https://doi.org/10.36866/pn.25.7

As I write my first “Chief Executive’s View” of 2022, I feel fortunate to be doing so from our headquarters in London. I felt that back-to-school excitement and buzz to be meeting face to face with colleagues in the office when the restrictions were again lifted in January.

While the COVID-19 pandemic is still very much a feature of our daily lives and facemasks continue to be the norm, I hope that meeting in person will be able to continue. Both for staff, for our members and the wider community of physiologists as we create opportunities for in-person collaboration and networking – to raise the visibility of physiology through an inclusive approach for a sustainable future.

As we enter the third year of living with COVID-19, I thought I would reflect on what has gone before and think of the year to come with its many opportunities and, no doubt, challenges for both physiology and physiologists.

Since the emergence of the novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, it has spread across the globe, having a profound effect on our health and lives. Globally, as of 28 January 2022, the World Health Organization reports there have been 364,191,494 confirmed cases, including 5,631,457 deaths (WHO, 2022).

When Coronavirus Disease 2019 (COVID-19) was first documented it was initially assumed to be a respiratory disease and classification was based around pneumonia severity, breathlessness, and low oxygen levels. Doctors and scientists including physiologists worked to try and understand this completely new disease and how to treat it. However, reports came in describing, mainly in severe cases, that in addition to the virus affecting the lungs it was also affecting multiple organs such as heart, liver and kidney, as well as the haematological and nervous systems (Mokhtari et al., 2020).

The Society quickly formed a COVID-19 advisory panel and launched our “Questions from the Frontline” initiative, which sought to provide physiological insight to clinicians dealing with patients by providing an evolving understanding of the physiological and pathophysiological mechanisms underpinning this disease.

We followed this up with “COVID-19: Lessons from the Frontline”. Working with the Intensive Care Society, the conference shared current knowledge and thinking across many physiological systems, showcased the symbiotic relationship between physiology and clinical care and helped set the agenda for research to identify future treatments and therapies.

Most people who have COVID-19 recover completely within a few weeks. But some have long-term problems recovering from the infection – even those who had mild versions of the disease. The term “long COVID” was coined for post-COVID conditions by patients (Perego et al., 2020); other terms have also been used, such as long haul COVID, postacute COVID-19 and chronic COVID.

The guideline scope published on 30 October 2020 by health watchdog the National Institute for Health and Care Excellence (NICE, 2020), defines long COVID as signs and symptoms that develop during or following an infection consistent with COVID-19, which continue for more than 12 weeks and are not explained by an alternative diagnosis. The definition says the condition usually presents with clusters of symptoms, often overlapping, which may change over time and can affect any system within the body. It also notes that many people with post-COVID-19 syndrome can experience generalised pain, fatigue, persisting elevated temperature and psychiatric problems. But there is no agreed-upon definition.

In a BMJ Opinion piece by Professor Paul Garner seven weeks into his journey he described his rollercoaster of ill health, extreme emotions, and utter exhaustion following COVID-19.

The illness went on and on. The symptoms changed, it was like an advent calendar, every day there was a surprise, something new. A muggy head; acutely painful calf; upset stomach; tinnitus; pins and needles; aching all over; breathlessness; dizziness; arthritis in my hands; weird sensation in the skin with synthetic materials. Gentle exercise or walking made me worse—I would feel absolutely dreadful the next day.

The Office for National Statistics (ONS) estimates about 1.3 million people in the UK were experiencing self-reported long COVID (symptoms persisting for more than four weeks after the first suspected COVID-19 infection that were not explained by something else) as of 6 December 2021 (ONS, 2022). It is clearly a public health concern affecting people’s ability to resume normal life and their capacity to work.

The Society ran an online conference in February 2022 – Long COVID: Mechanisms, Risk Factors, and Recovery – which reviewed the challenges of understanding the pathophysiological changes following COVID-19 infection. It brought together physiologists and clinicians, so we can better understand the underlying mechanisms and identify potential therapies. The conference report can be found in this issue.

Tedros Adhanom Ghebreyesus, WHO’s Director-General, has called on countries to prioritise recognition, rehabilitation, and research for the long-term consequences of COVID-19, as well as collection of data for long COVID (Ghebreyesus, 2020). As new variants of the virus occur, physiology and physiologists will be at the forefront of this search for answers.

References

Garner P. (2020). For 7 weeks I have been through a roller coaster of ill health, extreme emotions, and utter exhaustion. The BMJ Opinion [Online] Available at: https://blogs.bmj. com/bmj/2020/05/05/ [Accessed 28 January 2022].

Ghebreyesus TA (2020). WHO Director-General’s opening remarks at the media briefing on COVID-19. World Health Organization. [Online] Available at: https://bit.ly/3uu4XHl [Accessed 28 January 2022].

Mokhtari T. et al. (2020). COVID-19 and multiorgan failure: A narrative review on potential mechanisms. Journal of Molecular Histology 51(6), 613–628. doi: 10.1007/ s10735-020-09915-3.

NICE (2020). COVID-19 guideline scope: management of the long-term effects of COVID-19. [Online] Available at: https://www.nice.org.uk/guidance/ng188/documents/finalscope [Accessed 28 January 2022].

Office for National Statistics (2022). Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK : 6 January 2022. [Online] Available at: https://bit. ly/3gvChFv [Accessed 28 January 2022].

Perego E. et al. (2020). Why the Patient-Made Term ‘Long Covid’ is needed. Wellcome Open Research. [Online] Available at: https://wellcomeopenresearch.org/articles/5-224 [Accessed 28 January 2022].

World Health Organization (2022). WHO Coronavirus (COVID-19) Dashboard. [Online] Available at: https://covid19.who.int/ [Accessed 28 January 2022].