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Content ArticleNearly a year into the global coronavirus pandemic, scientists, doctors and patients are beginning to unlock a puzzling phenomenon: For many patients, including young ones who never required hospitalisation, COVID-19 has a devastating second act. Many are dealing with symptoms weeks or months after they were expected to recover, often with puzzling new complications that can affect the entire body—severe fatigue, cognitive issues and memory lapses, digestive problems, erratic heart rates, headaches, dizziness, fluctuating blood pressure, even hair loss. What is surprising to doctors is that many such cases involve people whose original cases weren’t the most serious, undermining the assumption that patients with mild COVID-19 recover within two weeks. Doctors call the condition “post-acute Covid” or “chronic Covid,” and sufferers often refer to themselves as “long haulers” or “long-Covid” patients. “Usually, the patients with bad disease are most likely to have persistent symptoms, but Covid doesn’t work like that,” said Trisha Greenhalgh, professor of primary care at the University of Oxford and the lead author of an August BMJ study that was among the first to define chronic Covid patients as those with symptoms lasting more than 12 weeks and spanning multiple organ systems. Other viral outbreaks, including the original SARS, MERS, Ebola, H1N1 and the Spanish flu, have been associated with long-term symptoms. Scientists reported that some patients experienced fatigue, sleep problems and joint and muscle pain long after their bodies cleared a virus, according to a recent review chronicling the long-term effects of viral infections. What differentiates COVID-19 is the far-reaching nature of its effects. While it starts in the lungs, it often affects many other parts of the body, including the heart, kidneys and the digestive and nervous systems, doctors said. “I haven’t really seen any other illness that affects so many different organ systems in as many different ways as Covid does,” said Zijian Chen, medical director for Mount Sinai Health System’s Center for Post-Covid Care. Read the full article in the Wall Street Journal.
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Content Article
Reflections of a COVID-19 Long Hauler (11 November 2020)
Patient Safety Learning posted an article in Blogs
Jeffrey Siegelman awoke on a Monday morning with a headache. Fever followed, and the next morning could taste nothing. Now, after more than 3 months of living with COVID-19 and the fatigue that has kept him couch-bound, Jeffrey reflects on what it means to be a patient, how an illness ripples through family and community, and how he will use this experience to be a better physician. Here is what he has learned. -
Content ArticleLecture presentation slides from Professor Carl Philpot, University of East Anglia, on losing your sense of smell with coronavirus.
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Content ArticleLarge numbers of people are being discharged from hospital following COVID-19 without assessment of recovery. Mandal et al. followed 384 patients who had tested positive and had been treated at Barnet Hospital, the Royal Free Hospital or UCLH. Collectively the average length of stay in hospital was 6.5 days. The team found that 54 days after discharge, 69% of patients were still experiencing fatigue, and 53% were suffering from persistent breathlessness. They also found that 34% still had a cough and 15% reported depression. In addition 38% of chest radiographs (X-rays) remained abnormal and 9% were getting worse. The study has identified persisting symptoms and radiological abnormalities in a significant proportion of subjects. These data may assist with the identification of people outside expected recovery trajectories who could benefit from additional rehabilitation and/or further investigation to detect post-COVID complications.
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Content ArticleFifth Sense is a UK charity that supports people affected by smell and taste disorders across the world and provides direct support, advice, and a signpost to potential diagnosis and treatment to people affected by such conditions. They regularly update their repository of information about smell/taste loss and COVID-19. It contains articles, interviews and video presentations to keep those affected by the virus and experiencing smell and taste loss informed with the latest news and research.
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Content ArticleAs we seek to develop a national healthcare system that delivers true 21st century care, we are confronted by a COVID-19 pandemic that has identified numerous challenges. Among the most important: the need to provide correct diagnoses. Definitive answers about diagnosis are critical not only for patients, but also for their families and others around them. Consequential questions gnaw at us: Are we diagnosing COVID-19 correctly? Are we missing cases? How do we know? How can we improve? Gopal Khanna and Jeff Brady are hopeful that some of the changes that have resulted from the US's battle against the pandemic will spark the long-term improvements in diagnostic safety that will strengthen the system’s ability to address COVID-19 and other challenges we face.
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Content Article
When the doctor Is a Covid ‘Long Hauler’
Patient Safety Learning posted an article in Blogs
Coronavirus may leave patients with a condition called POTS that makes the heart rate soar after even the mildest activities. Shannon Gulliver Caspersen is a physician in the US who contracted what was initially a fairly mild case of COVID-19 in early March. Seven months later, she remains substantially debilitated, with profound exhaustion and a heart rate that goes into the stratosphere with even the tiniest bits of exertion, such as pouring a bowl of cereal or making a bed. In this article in the New York Times, Shannon discusses her experience of long covid and her diagnosis of postural orthostatic tachycardia syndrome (POTS) and her concerns on how much disability we will accumulate by the end of this pandemic. -
Content ArticleThe past several months have shown that most people hospitalized with COVID-19 will get better. As inspiring as it is to see these patients breathe on their own and converse with their loved ones again, we are learning that many will leave the hospital still quite ill and in need of further care. But little has been published to offer a detailed demographic picture of those being discharged from our nation’s hospitals and the types of community-based care and monitoring that will be needed to keep them on the road to recovery. Dr. Francis Collins takes a look at the current research.
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Content ArticleDr John Campbell, a retired A&E nurse, discusses the research and evidence on the long-term health consequences of COVID-19 in this video.
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Content ArticlePost-intensive care syndrome (PICS) is a nonspecific syndrome that results from physical, mental, and emotional stresses associated with critical illness and treatment in intensive care units (ICUs). Common features include neuromuscular weakness from immobility, cognitive impairment from sedation, and anxiety, depression, post-traumatic stress syndrome (PTSD), and, as we are learning, additional sequelae for COVID-19 survivors. Symptoms can manifest or persist weeks, months, or years after patient discharge. This eBook from ECRI provides an overview of PICS, the common danger signs health providers and family members should be able to identify, and its potential long term negative effects. Learn about strategies like creating an ICU diary to help mitigate risks, in addition to understanding other recommendations to consider to protect the safety and well-being of patients during their recovery.
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Content ArticleReports of 'Long-COVID' are rising but little is known about prevalence, risk factors, or whether it is possible to predict a protracted course early in the disease.
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Content ArticlePatient Safety Movement's Dr Donna Prosser is joined by Dr Steven Deeks, Professor of Medicine, University of California, San Francisco, and Dr Jake Suett, Staff Grade Anaesthetist and Intensive Care Doctor, UUK, to discuss the long term implications of COVID-19 from clinical and personal perspectives. Dr Deeks shares the research around long COVID-19 symptoms and Dr Suett provides a personal anecdote of his experience with symptoms that have lasted months. Dr. Suett shares information about the COVID symptom study, which consists of an international mobile app to track COVID-19 symptoms over time.
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Content ArticleDoctors who contracted COVID, and thought the symptoms would be over in weeks, tell Jennifer Trueland about their continuing pain, exhaustion and – sometimes – struggle to be believed
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Content ArticlePatients collectively made Long Covid – and cognate term ‘long-haul Covid’ – in the first months of the pandemic. Patients, many with initially ‘mild’ illness, used various kinds of evidence and advocacy to demonstrate a longer, more complex course of illness than laid out in initial reports from Wuhan. Long Covid has a strong claim to be the first illness created through patients finding one another on social media: it moved from patients, through various media, to formal clinical and policy channels in just a few months. This initial mapping of Long Covid – by two patients with this illness – focuses on actors in the UK and USA and demonstrates how patients marshalled epistemic authority. Patient knowledge needs to be incorporated into how COVID-19 is conceptualised, researched, and treated.
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Content ArticleFrom acute delirium to long term fatigue, COVID-19 has serious neuropsychiatric effects. Viral infections of the respiratory tract can have multisystemic effects, including on the central nervous system (CNS), and thus may precipitate a spectrum of psychiatric and neurological disorders. Some patients with COVID-19 are now known to develop various CNS abnormalities with potentially serious and long term consequences, including stroke and isolated psychiatric syndromes. As COVID-19 cases rise again worldwide, Butler et al. review what we know and don’t know about the acute and chronic neuropsychiatric sequelae and their potential mechanisms.
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Content ArticlePeople aged under 60 who are hospitalised with COVID-19 are more likely than expected to experience severe psychiatric symptoms. Research found that altered mental states such as psychosis are being reported in these younger patients. It confirmed that strokes and other neurological symptoms are common in severe COVID-19. The authors are gathering and analysing more detailed clinical information about the patients reported in this study, and others reported since (540 are now included). They are seeking funding for a further study to include more clinical investigations such as analysis of spinal fluid, blood and brain imaging. Author Benedict Michael is co-chairing a World Health Organization commissioned task force which will consider how to use the information from the ongoing research project in guidance for clinicians. The task force will consider whether people with new-onset altered mental state or another acute neurological problem should be tested for COVID-19. Some patients with few respiratory signs present with this symptom. They will consider which tests and investigations people with COVID-19 and neurological symptoms should undergo. Doctors need to be sure COVID-19 is the cause of the symptoms, and to know how patients should be managed.
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Content ArticleApproximately 10% of patients with COVID-19 experience symptoms beyond 3–4 weeks. Patients call this 'long covid'. Greenhalgh et al. sought to document the lived experience of such patients, their accounts of accessing and receiving healthcare, and their ideas for improving services. They held 55 individual interviews and 8 focus groups with people recruited from UK-based long Covid patient support groups, social media and snowballing. Participants were invited to tell their personal stories and comment on other stories.
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Content ArticleNeurological symptoms are seen in patients with COVID-19 and can persist or re-emerge after clearance of SARS-CoV-2. Recent findings suggest that antibodies to SARS-CoV-2 can cross-react with mammalian proteins. Focusing on neurological symptoms, Kreye et al. discuss whether these cross-reactive antibodies could contribute to COVID-19 disease pathology and to the persistence of symptoms in patients who have cleared the initial viral infection.
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Content Article'Long Covid' is a term is used to describe individuals who continue to suffer from COVID-19 symptoms outside of the two-week period in which they are believed to be infected. The World Health Organization (WHO) endorsed this two-week period as enough time for the virus and its symptoms to be able to come and go, yet studies are revealing cases in which symptoms are persisting well outside of this window. Survivors may have a chronic debilitating illness for many months.
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Content ArticlePatient Led Research for COVID-19 invite you to participate in this research study if you have previously experienced or you are currently experiencing symptoms consistent with COVID-19 as a result of suspected or confirmed SARS-CoV-2 infection. The aim of this research study, sponsored by University College London (UCL), is to better describe and understand the patient experience and recovery of those with confirmed or suspected COVID-19, with a specific emphasis on the Long COVID experience. The focus of this study includes participants’ backgrounds, testing, symptoms, and psychological wellbeing. A secondary aim of this study is to publish patient-driven data in order to advocate for the Long COVID population within the medical community. Patient Led Research for COVID-19 are a self-organised group of COVID-19 long-haul patients working on patient-led research around the COVID experience and prolonged recoveries. They are all researchers in relevant fields – participatory design, neuroscience, public policy, data collection and analysis, human-centered design, health activism – in addition to having intimate knowledge of COVID-19.
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Content ArticleThis is the first study, published in Age and Ageing, demonstrating higher prevalence of probable delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.
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Content ArticleSeptember is Gynaecological Cancer Awareness Month. Through September The Eve Appeal runs a national campaign, Go Red, and this year they are raising awareness of the key red flag symptom – abnormal bleeding. They have created this infographic highlighting the signs and symptoms.
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Content ArticleThe COVID-19 pandemic has caused unprecedented morbidity, mortality and global disruption. Following the initial surge of infections, focus shifted to managing the longer-term sequelae of illness in survivors. ‘Post-acute COVID’ (also known as ‘Long COVID’) is emerging as a prevalent syndrome. It encompasses a plethora of debilitating symptoms (including breathlessness, chest pain, palpitations and orthostatic intolerance) which can last for weeks or more following mild illness. Dani et al. describe a series of individuals with symptoms of ‘Long COVID’, and posit that this condition may be related to a virus- or immune-mediated disruption of the autonomic nervous system resulting in orthostatic intolerance syndromes. They suggest that all physicians should be equipped to recognise such cases, appreciate the symptom burden and provide supportive management. They present our rationale for an underlying impaired autonomic physiology post-COVID-19 and suggest means of management.
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Content ArticleThis NHS Resolution video looks at three diseases where GPs often miss the diagnostic signs resulting in late referrals: cauda equina, colorectal cancer and subarachnoid haemorrhage. Clinical symptoms to be aware of in these diseases are highlighted.
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Content ArticleNeonatal herpes simplex virus (HSV) disease is a rare, and potentially fatal, disease which usually occurs in the first four weeks of a baby's life. Early recognition and treatment of the virus has been shown to significantly improve babies' chances of making a full recovery. Kit Tarka Foundation works to prevent newborn baby deaths; primarily through raising awareness of neonatal herpes, funding research and providing advice for healthcare professionals and the general public.
