Long COVID; an emerging complication of COVID-19

Since pandemic of COVID-19 new outcomes, manifestations, variations in clinical course and treatments are coming to light. Approximately 20% of those who develop COVID-19 experience symptoms that continue for at least a month however one in 12 are still unwell after 12 weeks on more. This condition has been termed Long COVID. The underlying cause for it is yet not very clear. The mechanism by which the infection leads to Long COVID are poorly understood. The behaviour of COVID-19 is different from a number of other viruses which can infect human and cause disease. Although some of the symptoms such as tiredness did exist for months among some patients after viral infection, there is growing evidence that this virus cannot only cause direct organ damage but also give rise to a number of other abnormal responses for example increase in blood clotting and release of pro-inflammatory molecules. As a result, a number of organs such as heart, lungs and brain are affected.

The reason why some people get Long COVID and the others do not remain unknown, although early observations show that an increasing age, the number of symptoms in the acute phase and being female favours the possibility of developing Long COVID. Children can also rarely develop Long COVID although up to now the mechanism of disease and its outcome among children seems to be relatively different compared to adults. One of the major causes for the lack of data in different groups is in part due to the lack of agreed definition of this condition so far.

Long COVID, in a small number of patients, can be very debilitating in nature and those suffering from it report various functional disabilities. So far there is no simple test or an individual symptom for diagnosing COVID-19, many people experience severe fatigue and a range of troubling physical symptoms develop that make it difficult for those who are employed to return to work. This has obvious economic and manpower consequences both at the level of families as well as on the national level. There are very significant serious effects on individual social life. This affects the mental health and may have significant economic consequences for them, their families and for society.

The is a need to have a consensus on best practice points for the assessment and management of COVID-19. The importance of multidisciplinary and multi-speciality approach may have a key role to play. Existing guidelines propose that the initial management of COVID should be in the primary care and should include a series of investigations both to find how the individual is affected and to exclude other conditions that may coexist. The lack of reliability of any single test and multiplicity of the symptoms patients may present with as well as a self-limiting nature of the infection in the majority of patients creates difficulties for making a universally acceptable plan although there is a growing need for a universally accessible management which should be tailored to the manifestations of disease, including investigations and a timely referral for signs of involvement of different organ systems in human body.

Particular attention should be paid to actions amid at narrowing inequalities in Long COVID, including employment rights and sick pay policies, particularly for healthcare workers more at risk than others. At present very few countries have developed specific policies or benefit packages to support patients to access disability benefits if the Long COVID develops and as a matter of fact, this complication of COVID-19 is not only being underestimated but also is being under treated and under supported.

Policy response needs to take account of the complexity of COVID-19 and Long COVID. A number of other areas, apart from those mentioned above, need to be addressed apart from having a multidisciplinary approach to assessment and management of this condition. We need to develop new care pathways in association with patients and their families in context with guidelines for professionals, especially in primary care to enable case management to be tailored to the manifestations of disease and its severity due to the involvement of different organ systems. Healthcare providers and health systems need to develop appropriate services including rehabilitation and online support tools. We need to take an urgent action to tackle the wider consequences of Long COVID, including attention to employment rights, sick pay policies, and access to benefits and disability allowances where appropriate.

Patient involvement is also to foster self-care and self-help and in shaping the awareness of Long COVID and its services; which is very important for the future management of this condition. There needs to be implementation of well-functioning patient registers and other surveillance systems; creating cohorts of patients; and following up those affected. This will also help in the research which is so critical to the understanding and treatment of Long COVID.

Different European countries have been responding to the emergencies of this new condition and its complications with organised healthcare system responses although all these actions are still in early stages. There are also examples of initiatives undertaken by local service providers and professional bodies that other countries can learn from. Patients suffering from Long COVID have been instrumental in shaping awareness, research and service provision. The importance of patients affected by the Long COVID is increasingly being recognised. Self-help groups have been created in several European countries as well as outside Europe which are not only helping in research but also helping in the rehabilitation is of those who are badly affected.

Given the many unanswered questions about this condition, a productive research is a high priority. Patients cohorts are being created, clinical course of individual disease is being studied closely, something that will be of great value for the evaluation of potential treatments.