Intended for healthcare professionals


Long covid: WHO calls on countries to offer patients more rehabilitation

BMJ 2021; 372 doi: (Published 10 February 2021) Cite this as: BMJ 2021;372:n405

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  1. Jacqui Wise
  1. London

The World Health Organization has urged countries to prioritise rehabilitation for the medium and long term consequences of covid-19 and to gather information on “long covid” more systematically.

WHO has produced a standardised form to report clinical data from individual patients after hospital discharge or after their acute illness to examine the medium and long term consequences of covid-19.1 It has also set up technical working groups to build a consensus on the clinical description of what WHO now calls “the post-covid-19 condition” and to define research priorities.

Speaking at the first of a series of seminars, WHO’s director general, Tedros Ghebreyesus, highlighted the “three Rs”—recognition, research, and rehabilitation. Recognition of the post-covid-19 condition was now increasing, he said, but still not enough research was carried out. He added that countries needed to show commitment to including rehabilitation as part of their healthcare service. “Long covid has an impact on the individual, on society, and on the economy,” he warned.


Danny Altmann, an immunologist at Imperial College London, told the seminar that the NHS needed to have long covid clinics but that these raised a number of questions, including how patients would be referred and which clinical specialties would staff the clinics. He said that, in the same way as lupus, a patient may need input from many specialties including neurology, cardiology, endocrinology, and respiratory teams.

Altmann added that it was not clear whether the condition would last for months or years and that there was a “large hidden iceberg” of people who self-isolated while unwell at home but had no formal health record evidence of covid-19, as they became ill before widespread testing. “If 10-20% of the globe’s covid-19 infections lead to long covid, we have a legacy of 10-20 million long term cases to manage. This has massive ramifications for the lives of the affected and for healthcare planning,” he said.

The seminar heard about the wide range of symptoms associated with the post-covid condition, which can continue for six months or more and is most commonly found in patients who were not admitted to hospital.

Hannah Davis, a patient researcher,2 told the seminar that her study with colleagues had identified 205 symptoms in 10 organ systems among patients with long covid. The survey, which was published as a preprint at the end of December,3 included 3762 respondents from 56 countries. Most patients (91.6%) had not been admitted to hospital.

The most frequent symptoms reported after six months were fatigue, post-exertional malaise, and cognitive dysfunction. The survey found that 21% of patients were still experiencing severe symptoms after six months. Two thirds required a reduced work schedule or were no longer working owing to their illness.

Davis told the seminar, “Most patients were not hospitalised, and many did not have low oxygen levels.” She said that it was important to ask about the right symptoms, as doctors often missed neurological symptoms including cognitive dysfunction and post-exertional malaise.

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