Living with long COVID
Post-COVID syndrome, or long COVID, is an increasing problem. Debbie Duncan looks at the evidence for management in primary care
One in five people have symptoms that persist after 5 weeks, and one in ten have symptoms for 12 weeks or longer after an acute COVID-19 infection (Office for National Statistics [ONS], 2020). NICE (National Institute for Health and Care Excellence, 2020) defines this condition as post-COVID syndrome or long COVID. Common symptoms vary from fatigue, shortness of breath, palpitations, insomnia and anxiety and depression and encompasses a plethora of debilitating symptoms (Dani et al, 2021). The new guideline for NICE (2021) recommends that patients presenting with new or ongoing symptoms 4 weeks or later after an initial COVID infection should have the investigations done to rule out acute, life-threatening complications or identify any unrelated diagnosis (NICE, 2021). Garg et al (2020) suggests that long COVID is a multisystem syndrome and needs a multifaceted approach to tackle the physical, cognitive, psychological, social, and vocational aspects of this condition. This article looks at the literature about long COVID and suggests there is a clear pathway for treatment in primary care. All physicians should be equipped to recognise long-COVID and provide supportive management (Dani et al, 2021).
The ONS predict that that one in five people have symptoms that persist after 5 weeks, and one in ten have symptoms for 12 weeks or longer after acute COVID-19 infection (ONS, 2020). NICE defines post-COVID syndrome or long COVID as symptoms that continue more than 12 weeks after a coronavirus infection, which are not explained by another condition NICE (2020).
Despite the fact that one fifth of COVID-19 patients have long COVID, the specific causes remain unclear. What is known is that mast cells are activated by the SARS-CoV-2 virus and the disease is a chronic multisystem disorder with inflammatory action (Afrin et al, 2020; Wang et al, 2020). Certainly following direct viral invasion thrombosis, hyper activation of the immune system and hormonal dysregulation have led to the acute symptoms of COVID-19 but it is unclear what plays a part in long COVID (Yelin et al, 2020). It is also unclear why some people recover quicker than others. Persistent viremia due to weak or absent antibody response, deconditioning, post-traumatic stress and an acute immune response may all contribute to the recovery time (Greenhalgh et al, 2020). The symptoms also vary from person to person but there is an extensive list of common symptoms mirroring the complex impact of COVID-19 and outlined by NICE (2020) (Box 1). It encompasses a plethora of debilitating symptoms which can last for weeks (Dani et al, 2021).
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