Millions of people in the UK may well be suffering from long COVID, according to two pieces of tracking research published today.
The government-backed REACT-2 study found that a third of people who suffered from COVID-19 reported long-lasting symptoms of the condition.
A second study estimates that one in six COVID patients have developed long COVID.
Both are published as doctors debate treatment for the condition, raising parallels with chronic fatigue syndrome. The government has allocated £100 million for care – with £30 million going to GP practices.
The REACT-2 study, led by Imperial College, London, found 5.8% of the population reporting symptoms – with 2% reporting severe symptoms.
Programme director Professor Paul Elliott said: “Our findings do paint a concerning picture of the longer-term health consequences of COVID-19, which need to be accounted for in policy and planning. Long COVID is still poorly understood but we hope through our research that we can contribute to better identification and management of this condition, which our data and others suggest may ultimately affect millions of people in the UK alone.
“People with persistent symptoms at 12 weeks fell into two broad groups. In the first the most common symptom was tiredness and muscle aches. In the second, the most common symptoms were shortness of breath affecting normal activities, tightness in chest, and chest pain, with more people reporting that they had severe symptoms.”
A second study, by University and King’s College London, found 17% of middle-aged survivors of COVID reporting symptoms with the proportion falling to 7.8% among young adults.
The problem was 50% greater among women than men. The findings come analysis of data from more than 1.2 million primary health records together with some population studies involving 45,000 people.
The researchers set out to identify risk factors linked to long COVID, linking it to pre-existing asthma and poor mental and physical health before contracting the disease.
Researcher Dr Dylan Williams, from UCL, said: “Our findings hint at the mechanisms behind long COVID. Next, we need to identify the predispositions that might explain, for example, why women or individuals with asthma appear to be at higher risk. Could a liability to suffer from autoimmunity or allergies play a role? Establishing concrete research avenues to go down will eventually lead to benefits for people with long COVID.”
Long COVID and chronic fatigue treatments
The issue of long COVID has reignited tensions about treatment and rehabilitation of chronic fatigue syndrome (CFS), according to a report in The BMJ today.
Freelance journalist Melanie Newman spoke to clinicians and academics involved in myalgic encephalomyelitis (ME)/CFS and long COVID research, finding doctors who have been challenged for speaking out about the role of exercise in rehabilitation.
In 2011, the PACE trial found that both cognitive behavioural therapy (CBT) and graded exercise therapy (GET) led to greater improvements in some participants than medical care alone. But some CFS/ME advocates objected to suggestions that the illness has a psychological element.
Now, similar arguments are resurfacing with long COVID, which is believed to affected about 376,000 people in the UK, with symptoms that are similar to post-viral fatigue syndromes and ME/CFS.
Michael Sharpe, a professor of psychological medicine, reported he was criticised for suggesting the disease is “all in the mind” or created by the media, while an activist asked for Trish Greenhalgh, professor of primary care at Oxford University, to be removed from a conference because she had previously commented on exercise and PACE in a public webinar.
Professor Paul Garner at the Liverpool School of Tropical Medicine, who has recovered from long COVID, told Newman that some people are opposed to research on exercise.
“They believe the disease lasts for life,” he said. “They reject any research that examines psychological approaches to treatment or that evaluates the role of progressive physical activity in recovery in ME/CFS, and I would assume by extension to long COVID.”
Charles Shepherd, medical adviser at the ME Association, added: “We are not against exercise. Our view is that graded exercise can be harmful.”
Newman spoke to other doctors and healthcare professionals treating long COVID patients. Who said they were aware of the concerns and were quietly working out how best to treat each patient without causing them harm.
She writes that results are so far mixed.
CFS/ME specialist Rachael Rogers at the Oxford long COVID clinic, believes careful screening, assessment and individualised treatments should be the focus.
Respiratory consultant Paul Whitaker, who set up the first long COVID clinic in Yorkshire, added: “For my longstanding patients with long COVID who fulfil the criteria for CFS they do seem to get worse with strenuous aerobic exercise. However, long COVID is a very diverse group and there are many others who do need an exercise based regimen.”
Newman M. Chronic fatigue syndrome and long COVID: moving beyond the controversy. BMJ 24 June 2021; doi: 10.1136/bmj.n1559
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