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Content Article
Top picks: 12 research papers on Long Covid
Patient Safety Learning posted an article in Blogs
We are seeing more and more people who have been devastated by the long-lasting impact of Covid-19. Long Covid is a relatively new condition which is still being studied and the need for more awareness and advocacy has never been greater. Scientists are carrying out large-scale clinical trials and researchers are on the hunt for new therapies in the hope that patients with Long Covid will finally see improvements in treatment and support for their symptoms. In this Top picks blog, shared on International Long Covid Awareness Day, we highlight 12 recent research papers on Long Covid.- Posted
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Content ArticleMore than 3 years after the onset of the Covid-19 global pandemic, a wave of evidence suggests that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to postacute sequelae in pulmonary and broad array of extrapulmonary organ systems—including increased risks and burdens of cardiovascular disorders, neurologic and mental health disorders, metabolic disorders (diabetes and dyslipidemia), kidney disorders and gastrointestinal disorders. However, up until now, evidence is mostly limited to the first year postinfection. Bowe et al. built a cohort of 138,818 individuals with SARS-CoV-2 infection and 5,985,227 noninfected control group from the US Department of Veterans Affairs and followed them for 2 years to estimate the risks of death and 80 prespecified postacute sequelae of Covid-19 (PASC) according to care setting during the acute phase of infection. They found that the increased risk of death was not significant beyond 6 months after infection among nonhospitalised but remained significantly elevated through the 2 years in hospitalised individuals. Within the 80 prespecified sequelae, 69% and 35% of them became not significant at 2 years after infection among nonhospitalised and hospitalised individuals, respectively. In summary, while risks of many sequelae declined 2 years after infection, the substantial cumulative burden of health loss due to PASC calls for attention to the care needs of people with long-term health effects due to SARS-CoV-2 infection.
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Content ArticleThis study compared the blood of patients with confirmed Covid-19 infection with that of uninfected controls. The authors found that there were changes to serum proteins in the blood of patients experiencing Long Covid. This indicates activation of the immune system’s complement cascade, altered coagulation and tissue injury. At the cellular level, Long Covid was linked to aggregates comprising monocytes and platelets. These findings provide knowledge of potential biomarkers for diagnosis and may inform directions for treatments.
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News ArticleNearly 70 healthcare workers with Long Covid will take their fight to the High Court later to sue the NHS and other employers for compensation. The staff, from England and Wales, believe they first caught Covid at work during the pandemic and say they were not properly protected from the virus. Many of them say they are left with life-changing disabilities and are likely to lose income as a result. The Department of Health said "there are lessons to be learnt" from Covid. The group believe they were not provided with adequate personal protective equipment (PPE) at work, which includes eye protection, gloves, gowns and aprons. In particular, they say they should have had access to high-grade masks, which help block droplets in the air from patient's coughs and sneezes which can contain the Covid virus. But the masks they were given tended to be in line with national guidance. Rachel Hext, who is 36, has always insisted that she caught Covid in her job as a nurse in a small community hospital in Devon. "It's devastating. I live an existence rather than a life. It prevents me doing so much of what I want to do. And it's been four years." Her list of long Covid symptoms includes everything from brain fog and extreme fatigue to nerve damage, and deafness in one ear. Solicitor Kevin Digby, who represents more than 60 members of the group, describes their case as "very important". He says: "It's quite harrowing. These people really have been abandoned, and they are really struggling to fight to get anything. "Now, they can take it to court and hope that they can get some compensation for the injuries that they've suffered." Read full story Source: BBC News, 6 March 2024 Related reading on the hub: Healthcare workers with Long Covid: Group litigation – a blog from David Osborn The pandemic – questions around Government governance: a blog from David Osborn
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Content ArticleThis cohort study in the Lancet aimed to evaluate the overall effect of vaccination to prevent Long Covid symptoms and assess comparative effectiveness of the most used vaccines (ChAdOx1 and BNT162b2). The results showed that vaccination against Covid-19 consistently reduced the risk of Long Covid symptoms, which highlights the importance of vaccination to prevent persistent Covid-19 symptoms, particularly in adults.
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News Article
‘Brain fog’ from Long Covid has measurable impact, study suggests
Patient Safety Learning posted a news article in News
People experiencing Long Covid have measurable memory and cognitive deficits equivalent to a difference of about six IQ points, a study suggests. The study, which assessed more than 140,000 people in summer 2022, revealed that Covid-19 may have an impact on cognitive and memory abilities that lasts a year or more after infection. People with unresolved symptoms that had persisted for more than 12 weeks had more significant deficits in performance on tasks involving memory, reasoning and executive function. Scientist said this showed that “brain fog” had a quantifiable impact. Prof Adam Hampshire, a cognitive neuroscientist at Imperial College London and first author of the study, said: “It’s not been at all clear what brain fog actually is. As a symptom it’s been reported on quite extensively, but what our study shows is that brain fog can correlate with objectively measurable deficits. That is quite an important finding.” Read full story Source: The Guardian, 29 February 2024- Posted
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Content ArticlePoor memory and difficulty thinking or concentrating (commonly referred to as “brain fog”) have been implicated in syndromes occurring after Covid-19 — a situation that has led to suggestions that Covid-19 may have lasting cognitive consequences. However, objective data on cognitive performance are largely lacking, and how long such deficits may persist and which cognitive functions are most vulnerable are unclear. In this observational study, Hampshire et al. invited 800,000 adults in a study in England to complete an online assessment of cognitive function. The authors estimated a global cognitive score across eight tasks. They hypothesised that participants with persistent symptoms (lasting ≥12 weeks) after infection onset would have objectively measurable global cognitive deficits and that impairments in executive functioning and memory would be observed in such participants, especially in those who reported recent poor memory or difficulty thinking or concentrating (“brain fog”). They found that participants with resolved persistent symptoms after Covid-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration Covid-19 was still associated with small cognitive deficits after recovery. Longer-term persistence of cognitive deficits and any clinical implications remain uncertain.
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Content ArticlePatient engagement technologies (PETs) are tools used to guide patients through the perioperative period. This study in the American Journal of Surgery aimed to investigate the levels of patient engagement with PETs through the perioperative period and its impact on clinical outcomes. The authors found that use of PETs improves patient outcomes and experiences in the perioperative period. Patients who engage more frequently with PETs have shorter length of stay (LOS) with lower readmission and post-operative complication rates.
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Content ArticleStudies from medical and surgical intensive care units (ICU) suggest that long-term outcomes are poor for patients who have spent significant time in an ICU. This study in the American Journal of Surgery aimed to identify determinants of post-intensive care physical and mental health outcomes 6–12 months after injury. The authors found that: Delirium during an intensive care unit (ICU) stay is linked with long-term physical impairment in injury survivors who spent three or more days in the ICU. The use of ventilators in the ICU is another factor associated with long-term physical impairment and mental health symptoms in these patients. Delirium and ventilator use are potentially modifiable, suggesting opportunities for improving patient outcomes. They suggest that that this knowledge can inform the development of interventions that specifically target delirium and ventilator use to mitigate long-term impairments.
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Content ArticleThis Lancet article highlights new evidence from analysis of population-based electronic health records for almost the entire population of the UK. The analysis showed that, as of 1 June 2022, a high proportion of the population had received fewer than the recommended number of Covid-19 vaccinations: 45·8% in England, 49·8% in Northern Ireland, 34·2% in Scotland and 32·8% in Wales. Combining the results across countries suggests that a substantial number of severe Covid-19 outcomes, including hospital admissions or deaths from Covid-19, might be prevented if recommended vaccination schedules were fully implemented. These findings reinforce the message that the role of vaccination in Covid-19 is to mitigate the severity of the illness, reducing the risk of complications and mortality, rather than avoiding all Covid-19 infections.
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Content ArticleIn the fast-evolving realm of contemporary healthcare, surgical techniques have attained unprecedented levels of advancement, leading to substantial enhancements in patient care. However, the journey towards complete recovery extends far beyond the operating room, emphasising the importance of effective postoperative care. In this critical phase, patient partnerships play a pivotal role, ensuring a holistic and personalised approach to recovery.
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Five bold predictions for Long Covid in 2024 (25 January 2024)
Patient-Safety-Learning posted an article in Blogs
With a number of large-scale clinical trials underway and researchers on the hunt for new therapies, Long Covid scientists are hopeful that this is the year patients will finally see improvements in treating their symptoms. This article in Medscape makes five research-based predictions that could happen in 2024. They provide promising signs of progress in treating a debilitating and frustrating disease. The predictions are: We'll gain a better understanding of each Long Covid phenotype Monoclonal antibodies may change the game Paxlovid could prove effective for Long Covid Anti-inflammatories like metformin could prove useful Serotonin levels may be keys to unlocking Long Covid- Posted
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Content ArticleIn this episode of the Medicine and the Machine podcast, Scottish GP Gavin Francis talks about the need to reconsider the importance of convalescence. He discusses the role of GPs in supporting patients through recovery after a hospital admission or period of illness and talks about a lack of awareness of the principles of convalescence amongst patients.
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Content ArticleDelayed discharges from hospital are a widespread and longstanding problem that can have a significant impact on both patients’ recovery and the efficiency and effectiveness of health and care services. In England, it has become normal practice for government to provide additional one-off funding to reduce delays every winter, as the problem is particularly acute during the colder months.
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Content ArticleThe pandemic is not gone but it is largely forgotten. Especially the first year, with its two devastating waves in which over 140,000 people died. The NHS reorganised itself completely to deliver care to the thousands of very sick Covid patients, alongside continuing care for other patients throughout. The system strained and buckled and staff were pushed to their limits and beyond. The impact continues today as the NHS is weaker, less resilient and with much longer waits than before. In this article, Christina Pagel looks back at the reality of the first year and its aftermath and hears anonymous testimony from staff at the NHS front line. “Staff sitting in literal cupboards crying alone because staff weren’t allowed to sit together & we couldn’t take all the death around us. It was utterly traumatising”
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News Article
The ‘wrecked’ lives of forgotten Long Covid sufferers
Patient Safety Learning posted a news article in News
Nearly four years since the start of the coronavirus outbreak, you could be forgiven for believing the pandemic is behind us. But for many, it feels far from over. Close to two million people face a daily battle with debilitating symptoms of Long Covid – the lasting symptoms of the virus that remain after the infection is gone – with some now housebound, unable to walk and even partially blind. Alan Chambers, 49, is among those who have been grappling with the illness for years, having caught coronavirus in March 2020. Mr Chambers went from being “a fit, healthy, working member of the community who would do anything to help anyone” to being “ill and isolated in our bedroom”, blind in one eye and no longer able to walk unaided, his wife Vicki said. As of March, an estimated 1.9 million people in the UK have experienced coronavirus symptoms for more than four weeks, according to the latest figures from the Office for National Statistics. Of those, 1.5 million reported the condition had adversely affected their day-to-day activities. It comes as coronavirus case rates have shown an overall increase since July, with fears the approaching winter will bring a further surge in infections. Yet in May, the World Health Organisation (WHO) declared that coronavirus no longer represents a global health emergency, which was seen as a symbolic step towards the end of the pandemic. Dr Jo House, founding member and health advocacy lead at Long Covid Support, said the advocacy group now has 62,000 members, with about 250 more people joining every month. “In their words, they feel ‘forgotten, unheard, disbelieved, isolated, unemployed, disabled, immobile’. NHS England admitted to The Independent that access to necessary support, treatment and care for Long Covid patients is still lacking. It said there was “still more to do to ensure support is there for everyone who needs it”, so that patients requiring specialist assessment and treatment for Long Covid can access care in a timely way. Read full story Source: The Independent, 29 November 2023- Posted
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Content Article
Surgical Voices podcasts
Patient Safety Learning posted an article in Surgery
A series of podcasts from Molnlycke UK, with host Steve Feast, discussing topics such as sustainability, patient safety and more.- Posted
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News Article
Brain fog after Covid linked to blood clots - study
Patient Safety Learning posted a news article in News
Blood clots in the brain or the lungs might explain some common symptoms of "Long Covid", including brain fog and fatigue, a UK study suggests. In the study, of 1,837 people admitted to hospital because of Covid, researchers say two blood proteins point to clots being one cause. It is thought 16% of such patients have trouble thinking, concentrating or remembering for at least six months. But the research team, from the universities of Oxford and Leicester, stress: Their findings are relevant only to patients admitted to hospital. They are "the first piece of the jigsaw" but further research is needed before they can propose or test any potential treatments. They tracked cognitive problems at six and 12 months only and through tests and questionnaires, which may "lack sensitivity". Identifying predictors and possible mechanisms was "a key step" in understanding post-Covid brain fog, study author Prof Paul Harrison, from the University of Oxford, said. Leicester's professor of respiratory medicine, Chris Brightling, said: "It's a combination of someone's health before, the acute event itself and what happens afterwards that lead on to physical and mental health consequences." Read full story Source: BBC News, 31 August 2023- Posted
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Content ArticleThe aim of the Long Covid webinar held on 5 July 2023 was to discuss where we are now with Long Covid clinics and research. The presentation videos from the webinar can be accessed from the link below.
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Content ArticleIn a new Lancet Respiratory Medicine Series about Long Covid, Sally J Singh and colleagues discuss the origins of respiratory sequelae and consider the promise of adapted pulmonary rehabilitation programmes and physiotherapy techniques for breathing management. Pratik Pandharipande and colleagues review the epidemiology and pathophysiology of neuropsychological sequelae of COVID-19-related critical illness, highlighting the combined threat of long COVID and post-intensive care syndrome (PICS), and outline potential mitigation strategies. Finally, Matteo Parotto and colleagues discuss pathophysiological mechanisms of diverse, multisystem sequelae in adult survivors of critical illness, including longitudinal effects of endothelial and immune system dysfunction, and consider the challenges of providing appropriate care and support for patients.
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Content ArticleSuccessful day surgery requires a day surgery team with the correct knowledge and skills to enable safe, early recovery and discharge but there is an absence of national guidance on supporting competencies. Applying in-patient competency criteria is inappropriate as this pathway is not aimed at promoting early discharge. This joint publication between AfPP and BADS (the British Association Of Day Surgery) provides recommendations for core competencies for adult day surgery through (1) admission, (2) anaesthetic room, (3) theatres, (4) first-stage recovery and (5) second-stage recovery and discharge. They are relevant for staff new to or after a long absence from day surgery and acknowledge some members of the day surgery team may include non-registered practitioners. All can be used as a reference for workbook competency documents in place or in development.
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Content ArticleThe AHRQ Safety Program for Improving Surgical Care and Recovery (ISCR) Toolkit helps hospitals improve patients' surgical experience by adopting enhanced recovery practices. Enhanced recovery practices are evidence-based processes that are supported by multidisciplinary teams and span the continuum of perioperative care. Hospitals can use the toolkit to apply the evidence for enhanced recovery within the proven principles and methods of AHRQ's Comprehensive Unit-based Safety Program (CUSP) to prevent complications such as surgical site infections, venous thromboembolism, and urinary tract infection, and improve perioperative safety culture.
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News Article
Long Covid can impair quality of life more than advanced cancers, study says
Patient Safety Learning posted a news article in News
Many people with Long Covid have a lower health-related quality of life than people with some advanced cancers, research suggests. Fatigue is the symptom with the greatest impact on the daily lives of Long Covid patients, according to a study led by researchers at University College London (UCL) and the University of Exeter. They found that many were seriously ill and had fatigue scores worse than or similar to people with cancer-related anaemia or severe kidney disease. Their health-related quality of life scores were also lower than those of people with advanced metastatic cancers, such as stage 4 lung cancer. Overall, the impact of long Covid on the daily activities of patients was worse than that for stroke patients and comparable to people with Parkinson’s disease. The study co-author Prof William Henley, of Exeter University medical school, said: “Long Covid is an invisible condition, and many people are left trying to manage significant changes to how they can function. “Shockingly, our research has revealed that Long Covid can leave people with worse fatigue and quality of life than some cancers, yet the support and understanding is not at the same level. We urgently need more research to enable the development of evidence-based services to support people trying to manage this debilitating new condition.” Read full story Source: The Guardian, 8 June 2023- Posted
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Content ArticleThis study from Walker et al. describes self-reported characteristics and symptoms of treatment-seeking patients with Long Covid and assesses the impact of symptoms on health-related quality of life (HRQoL) and patients’ ability to work and undertake activities of daily living. It found that a high proportion were of working age with over half reporting moderately severe or worse functional limitation. There were substantial impacts on ability to work and activities of daily living in people with Long Covid. Clinical care and rehabilitation should address the management of fatigue as the dominant symptom explaining variation in functionality.
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