Now published in British Medical Journal doi: 10.1136/bmj-2022-072117
The opening paragraphs of the article can be read here. For the full article, please follow the link above.
What you need to know:
- Long covid (prolonged symptoms following covid-19 infection) is common
- The mainstay of management is supportive, holistic care, symptom control, and detection of treatable complications
- Many patients can be supported effectively in primary care by a GP with a special interest
This article updates and extends a previous BMJ Practice Pointer published in August 2020 when almost no peer reviewed research or evidence based guidance on the condition was available. In this update we outline how clinicians might respond to the questions that patients ask.
The term “long covid” refers to prolonged symptoms following infection with SARS-CoV-2 that are not explained by an alternative diagnosis. It embraces the National Institute for Health and Care Excellence (NICE)’s terms “ongoing symptomatic covid-19” (symptoms lasting 4-12 weeks) and “post covid-19 syndrome” (symptoms beyond 12 weeks), the US Centres for Disease Control and Prevention’s group of “post-covid conditions,” and the World Health Organization’s “post covid-19 condition.”
In mid-2022, approximately 70% of the UK adult population had been infected with SARS-CoV-2.6 Of these, almost 2 million report covid-19 symptoms persisting for more than four weeks; 807 000 (41% of all people with long covid) for more than a year; and 403 000 (19%) for more than two years. Based on workforce data from the British Medical Association, a full time equivalent general practitioner with an average list size (approximately 2000) has around 65 patients with long covid, 27 of whom will have been unwell for more than a year, and 12 for more than two years. Most general practices have far fewer patients with a long covid diagnostic code on their electronic health record9 for a combination of reasons, including lack of presentation, lack of recognition, and inadequate coding. These figures do not cover children, who are outside the scope of this article.
Rates of long covid are lower in people who are triple vaccinated, but prevalence of long covid (persistent symptoms at 12-16 weeks after laboratory confirmed SARS-CoV-2 infection) remains high at 5% for the delta variant and 4.2% for omicron BA.2.10
Trisha Greenhalgh, professor of primary care health sciences,
Manoj Sivan, associate professor in rehabilitation medicine,
Brendan Delaney, professor of medical informatics and decision making,
Rachael Evans, associate professor in respiratory medicine, associate professor in respiratory medicine,
Ruairidh Milne, person with long covid and, emeritus professor of public health