18 October 2020.
- "Coronavirus patient unable to work six months on". BBC News. 14 September 2020. Retrieved 18 October 2020.
- Davis N (24 September 2020). "UK coronavirus: record 6,634 new cases reported; chancellor announces job support scheme – as it happened". The Guardian. ISSN 0261-3077. Retrieved 18 October 2020.
- Pandey V (27 September 2020). "Why India should worry about post-Covid-19 care". BBC News. Retrieved 18 October 2020.
- "People could suffer impact of having Covid for years, professor warns". ITV News. 27 September 2020. Retrieved 18 October 2020.
- Triggle N (28 September 2020). "Covid: Is it time we learned to live with the virus?". BBC News. Retrieved 18 October 2020.
- Rutherford A (29 September 2020). "Long Covid". BBC Radio 4. Retrieved 18 October 2020.
- Morris N (29 September 2020). "Boris Johnson dismisses long Covid health rumours, saying he's 'fitter than a butcher's dog'". i News. Retrieved 18 October 2020.
- Perego E, Callard F, Stras L, Melville-Jóhannesson B, Pope R, Alwan NA (1 October 2020). "Why we need to keep using the patient made term "Long Covid"". The BMJ. Retrieved 18 October 2020.
- Cox D (4 October 2020). "Long Covid: the evidence of lingering heart damage". The Observer. ISSN 0029-7712. Retrieved 18 October 2020.
- "NICE & SIGN announce latest rapid Covid-19 guideline will address Long Covid". National Institute for Health and Care Excellence. 5 October 2020. Retrieved 18 October 2020.
- Gallagher, James (5 October 2020). "'Long Covid': Why are some people not recovering?". BBC News. Retrieved 18 October 2020.
- "NHS to offer 'long covid' sufferers help at specialist centres". NHS England. 7 October 2020. Retrieved 18 October 2020.
- "Long COVID: let patients help define long-lasting COVID symptoms". Nature. 586 (7828): 170. October 2020. doi:10.1038/d41586-020-02796-2. PMID 33029005. S2CID 222217022.
- "Coronavirus: Specialist 'long Covid' clinics to be set up in England". BBC News. 7 October 2020. Retrieved 18 October 2020.
- Tanner C (7 October 2020). "I used to run marathons but long Covid has left me feeling like a weak 90-year-old". i News. Retrieved 18 October 2020.
- Stone J (6 October 2020). "Boris Johnson says claims he is suffering from long Covid are 'seditious propaganda'". The Independent. Retrieved 18 October 2020.
- Kingstone T, Taylor AK, O'Donnell CA, Atherton H, Blane DN, Chew-Graham CA (October 2020). "Finding the 'right' GP: a qualitative study of the experiences of people with long-COVID". BJGP Open. Royal College of General Practitioners. 4 (5): bjgpopen20X101143. doi:10.3399/bjgpopen20X101143. PMID 33051223. S2CID 222351478.
- Lintern S (14 October 2020). "The NHS is not ready to tackle the debilitating effects of 'long Covid'". The Independent. Retrieved 18 October 2020.
- Alwan NA, Burgess RA, Ashworth S, Beale R, Bhadelia N, Bogaert D, et al. (October 2020). "Scientific consensus on the COVID-19 pandemic: we need to act now". Lancet. 396 (10260): e71–e72. doi:10.1016/s0140-6736(20)32153-x. PMC 7557300. PMID 33069277. S2CID 222348171.
- Barrett J (15 October 2020). "Long COVID: Just how common is it?". BBC Science Focus Magazine. Retrieved 18 October 2020.
- Deith J (15 October 2020). "Scientists probe possible DNA link to 'Long Covid'". Channel 4 News. Retrieved 18 October 2020.
- Culbertson A. "Long COVID: The debilitating after-effects of coronavirus". Sky News. Retrieved 18 October 2020.
- Hutchison C (16 October 2020). "Coronavirus Scotland: Long Covid sufferers terrified they 'won't get their lives back'". The Herald. Retrieved 18 October 2020.
- Ducharme, Jamie (16 October 2020). "Studying Long-Haul Coronavirus Could Bring Benefits—and Recognition—to Forgotten Patients". Time.
- Mitchell, Natasha (22 October 2020). "COVID-19 effects can be persistent and serious say doctors suffering 'long COVID'". ABC News. Australian Broadcasting Corporation.
- "These doctors got COVID-19, now they're suffering the serious, mysterious symptoms of 'long COVID'". ABC Radio National. Science Friction. 10 October 2003. With guests Dr Ian Frayling (Ireland), Dr Nathalie Macdermott (Great Ormond Street), and Dr Nathalie Macdermott (Scotland).
- Yong, Ed (19 August 2020). "Long-Haulers Are Redefining COVID-19". The Atlantic.
- Perego, Elisa; et al. (1 October 2020). "Why we need to keep using the patient made term "Long Covid"". The BMJ Opinion.
External links[edit]
- Living with COVID-19 review, UK National Institute for Health Research (October 2020)
- Long Covid, UK Government film about long COVID
- Summary of COVID-19 Long Term Health Effects: Emerging evidence and Ongoing Investigation, University of Washington, Sep 2020
- Post-hospitalisation COVID-19 study (PHOSP-COVID) by the University of Leicester
- LongCovid.org – The Long COVID Support Group
- LongCovidSOS – A public campaign in the UK to raise awareness about the problem