Long Covid could be a long-term problem

10% of people who have had Covid-19 may have symptoms and side effects for months afterwards and this will be a strain on the healthcare system, says Darragh Bermingham
Long Covid could be a long-term problem

360,000 people in Ireland have contracted the Covid-19 virus since the onset of the pandemic in early 2020.

The Covid-19 virus has killed four million people worldwide, infected many more, and has had an unprecedented impact, socially and economically. It has also left a new threat that the world could be facing for years: Long Covid.

360,000 people in Ireland have contracted the Covid-19 virus since the onset of the pandemic in early 2020.

The HSE said that 10% of these people could get long Covid, with long-term symptoms ranging from brain fog and fatigue to organ damage or neurological issues.

In May this year, the HSE said it was finalising a national model of management for long Covid, and chief clinical officer, Dr Colm Henry, said that clinics had already been established in some hospitals.

Dr Henry said that the HSE was finalising a formal, community-based model for the management of long Covid, which would provide pathways for patients who require specialist care.

A Cork researcher has highlighted the need for more research on long Covid to identify its risk factors and how to achieve better care options.

Liam O’Mahony, professor of immunology at University College Cork, is working with infectious-disease doctors at Cork University Hospital to study long Covid in Ireland.

Speaking to The Echo, Professor O’Mahony said that long Covid is reducing quality of life for those who contract it, and said more research was needed.

“There are a wide range of symptoms and levels of severity, but many people do report a very significant impact on their ability to return to the same quality-of-life level that they had pre-infection,” Prof O’Mahony said.

“We don’t yet know the exact number of people that develop long Covid and one of the primary research activities, right now, is to try and identify the risk factors that might increase someone’s chance of developing long Covid.

“A co-ordinated, precision-medicine approach that empowers the patient-researcher-clinician partnership will be required to optimally care for the individual needs and circumstances of each person with long Covid,” Prof O’Mahony said.

“The future is still uncertain, but we hope that the ongoing, engaged research activities will lead to new options and improved care for those with long Covid in the near future.”

Meanwhile, Cork healthcare workers have highlighted the need for a swift approach to monitor the growing problem of long Covid and resource the services that will be required to tackle it, possibly for years to come.

Liam O’Mahony Principal Investigator at APC Microbiome Ireland SFI Research Centre & Prof of Immunology University College Cork, Tanja Buwalda, Long COVID sufferer and representative of Long Covid Support Ireland - patient support group, Dr Corinna Sadlier, Consultant in Infectious Diseases at Cork University Hospital and Prof Paul Ross, APC Director who are collaborating on ‘Tackling Long COVID Together’ - a public information webinar about Long COVID taking place 6pm, Tuesday 28th September. Image:Gerard McCarthy
Liam O’Mahony Principal Investigator at APC Microbiome Ireland SFI Research Centre & Prof of Immunology University College Cork, Tanja Buwalda, Long COVID sufferer and representative of Long Covid Support Ireland - patient support group, Dr Corinna Sadlier, Consultant in Infectious Diseases at Cork University Hospital and Prof Paul Ross, APC Director who are collaborating on ‘Tackling Long COVID Together’ - a public information webinar about Long COVID taking place 6pm, Tuesday 28th September. Image:Gerard McCarthy

Speaking to The Echo, both GP Dr Paul O’Sullivan and physiotherapist Shane Hennessy said time is of the essence in tackling long Covid and its impact on people.

“The truth is, we do not know the full extent of the impact long Covid will have on our health system yet, but the signs, so far, suggest it will put a huge strain on our already overrun primary care services, such as GPs and physiotherapists,” Mr Hennessy said.

“One recent study suggested that one in 10 patients with Covid will experience symptoms beyond 12 weeks.

“The most common symptoms reported are fatigue, breathlessness, headaches, and joint and muscle soreness,” he said.

Mr Hennessy has already encountered patients who appear to be suffering from long-Covid issues. “One patient, in their early 40s, had Covid in March this year, who continues to suffer with severe episodes of fatigue after minimal activity,” Mr Hennessy said.

“There are no clear evidence-based guidelines yet on how to manage these patients, but what we do know is they need to be closely monitored, as they work through a rehabilitation programme.”

At the height of the Covid-19 pandemic, when many hospitals were battling high numbers of cases every day, physiotherapists in acute hospitals did vital work, Mr Hennessy said.

With the worst of the pandemic seemingly behind us, the focus will shift to physiotherapists in the community.

“Physiotherapists working in acute hospitals played a hugely important role throughout the pandemic, in ICU and hospital wards, helping patients with breathlessness to regain their mobility,” Mr Hennessy said.

“However, the emphasis now will move towards the community services, such as supervised group classes and individualised assessments and rehabilitation programmes.”

Mr Hennessy said that prior to the onset of the pandemic in the early months of last year, there were already lengthy waiting lists for physiotherapy.

That these waiting lists do not impact upon patients with long Covid needs to be a priority for government, he said.

“Before the pandemic, there had been a substantial waiting list for physiotherapy services around the country, with waiting times of over 12 months for certain services,” Mr Hennessy said. “If patients with long Covid are to gain timely access to important rehabilitation services, then this will need to be resourced and quickly.”

Mr Hennessy outlined some advice for anyone who thinks they may have long-Covid complications, and recommended a slow return to normality.

“My advice to anyone who thinks they may be suffering from long Covid and wants to get back doing the activities they enjoy would be to take a cautious approach, and very gradually increase their activity levels each week, whilst closely monitoring how they feel afterwards,” he said.

“If they are worried about it, then they should contact their GP or physiotherapist.”

Bantry GP Dr Paul O’Sullivan said his practice has already seen a number of patients who presented with symptoms associated with long Covid.

Dr O’Sullivan highlighted the importance of monitoring these cases and providing additional medical assistance.

“We have seen occasional cases, some which involve persistent shortness of breath and tiredness and lethargy, muscle aches, and so on,” Dr O’Sullivan said.

“We have also seen it causing a brain fog, which affects work and dealing with detailed issues.

“I think it is an emerging issue and I feel that a lot of people don’t know they have it or are reluctant to come to see doctors about it,” he said.

“However, as more and more cases emerge and they are persistent, these people would meet the needs for long-term monitoring and medical assistance, and they may find it difficult to return to work in the way they did before.”

A spokesperson for the HSE said that a national approach to post-Covid-19 or long Covid has been developed and the HSE are recruiting for an implementation lead for a long-Covid care model.

“The HSE, as part of its work on post-Covid, is looking at how it can model the possible numbers that will be affected, noting that this will take time as more evidence emerges,” the spokesperson said.

“There is a lot of uncertainty in the international literature about how many people experience prolonged symptoms, so it is extremely difficult to determine the scale, as yet, in Ireland.

“However, we are monitoring the situation very closely and looking at how we can best estimate the scale. This will take some time and will need continual review.

“Longer-term observational studies will be required to understand the health consequences presently being attributed to post-Covid-19 infection. The HSE has been in touch with, and will be engaging with, a group of people who are suffering post-Covid symptoms.”

The spokesperson said that guidance is being developed to align needs with care provision and to develop criteria and strategies for the evaluation of patients.

“There is a range of supports available in general practice and in the hospital setting, and we are working on further developing those supports,” they said.

“Treatment is currently focused on management of specific symptoms.

“The hospital team that provides the ongoing support will depend on the nature of the symptoms, or in the cases of those previously admitted to hospital, the team that led their hospital care, and could include cardiologists, respiratory physicians, infectious-disease specialists, or others, as appropriate,” the spokesperson said.

UCC is to host a webinar on long Covid in the coming weeks. Register at: https://conference. ucc.ie/tackling-long-covid-together/long-covid/Site/Register

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