Intended for healthcare professionals

Letters Scale and scope of long covid

Acknowledging breathlessness post-covid

BMJ 2021; 373 doi: (Published 20 May 2021) Cite this as: BMJ 2021;373:n1264
  1. Nicholas Hopkinson, reader in respiratory medicine, honorary consultant physician
  1. National Heart and Lung Institute, Imperial College London, Royal Brompton Hospital Campus, London, UK
  1. n.hopkinson{at}

Covid-19 is a respiratory infection, although it can be associated with both acute and long term systemic complications. Breathlessness is among the most common symptoms reported in people followed up after hospital admission,1 following infection identified in the community,2 and in those reporting that they have long-covid.3 Consistent with this, Ayoubkhani and colleagues report rates of respiratory disease, diabetes, and cardiovascular disease to be significantly raised in patients who had been hospitalised with covid-19; 770 (95% confidence interval 758 to 783), 127 (95% CI 122 to 132), and 126 (95% CI 121 to 131) diagnoses per 1000 person years, respectively.4

Given this sixfold higher rate of lung problems than the next nearest comparator, it is striking that in illustrating this The BMJ uses an image of a “warning sign” that includes cardiovascular disease, multiorgan disease, liver disease, and diabetes but omits respiratory involvement. The respiratory data are also omitted from the key bar chart in the paper. Of note, the authors regret that they “did not capture symptoms such as fatigue, disturbances in taste and smell, and anxiety, widely reported in post-covid syndrome,” but not breathlessness.

People with lung disease, and those looking after them, are accustomed to the relative neglect these conditions receive compared with the burden they cause,5 but erasing lung disease and the experience of breathlessness from post-covid starts to look like Hamlet without the Prince.


  • NH is medical director, Asthma UK and British Lung Foundation Partnership.

  • Competing interests: None declared.

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