New approaches to assisting people with long-term effects from Covid-19 should urgently be explored, with an emphasis on providing “holistic” care. This is evident from the most recent report, which was carried out by an ongoing review by a nurse.
The second paper from the study by Dr. Elaine Maxwell at the National Institute for Health Research (NIHR) revealed that there is still a lot of uncertainty about the condition known as Long Covid.
“Looking ahead, we need to offer a holistic, integrated approach rather than symptom through symptom management.”
The latest report entitled Living with Covid-19, looked at evidence from more than 300 articles and scholarly opinion pieces from around the world.
The term “Long Covid” was found to be associated with 205 different symptoms related to 10 different systems in the body.
The results confirm the results of a first NIHR report published in October 2020 that showed that the term Long Covid can be used to describe up to four different syndromes.
These included the pre-existing post-ICU syndrome and post-virus syndrome, as well as long-term organ damage.
However, the NIHR noted that there could be a fourth “Entirely Novel Syndrome” that is separate from the others so that it can be more specifically and clearly identified as “Long Covid”.
There has been evidence that Covid has long been an “active disease,” meaning that people’s condition could continue to get worse over time.
The NIHR team noted “huge differences in the estimated prevalence of Long Covid”.
The variation was not supported by the fact that some people who believe they have had Covid for a long time were not excluded in some studies because they never had an initial diagnosis of Covid-19.
“The uncertainty about previous infection means some people are struggling to access services because of their long covid symptoms,” the report added.
However, the review of the articles found that at least 10% of people infected with Covid-19 had at least one symptom for 12 weeks or more.
Among those not hospitalized for Covid-19, at least 20 to 30% experienced at least one persistent symptom about a month later and at least 10% three months later.
For those hospitalized, between 50% and 89% have at least one persistent symptom after two months.
Further results of the review were:
- Increased signs of organ dysfunction in both those who were hospitalized and those who stayed at home;
- The symptom of “brain fog” often reported by long-term Covid patients may have a neurological rather than a social cause.
- Long Covid appears to be more common in women and young people than would be expected based on acute Covid-19 trends.
- In one study, 30% of people had anxiety and / or depression one to three months after recovering from Covid-19.
In addition to reviewing the scientific work, the NIHR team conducted its own survey of more than 3,000 people with long Covid.
The survey found that for a long time Covid influenced family life in 71% of respondents, while it impaired their ability to work for 80% of respondents.
Almost a third (32%) did not have access to all of the health services they felt were necessary. Almost a quarter (23%) of the respondents would like a clerk to coordinate their care.
The NIHR team concluded that there is an urgent need for further research into the incidence of long-term Covid and its causes, as well as various treatments for those affected.
The report also reflected concerns from the first review in October that current NHS services were not prepared to meet the needs of this new group of patients.
“What we currently refer to as ‘Long Covid’ is likely to cover a range of syndromes that require different approaches.”
A “quick assessment” of various service and workforce models for people with long-term Covid was therefore required.
“Long Covid can be a multi-system disease and some people may have an active disease that needs to be continuously monitored in secondary care,” the report said.
“This requires joint care management between specialist areas and between primary and secondary care,” it says.
“New models for the delivery of services that allow quick access to an increasing number of people with long covid need to be designed and evaluated. This also requires a multi-professional personnel strategy. “
The author of the report, Dr. Maxwell, added, “Long Covid’s management has so far focused on ruling out other diagnoses, treating and rehabilitating individual symptoms, and access to services has varied.
“Looking ahead, we need to offer a holistic, integrated approach rather than symptom through symptom management,” she said.
“We recommend a quick assessment of various service models and the mix of qualifications in order to support people with long-term Covid.”
Dr. Maxwell, content director of the NIHR Center for Engagement and Dissemination, previously served as the Executive Director of Nursing for the NHS.
She heads the ongoing long Covid review, which is supported by a steering group that also includes the head of community maintenance, Dr. Crystal Oldman, the executive director of the Queen’s Nursing Institute, belongs.
Meanwhile, Professor Chris Whitty, Chief Medical Officer for England and Co-Head of the NIHR, commented on the latest findings: “This is a useful review of the evidence currently available for the persistent symptoms after Covid, currently known as ‘Long Covid’ . This is very debilitating for some of those who have had Covid.
“What we currently refer to as ‘Long Covid’ is likely to cover a range of syndromes that require different approaches.
“It is important that we find out what exactly the different elements of ‘Long Covid’ are and then we can target research on those parts to prevent and treat it,” he said.
NHS England has set up a network of dedicated Covid clinics across the country.
Health and Social Services Secretary Matt Hancock said: “Today’s report will help improve understanding and management of Long Covid, in addition to the £ 20 million research grant to support innovative projects and clinics across the country . “
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