INTRODUCTION
Long COVID-19 (LC) is defined as the persistent symptoms ≥12 weeks following acute COVID-19 infection. The Office for National Statistics, ONS, estimated that there are 2M self-reported UK patients with (LC) ie 3% population (REF1).
METHODS & RESULTS
We currently have 400 adult patients in our teaching hospital NHS trust (which serves a population of 800 000) being managed with LC ie 0.0005% and another 120 on the waiting list. Applied nationwide, this suggests that only a small proportion of self-reported LC cases have the benefit of Hospital-based treatment. Raised BMI, associated type 2 diabetes, anxiety- depression and asthma were common co-morbidities as was seen in the national study.
A recent analysis by Subramaniam et al (2022) of national GP records of 486,149 non-hospitalized patients with some of 62 possible recorded LC symptoms during the first two surges of the pandemic produced three symptom cluster classes. The three classes were heterogenous symptoms, respiratory and anxiety-depression. Mean age was 43.8 years (s.d. 16.9), 55.3% of participants were female. 64.7% were white, 12.2% were Asian origin, 4.0% were Black Afro-Caribbean; 16.2% had missing ethnicity data. 53.8% were overweight or obese (BMI data missing for 13.0%), and 22.5% were current smokers (smoking data missing for 4.3%).
Separately, three leading (but not mutually exclusive) hypotheses and some putative treatments for each have been proposed (Couzin Frankel, 2022) :
1. Microvascular blood clots (identified by single photon emission computed tomography SPECT-CT or Hyperpolarised hyperpolarized xenon 129 MRI (XeMRI ) to identify alveolar capillary diffusion limitation – DOAC anticoagulants
2. Persistent virus-antiviral therapy
3. An aberrant immune system – antihistamines
The results from the available clinical trials of treatment are awaited. Stimulate ICP. (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways) tests the effectiveness of repurposed drugs (participants are allocated to (1) usual care, (2) famotidine/loratadine antihistamines, (3) Colchicine anti-inflammatory or (4) Rivaroxaban DOAC anticoagulant groups for 3 months). to treat long COVID. The effects of 3 months of treatment is measured on peoples’ symptoms, mental health and other outcomes in patients attending 6-10 UK LC clinics. Cluster randomisation is at level of primary care networks so that integrated care pathway interventions are delivered as “standard of care” in that area. (Forshaw et al 2023)
CONCLUSIONS
Given the paucity of patients being referred to hospital, the majority of patients do not have ready access to advanced diagnostic techniques, associated tailored putative treatments or the above clinical trials. Underpowered clinical trials have in the past failed to provide reliable results applicable to the general population.
New approaches using analysis of real-world data of vastly larger patient numbers combined with machine learning may deliver reliable results faster in the future. Such initiatives are in line with UK government ambitions to provide more services out of hospitals, a larger primary care workforce and greater integration with social care, so that care is more joined up to meet people's physical health, mental health and social care needs.