Intended for healthcare professionals

Letters Management of long covid

From doctors as patients: a manifesto for tackling persisting symptoms of covid-19

BMJ 2020; 370 doi: (Published 15 September 2020) Cite this as: BMJ 2020;370:m3565
  1. Nisreen A Alwan, associate professor in public health1,
  2. Emily Attree, salaried general practitioner2,
  3. Jennifer Mary Blair, consultant anaesthetist and trust lead for simulation and human factors3,
  4. Debby Bogaert, chair of paediatric medicine, professor of paediatric infectious diseases, and honorary consultant paediatric infectious diseases4,
  5. Mary-Ann Bowen, general practice partner5,
  6. John Boyle, consultant psychiatrist6,
  7. Madeleine Bradman, general practitioner7,
  8. Tracy Ann Briggs, senior lecturer and honorary consultant in clinical genetics8,
  9. Sarah Burns, general practitioner9,
  10. Daniel Campion, travel health physician2,
  11. Katherine Cushing, general practitioner and clinical commissioning group clinical lead for children, young people, and families10,
  12. Brendan Delaney, chair in medical informatics and decision making11,
  13. Chris Dixon, full time general practice partner12,
  14. Grace E Dolman, hepatology specialty trainee year 713,
  15. Caitriona Dynan, consultant radiologist14,
  16. Ian M Frayling, honorary consulting genetic pathologist and president elect151617,
  17. Nell Freeman-Romilly, foundation doctor18,
  18. Iulia Hammond, general practice specialty trainee year 119,
  19. Jenny Judge, consultant forensic psychiatrist20,
  20. Linn Järte, core trainee year 2 anaesthetist21,
  21. Amali Lokugamage, consultant obstetrician and gynaecologist and honorary associate professor22,
  22. Nathalie MacDermott, NIHR academic clinical lecturer and specialty trainee year 7 paediatric infectious diseases23,
  23. Mairi MacKinnon, general practitioner24,
  24. Visita Majithia, salaried general practitioner2,
  25. Tanya Northridge, general practice partner25,
  26. Laura Powell, anaesthetics core trainee year 126,
  27. Clare Rayner, consultant occupational physician27,
  28. Ginevra Read, specialty trainee year 8 psychiatry26,
  29. Ekta Sahu, specialty doctor paediatrics28,
  30. Claudia Shand, retired general practitioner29,
  31. Amy Small, general practice partner and, member303132,
  32. Cara Strachan, general practitioner33,
  33. Jake Suett, staff grade anaesthetist and intensive care doctor34,
  34. Becky Sykes, salaried general practitioner35,
  35. Sharon Taylor, consultant child and adolescent psychiatrist2,
  36. Kevin Thomas, general practitioner36,
  37. Margarita Thomson, general practitioner2,
  38. Alexis Wiltshire, locum general practitioner37,
  39. Victoria Woods, general practitioner38
  1. 1University of Southampton
  2. 2London
  3. 3Epsom and St Helier University Hospitals NHS Trust
  4. 4Centre for Inflammation Research, University of Edinburgh, Edinburgh
  5. 5West Midlands
  6. 6Belfast
  7. 7North Yorkshire
  8. 8University of Manchester
  9. 9Southampton
  10. 10Newcastle
  11. 11Imperial College London
  12. 12Bexhill on Sea
  13. 13Cambridge University Hospitals NHS Foundation Trust
  14. 14Antrim Area Hospital Northern Ireland
  15. 15St Mark’s Hospital, Harrow
  16. 16St Vincent’s Hospital, Dublin
  17. 17Association of Clinical Pathologists
  18. 18Oxford
  19. 19Greater Manchester
  20. 20Surrey and Borders NHS Trust
  21. 21Swansea
  22. 22University College London
  23. 23King’s College London
  24. 24Inverness
  25. 25Brixton Hill Group Practice
  26. 26Severn Deanery
  27. 27Altrincham
  28. 28Coventry
  29. 29Hook, Hampshire
  30. 30Prestonpans Group Practice
  31. 31BMA Scottish Council
  32. 32BMA Scottish GP Committee
  33. 33East Lothian
  34. 34Queen Elizabeth Hospital King’s Lynn
  35. 35Bristol
  36. 36Pontcae Medical Practice, Merthyr Tydfil
  37. 37Liverpool
  38. 38Chandler’s Ford
  1. jakesuett{at}

We write as a group of doctors affected by persisting symptoms of suspected or confirmed covid-19. We aim to share our insights from both personal experience of the illness and our perspective as physicians.

Tackling this problem will involve collaboration between politicians, healthcare services, public health professionals, scientists, and society. We call for the following principles to be used so that the best possible outcomes can be achieved for all people affected by persisting symptoms of covid-19.

  • Research and surveillance—persisting symptoms of covid-19 should be dealt with using a scientific methodology and without bias. People experiencing them should be counted.

The effects of the virus should be studied in the way that any other disease would be, with thorough attention paid to epidemiology, pathophysiology, and management. “We still know very little about covid-19, but we do know that we cannot fight what we do not measure.”1 Research and surveillance need 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. We need a clear definition for recovery from covid-19. While further evidence is awaited, clinicians should “be open about uncertainty and transparent in the ways in which we acknowledge the limitations of the imperfect data we have no choice …

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