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 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]

Other situations that might cause new and ongoing symptoms include:

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]

References[edit]

  1. ^ Baig AM (October 2020). "Chronic COVID Syndrome: Need for an appropriate medical terminology for Long-COVID and COVID Long-Haulers". Journal of Medical Virology. doi:10.1002/jmv.26624. PMID 33095459.
  2. ^ Staff (13 November 2020). "Long-Term Effects of COVID-19". Centers for Disease Control and Prevention. Retrieved 27 November 2020.
  3. ^ "Overview | COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance | NICE". National Institute for Health and Care Excellence. 18 December 2020. Retrieved 18 December 2020.
  4. ^ a b c d e f g h i j Greenhalgh T, Knight M, A'Court C, Buxton M, Husain L (August 2020). "Management of post-acute covid-19 in primary care". BMJ. 370: m3026. doi:10.1136/bmj.m3026. PMID 32784198. S2CID 221097768.
  5. ^ a b Sudre CH, Murray B, Varsavsky T, Graham MS, Penfold RS, Bowyer RC, Pujol JC, Klaser K, Antonelli M, Canas LS, Molteni E (19 December 2020). "Attributes and predictors of Long-COVID: analysis of COVID cases and their symptoms collected by the Covid Symptoms Study App". MedRxiv, Preprint Server for the Health Sciences. doi:10.1101/2020.10.19.20214494. S2CID 224805406. Retrieved 23 December 2020. Not peer-reviewed as of December 2020
  6. ^ Brito D, Meester S, Yanamala N, Patel HB, Balcik BJ, Casaclang-Verzosa G, et al. (November 2020). "High Prevalence of Pericardial Involvement in College Student Athletes Recovering From COVID-19". JACC. Cardiovascular Imaging: S1936878X20309463. doi:10.1016/j.jcmg.2020.10.023. PMC 7641597. PMID 33223496.
  7. ^ Cook TM (July 2020). "Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic - a narrative review". Anaesthesia. 75 (7): 920–927. doi:10.1111/anae.15071. PMID 32246849.
  8. ^ Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. (December 2020). "Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine". The New England Journal of Medicine. 383 (27): 2603–2615. doi:10.1056/NEJMoa2034577. PMC 7745181. PMID 33301246.
  9. ^ Anderson EJ, Rouphael NG, Widge AT, Jackson LA, Roberts PC, Makhene M, et al. (December 2020). "Safety and Immunogenicity of SARS-CoV-2 mRNA-1273 Vaccine in Older Adults". The New England Journal of Medicine. 383 (25): 2427–2438. doi:10.1056/NEJMoa2028436. PMC 7556339. PMID 32991794.
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  15. ^ a b "COVID-19 (coronavirus): Long-term effects". Mayo Clinic. 18 August 2020. Retrieved 19 October 2020.
  16. ^ a b "What are the long-term health risks following COVID-19?". NewsGP. Royal Australian College of General Practitioners (RACGP). 24 June 2020. Retrieved 19 October 2020.
  17. ^ Carfì A, Bernabei R, Landi F (August 2020). "Persistent Symptoms in Patients After Acute COVID-19". JAMA. 324 (6): 603–605. doi:10.1001/jama.2020.12603. PMC 7349096. PMID 32644129. Retrieved 19 October 2020.
  18. ^ a b "Context | COVID-19 rapid guideline: managing the long-term effects of COVID-19". National Institute for Health and Care Excellence. 18 December 2020. Retrieved 18 December 2020.
  19. ^ a b c d "Living with Covid19. A dynamic review of the evidence around ongoing covid-19 symptoms (often called long covid)". National Institute for Health Research. 15 October 2020. doi:10.3310/themedreview_41169. Archived (PDF) from the original on 18 October 2020.
  20. ^ 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. ISSN 2163-0402. Retrieved 27 December 2020.
  21. ^ a b Servick K (8 April 2020). "For survivors of severe COVID-19, beating the virus is just the beginning". Science. doi:10.1126/science.abc1486. ISSN 0036-8075.
  22. ^ Tanner C (12 August 2020). "All we know so far about 'long haul' Covid – estimated to affect 600,000 people in the UK". inews. Retrieved 19 October 2020. i spoke to Professor Tim Spector of King's College London who developed the Covid-19 tracker app
  23. ^ a b Ludvigsson JF (November 2020). "Case report and systematic review suggest that children may experience similar long-term effects to adults after clinical COVID-19". Acta Paediatrica. doi:10.1111/apa.15673. PMC 7753397. PMID 33205450.
  24. ^ Simpson F, Lokugamage A (16 October 2020). "Counting long covid in children". The BMJ. Retrieved 18 October 2020.
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  28. ^ Boseley, Sarah (8 September 2020). "Coronavirus: 60,000 may have 'long Covid' for more than three months – UK study". The Guardian. Retrieved 28 December 2020.
  29. ^ Davis, Nicola (16 December 2020). "Long Covid alarm as 21% report symptoms after five weeks". The Guardian. Retrieved 28 December 2020.
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  33. ^ Gallagher J (21 October 2020). "Long Covid: Who is more likely to get it?". BBC. Retrieved 21 October 2020.
  34. ^ "New research identifies those most at risk from 'long COVID'". King's College London. 21 October 2020. Retrieved 22 October 2020.
  35. ^ Cookson C (15 October 2020). "'Long Covid' symptoms can last for months". Financial Times. Retrieved 15 October 2020.
  36. ^ a b Greenhalgh, Trisha (21 September 2020). "Covid-19: An open letter to the UK's chief medical officers". The BMJ. Retrieved 19 October 2020.
  37. ^ "NHS to offer 'long covid' sufferers help at specialist centres". NHS England. 7 October 2020. Retrieved 19 October 2020.
  38. ^ "Your COVID Recovery". Your COVID Recovery. Retrieved 19 October 2020.
  39. ^ "UCLH opens second 'long Covid' clinic for patients with neurological complications". University College London NHS Foundation Trust. Retrieved 19 December 2020.
  40. ^ "NICE, RCGP and SIGN publish guideline on managing the long-term effects of COVID-19". NICE. 18 December 2020. Retrieved 28 December 2020.
  41. ^ Blazonis, Sarah (27 November 2020). "Facebook Group Created by Tampa Man Aims to Connect COVID-19 Long Haulers". www.baynews9.com. Retrieved 29 November 2020.
  42. ^ a b Witvliet, Margot Gage (27 November 2020). "Here's how it feels when COVID-19 symptoms last for months". PBS NewsHour. Retrieved 29 November 2020.
  43. ^ Yelin D, Wirtheim E, Vetter P, Kalil AC, Bruchfeld J, Runold M, et al. (October 2020). "Long-term consequences of COVID-19: research needs". The Lancet. Infectious Diseases. 20 (10): 1115–1117. doi:10.1016/S1473-3099(20)30701-5. PMC 7462626. PMID 32888409. Retrieved 19 October 2020.

Further reading[edit]

External links[edit]

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