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Long covid: Damage to multiple organs presents in young, low risk patients

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4470 (Published 17 November 2020) Cite this as: BMJ 2020;371:m4470

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Re: Long covid: a potential longer term morbidity time bomb?

Dear Editor

The worrying findings of Dennis and colleagues [1] in relation to extra-pulmonary sequelae and multiple organ damage are all the more concerning when combined with recent cardiac MRI investigations of recently “recovered” cases in Germany [2].

As in the former pre-print paper which your news item reports, the Frankfurt based cardiac MRI study selected cases of relatively low symptomatic severity in that none had been hospitalised, yet their results revealed cardiac involvement in 78% and ongoing myocardial inflammation in 60%. Given that the number of ‘milder’ cases will always inevitably far outweigh the numbers hospitalised or tragically do not survive, the sheer scale of potential public health morbidity and potentially mortality if cardiac health is undermined, begins to look very concerning.

While every applause must be accorded to the tremendous, unprecedented and very encouraging progress with vaccine development, we must not lose sight of what could potentially be an even greater challenge to come in terms of health service burdens and premature mortality. It remains vital therefore to redouble research efforts at furthering our understanding of long-COVID and how those affected might be most effectively treated: might they benefit from vaccination for instance, or would that risk further harms from what appears to be an immune-triggered pathway?

For these reasons, the UK Governments announcement of 40 long-COVID assessment centres in England [3] is only to be welcomed. It will be interesting to note if other UK governments follow suit as the cumulative incidence of long-COVID disease continues to rise across all parts of the UK affecting many previously healthy adults with no underlying health conditions or known risk factors.

References:
1. Dennis A, Wamil M, Kapur S, Alberts J, Badley AD. Multi-organ impairment in low-risk individuals with long COVID. https://www.medrxiv.org/content/10.1101/2020.10.14.20212555v1.full.pdf.
2. Puntmann VO, Carerj ML, Wieters I, et al. Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19). JAMA Cardiol. Published online July 27, 2020. doi:10.1001/jamacardio.2020.3557
3. NHS News: NHS to offer ‘long covid’ sufferers help at specialist centres. Published online October 7, 2020. https://www.england.nhs.uk/2020/10/nhs-to-offer-long-covid-help/

Competing interests: No competing interests

20 November 2020
John D Mooney
Locum Consultant in Public Health
Professor Jonathan Ling, University of Sunderland
NHS Highland
Larch House, Stoneyfield Business Park, Inverness IV2 7PA