Understanding the impact of long COVID

The wide-ranging effects of long COVID and the associated issues for healthcare providers have been revealed in a new review of the major studies into the condition, which specifically highlights the impact of long COVID impact on the cardiovascular system.

But first things first: long COVID refers to lingering symptoms after infection with the SARS-CoV-2 virus that causes COVID-19.

The ailment is characterised by a diverse range of symptoms and signs spanning multiple organ systems including the respiratory system, neurological system, cardiovascular system, gastrointestinal system, dermatological system, endocrine/genitourinary systems, and skeletal muscle/joints as illustrated here. PTSD, post-traumatic stress disorder.

Thankfully, people with mild-to-moderate cases of COVID-19 ordinarily get better within one to two weeks, but severe cases can go on for months.

Researchers do not yet fully understand long COVID, also known as long-haul COVID, post-acute COVID, or chronic COVID. Experts worldwide are trying to understand who is most at risk of its short- and long-term health effects.

Some studies have found that nearly 37% of people had long-COVID symptoms up to 6 months after the infection, and half of those who did not require admission to the hospital had one or more symptoms of long COVID.

Multi-institute review

Now, a major new review published in the European Heart Journal, conducted by researchers from the University of Oxford, the University of Wisconsin School of Medicine and Public Health, Royal Brompton Hospital and Imperial College, London, as well as the University of Zurich, Switzerland, sheds new light on the issue.

The review spans each step from a patient’s original coronavirus infection and the direct impacts, such as myocardial infarction or inflammatory myocarditis, to the long-term impacts on aspects of wellbeing such as mental health and fatigue.

The researchers also concluded that current evidence for the treatment of long COVID is lacking and that our current understanding of pathophysiological mechanisms and treatment options remains limited.

They also found that the vast inequalities in healthcare provision exposed by COVID-19 continue to be magnified by long COVID, a problem that calls for global humanitarian efforts to promote and fund equitable access to healthcare, social and welfare support, and vaccines across the world.

Public health

Dr Betty Raman, of Oxford’s Radcliffe Department of Medicine, said: “Long COVID is emerging as a major public health issue, which makes it important that we better understand the long-term effects of COVID-19 to improve our treatment of it.”

“This review highlights the wide range of short and long-term health impacts and the mechanisms behind them, which is key to providing treatment and ongoing care.”

Professor Stefan Neubauer, head of the Division of Cardiovascular Medicine, Radcliffe Department of Medicine, added: “Long COVID is a huge medical challenge. This review gives a comprehensive update on its effect on the cardiovascular system, and will also be important in guiding future research into the condition and for finding new treatments.”

Dr Betty Raman is currently leading one of the first randomized, double-blind, placebo-controlled studies in the UK. Other trials to date have been open label or non-random assignment of therapy. The team’s work is supported by the NIHR Oxford Biomedical Research Centre, a partnership between Oxford University Hospitals NHS Foundation Trust and the University of Oxford.

Professor Thomas Lüscher, director of Research, Education and Development, Royal Brompton and Harefield Clinical Group, said: “This is the first review that summarises the diverse evidence on Long Covid and provides a balanced picture of this important issue. The pandemic brought not only acute illness and death, it became a chronic disease of many organs, not just the lungs, but the heart, brain, kidney among others.”

“Long Covid is, besides its huge impact for the affected individual, of great societal and economic importance as it leads to leave of absence from work, reduced work performance and hence unforeseen costs.”

Treatment options

According to the paper, Long COVID is emerging as a major public health issue. It says that our current understanding of pathophysiological mechanisms and treatment options remains limited; however, there is great optimism as several national and international research initiatives promise to disentangle the complexities of this disease.

The high burden of cardiopulmonary symptoms it found, along with other organ manifestations, underscores the need for multispecialty input – a model that is likely to also profit other chronic diseases.

Proactive screening

The paper suggests that proactive screening and investigation, where appropriate, could allay fears and anxiety among patients. Considerable efforts to find the right balance between cost-effective investigations and benefit to patients are needed to ensure sustainable service provision in these challenging economic times.

Finally, it adds, the vast inequalities in healthcare provision exposed by COVID-19 will continue to be magnified by long COVID, a problem that calls for global humanitarian efforts to promote and fund equitable access to healthcare, social and welfare support, and vaccines across the world.

The full paper, ‘Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus’, can be read in the European Heart Journal.

According to the paper, Long COVID is emerging as a major public health issue. It says that our current understanding of pathophysiological mechanisms and treatment options remains limited; however, there is great optimism as several national and international research initiatives promise to disentangle the complexities of this disease.

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