Hello to you all,
This week saw the release of an interesting paper on long covid by the BMJ. From my experience, long covid-19 is a tricky one.
I’ve seen acute covid plenty of times in A&E but I’m now seeing what seems like long covid-19. In the absence of a rigid diagnostic criteria, I often end up listening to a patients chest, ordering an X-ray and occasional blood test only to end up shrugging my shoulders in the end. This paper is an easy read and explains some of the emerging data surrounding long covid:
Long covid is real: “a full time equivalent general practitioner with an average list size (approximately 2000) has around 65 patients with long covid, 27 of whom will have been unwell for more than a year, and 12 for more than two years.
Rates of long covid were lower in patients who were triple vaccinated.
The severity of long covid seems to be linked to the severity of the acute phase. Therefore, it’s important to enquire about a patients first experience with covid (admission/steroid use/oxygen requirement etc).
On a microscopic level there are a number of processes including microvascular damage, increase in autoimmune T cells, endothelial dysfunction and immunothrombosis.
Symptoms of long covid are general but often come in symptom clusters affecting single organ systems. The most common feature is severe fatigue which could be generalised or after exertion. Here is a useful table summarising the symptom clusters.
Investigations at the moment are generalised. There are some deeper level immunological testing available but this is not currently licensed by the NHS.
Treatment depends on the symptom cluster but involve breathing exercises, head tilt exercises for vertigo, smell training and NSAIDs for myalgia.
There are specialist long covid clinics and referrals can be made from primary care.
Hope these are useful!
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