Long covid: doctors call for research and surveillance to capture disease

A group of doctors who have been affected by persistent symptoms of covid-19 have written a manifesto based on their personal experiences.1

In a letter published in The BMJ, the group of 39 UK doctors called for research and surveillance to capture the full spectrum of disease, including in those not admitted to hospital and not tested, to build an accurate picture of covid-19 phenotypes. They said that there was an emerging picture that prolonged symptoms were having substantial effects on a significant minority of people and that death was not the only outcome to measure. They called for a clear definition of recovery from covid-19.

“Failure to understand the underlying biological mechanisms causing these persisting symptoms risks missing opportunities to identify risk factors, prevent chronicity, and find treatment approaches for people affected now and in the future,” they wrote.

The action plan also called for the establishment of one-stop clinics involving multidisciplinary teams to help the rehabilitation of patients experiencing long covid. Thorough investigations should be carried out to detect any organic pathology and to evaluate the patient’s cardiac and respiratory function before any active rehabilitation can start.

In the letter, the doctors warned against reliance on “one size fits all” online rehabilitation services as they risk “serious harm to patients if pathology goes undetected.” They pointed out that the National Institute for Health and Care Excellence recently cautioned against using graded exercise therapy for patients recovering from covid-19 and that it was important that information like this was communicated quickly to clinicians.2

Patients experiencing persisting symptoms of covid-19 have a great deal to contribute to the search for solutions and should be involved in the commissioning of clinical services and the design of research studies, the letter said. Finally, the doctors said that a clinical diagnosis should be sufficient to access any appropriate services because widespread testing was not available in the early days of the pandemic and because of the risk of false negatives associated with antibody tests.