We are now entering the second year of the COVID-19 pandemic caused by one of the SARS coronaviruses, SARS-CoV-2. As of 30 March 2021, more than 127 million cases have been confirmed, with more than 2.79 million deaths attributed to COVID-19, making it one of the deadliest pandemics in history.

The symptoms can vary from none, to life threatening illness predominantly affecting the respiratory system. Spread is mainly airborne and may also spread via contaminated surfaces, and people can be contagious for up to 2 weeks even if they are not displaying any symptoms.

There have been more than 4.3 million confirmed cases of coronavirus in the UK and over 126,000 people have died. As lockdown restrictions ease, figures are at a low with 4,560 people with coronavirus in hospital across the UK. PHE figures for 28th March show that no deaths have been reported in London due to Covid-19 for the second time this year, and there were 56 deaths across the UK within 28 days of a positive test for coronavirus reported on 30 March 2021.

The vaccine programme which was the first in the world starting on 8th December 2020 has now resulted in an incredible 30,444,829 people being given a first dose by the end of 28 March 2021 which accounts for half of the UK’s adult population, and more than three million people have had a second dose. At Preventicum, 100% of our medical team have been vaccinated.

The majority of people who have SARS-CoV-2 either have no or mild symptoms. If they get symptoms these usually appear within 2-14 days of being infected and last for a couple of weeks. Around 1% of people will die from SARS-CoV-2, but as treatments for the disease improves, survival rates are also going up. The majority of people make a full recovery within 12 weeks. However, what we are also seeing is that some people have prolonged symptoms which have been called “Long Covid” or “Post-COVID-19 syndrome”.

At present there is no long-term evidence base to determine how long the ongoing effects seen after an infection will last and the term “post COVID-19 syndrome” reflects the acute phase of the illness has ended, not that the person has recovered.

 

There are two stages to what is commonly known as Long COVID:

  • Ongoing symptomatic COVID-19 – symptoms that last 4-12 weeks
  • Post-COVID-19 syndrome – symptoms that last for more than 12 weeks and cannot be explained by another diagnosis

Older people and people with underlying medical conditions are the most likely to experience lingering COVID-19 symptoms, but even young, otherwise healthy people can feel unwell for weeks to months after infection.

Other long-term signs and symptoms may include:

  • Brain fog
  • Insomnia
  • Dizziness
  • Palpitations
  • Mood changes
  • Tinnitus and ear pain
  • Nausea, diarrhoea and a reduction in appetite
  • Changes to sense of smell or taste
  • Rashes or hair loss

Everyone experiences the symptoms differently and they are not always constant.

At the start of the illness severe COVID-19 can cause significant lung problems including pneumonia and respiratory failure, which can result in permanent damage and scarring to the lungs, and so is seen as a disease that primarily affects the lungs. But it can damage many other organs including the heart and brain as well and this organ damage may increase the risk of long-term health problems. COVID-19 can also make blood cells more likely to clump up and form clots. While large clots can cause heart attacks and strokes, much of the heart damage caused by COVID-19 is believed to come from very small clots that block tiny blood vessels (capillaries) in the heart muscle. Other parts of the body affected by blood clots include the lungs, legs, liver and kidneys.  It can also cause heart muscle inflammation and heart rhythm disturbances.

The British Lung Foundation and Asthma UK’s post-COVID survey of over 1000 patients, of which over 800 had not been admitted to hospital, found that:

“…many people who had mild – moderate COVID are now on a long road to recovery, affecting both their physical and mental health” and

“When asked what symptoms most affect them, the top five were: breathing problems (90%), extreme tiredness (64%), sleep problems (22%), cough (22%) and changes in mood, or anxiety or depression (22%). The majority of people had not experienced these symptoms before having COVID.”

Potential explanations for long Covid include this may be the result of a persistent immune response that is triggered by the virus which causes inflammation and damage to other parts of body, it could be due to tissue damage done during the acute part of the illness and the virus could also hide in the body as we had seen with other viruses e.g. EBV and herpes before reactivating. There have also been a number of comparisons between long Covid and chronic fatigue syndrome/ME which is also linked to viral infections.

Currently the only treatment available are those that manage the symptoms, optimise overall health and boost immune function through supportive therapy and lifestyle factors including diet and exercise.

Unfortunately we cannot predict how long recovery from long Covid will take, this is not unique to this illness as other viral illnesses can also have lasting effect. When looking at the data from other viruses this suggests that the majority of symptoms will resolve within 3 months, although tiredness may persist for longer, but this may not apply to everyone. There does not seem to be a direct correlation between the seriousness of COVID-19 and the long-term illness.

In October 2020 NHS England and NHS Improvement announced a £10 million investment to help local services in every part of the country bring together the right professionals. These professionals will provide physical, cognitive and psychological assessments of those experiencing suspected post-COVID syndrome, so that they are put onto the right clinical pathway to treat their symptoms.

If you have persistent symptoms following COVID-19 infection please do follow up with your GP who can arrange further investigations which might include blood tests, observations like blood pressure and heart rate and a chest x-ray. There are a number of excellent private services and specialists who also offer a multidisciplinary approach to managing long covid symptoms.

It is important to remember that most people who have COVID-19 recover quickly. But the potentially long-lasting problems make it even more important to reduce the spread of the disease by following precautions such as wearing masks, social distancing, hand hygiene and following the government guidelines.

Sources:

https://www.nhs.uk/conditions/coronavirus-covid-19/long-term-effects-of-coronavirus-long-covid/

https://www.yourcovidrecovery.nhs.uk/

https://www.nice.org.uk/guidance/ng188/documents/final-scope

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/11/C0840-national-guidance-for-post-covid-syndrome-assesment-clinics-111220.pdf

https://en.wikipedia.org/wiki/COVID-19_pandemic