Post by Nadica (She/Her) on Dec 9, 2024 2:34:56 GMT
Long Covid: Do people recover - and how do they do it? - Published Dec 7, 2024
By Helen McArdle
How likely are people to make a full recovery from long Covid - and how do they get there?
These questions have been the focus of research studies published in recent weeks which come as the toll of the condition on the population, and the NHS, was also highlighted.
According to the the latest annual Scottish Health Survey, published in mid-November, 8% of adults and 2% of children in Scotland self-report suffering from long Covid - where symptoms persist at least four weeks beyond the onset of infection.
This was up from 5% of adults and 1% of children in 2021.
One in 50 adults responding to the survey said long Covid was impacting "a lot" on their day-to-day activities.
Post-viral syndromes are not a new phenomena, but for 2% of Scotland's adult population to be debilitated at any one time by long Covid is a marker of just how devastating the coronavirus pandemic was - and continues to be - for population health.
Much as we might like, Covid is not "over".
Earlier this year a report on the Economic Impact of Long Covid in the UK estimated that, by 2030, long Covid would be to blame for 138,000 people dropping out of employment and "macroeconomic costs" to GDP of £1.6 billion.
Translated to Scotland, that would equate to around 11,000 people out of work and a £120 million yearly impact on the economy.
It did not go unnoticed, however, by scientists and clinicians working in the field that the UK Government's plan to tackle worklessness - the Get Britain Working white paper published on November 26 - made no specific mention of long Covid, or what it might do to try to stop it.
It seems that "living with Covid" means accepting the reality that a certain, unlucky percentage of people will be sickened long-term.
As well as the labour market, that has serious implications for the health service.
A study published in the Journal of the Royal Society of Medicine on November 28 found that long Covid more than doubles a person's cost to the NHS.
Researchers from University College London (UCL) analysed how 280,000 adults with the condition use healthcare services in the UK.
They found that their median annual cost to the NHS was £705 as a result of their significantly increased use of GP, outpatient, inpatient and emergency services.
Before being diagnosed, those same people had median NHS costs of £294 a year.
The paper noted that treatment is complicated because long Covid affects multiple organs and "different organ abnormality patterns necessitate different clinical specialties, investigations and potentially different levels of care, monitoring, [follow-up], resourcing and costs".
Exactly what causes some people to develop long Covid is not yet fully known.
Dr Yi Mu, a co-author on the study from the Institute of Health Informatics at UCL, said the condition is "stretching staff and infrastructure" as well as having "far-reaching implications for those affected".
Symptoms can range from extreme fatigue and post-exertional malaise to heart palpitations, dizziness, pain, breathlessness, brain fog, rashes, and gastrointestinal problems like nausea and diarrhoea.
It appears to affect women more than men, and can occur in previously healthy individuals even after a mild infection - sometimes following a third or fourth case of Covid in people who previously recovered normally.
The good news is that patients can, and do, get better. But it remains unclear why some recover while others do not.
New results published this week from the Children and young people with Long Covid (CLoCK) study - the largest study of its kind into long Covid in children - indicates that around 70% of young people recover within two years.
The findings are based on data from more than 12,600 youngsters aged 11 to 17 who had been tested for Covid between September 2020 and March 2021.
Of the 943 who had tested positive and who responded to follow-up questions three, six, 12, and 24 months on, 233 met the research definition of long Covid three months after their initial positive test.
By the 24-month point, however, only 68 continued to meet the definition for long Covid, pointing to a recovery rate of 70%.
Chief Investigator Professor Sir Terence Stephenson said this was "good news", but that further research is needed "to better understand why 68 teenagers had not recovered".
The most common persisting symptoms were tiredness, trouble sleeping, shortness of breath and headaches.
Older teenagers, females, and youngsters from the most deprived areas were less likely to have recovered.
Professor Peter Openshaw, a respiratory physician and immunologist at Imperial College London, said the findings were consistent with what has been found already in adults, but added that the mystery over why a significant subset of young people fail to recover "warrants further study and support".
Dr Nathan Cheetham, a data scientist King’s College London, noted that the "trends in long Covid by deprivation were seen whether or not the young person’s first infection was before or after the roll-out of Covid-19 vaccinations".
A separate review, published in the British Medical Journal at the end of November, evaluated 24 randomised control trials looking at the benefits of drug and non-drug treatments in long Covid.
It concluded that there was "moderate" evidence to support the use of cognitive behavioural therapy and combined physical and mental rehabilitation, but with 239 other trials still ongoing or unpublished we remain in the early stages of understanding what works.
Somewhat clearer were the interventions that showed no benefit: for example, dietary supplements and hyperbaric oxygen chambers.
However, Dr Janet Scott, a consultant in the NHS Highlands long Covid service, said the bottom line is that each patient requires "holistic and individualised management", including a full medical assessment.
She added: "Many of our patients have underlying health conditions that, while not explaining all their long Covid symptoms, need proper medical attention to ensure the best possible outcomes.
"We have no magic bullet yet, but we regularly use proven symptomatic treatments that won’t appear in long Covid trials precisely because they’re already standard medical care.
“With 239 trials registered but not yet reported, we’re likely to see much more evidence about potential treatments emerging soon."
By Helen McArdle
How likely are people to make a full recovery from long Covid - and how do they get there?
These questions have been the focus of research studies published in recent weeks which come as the toll of the condition on the population, and the NHS, was also highlighted.
According to the the latest annual Scottish Health Survey, published in mid-November, 8% of adults and 2% of children in Scotland self-report suffering from long Covid - where symptoms persist at least four weeks beyond the onset of infection.
This was up from 5% of adults and 1% of children in 2021.
One in 50 adults responding to the survey said long Covid was impacting "a lot" on their day-to-day activities.
Post-viral syndromes are not a new phenomena, but for 2% of Scotland's adult population to be debilitated at any one time by long Covid is a marker of just how devastating the coronavirus pandemic was - and continues to be - for population health.
Much as we might like, Covid is not "over".
Earlier this year a report on the Economic Impact of Long Covid in the UK estimated that, by 2030, long Covid would be to blame for 138,000 people dropping out of employment and "macroeconomic costs" to GDP of £1.6 billion.
Translated to Scotland, that would equate to around 11,000 people out of work and a £120 million yearly impact on the economy.
It did not go unnoticed, however, by scientists and clinicians working in the field that the UK Government's plan to tackle worklessness - the Get Britain Working white paper published on November 26 - made no specific mention of long Covid, or what it might do to try to stop it.
It seems that "living with Covid" means accepting the reality that a certain, unlucky percentage of people will be sickened long-term.
As well as the labour market, that has serious implications for the health service.
A study published in the Journal of the Royal Society of Medicine on November 28 found that long Covid more than doubles a person's cost to the NHS.
Researchers from University College London (UCL) analysed how 280,000 adults with the condition use healthcare services in the UK.
They found that their median annual cost to the NHS was £705 as a result of their significantly increased use of GP, outpatient, inpatient and emergency services.
Before being diagnosed, those same people had median NHS costs of £294 a year.
The paper noted that treatment is complicated because long Covid affects multiple organs and "different organ abnormality patterns necessitate different clinical specialties, investigations and potentially different levels of care, monitoring, [follow-up], resourcing and costs".
Exactly what causes some people to develop long Covid is not yet fully known.
Dr Yi Mu, a co-author on the study from the Institute of Health Informatics at UCL, said the condition is "stretching staff and infrastructure" as well as having "far-reaching implications for those affected".
Symptoms can range from extreme fatigue and post-exertional malaise to heart palpitations, dizziness, pain, breathlessness, brain fog, rashes, and gastrointestinal problems like nausea and diarrhoea.
It appears to affect women more than men, and can occur in previously healthy individuals even after a mild infection - sometimes following a third or fourth case of Covid in people who previously recovered normally.
The good news is that patients can, and do, get better. But it remains unclear why some recover while others do not.
New results published this week from the Children and young people with Long Covid (CLoCK) study - the largest study of its kind into long Covid in children - indicates that around 70% of young people recover within two years.
The findings are based on data from more than 12,600 youngsters aged 11 to 17 who had been tested for Covid between September 2020 and March 2021.
Of the 943 who had tested positive and who responded to follow-up questions three, six, 12, and 24 months on, 233 met the research definition of long Covid three months after their initial positive test.
By the 24-month point, however, only 68 continued to meet the definition for long Covid, pointing to a recovery rate of 70%.
Chief Investigator Professor Sir Terence Stephenson said this was "good news", but that further research is needed "to better understand why 68 teenagers had not recovered".
The most common persisting symptoms were tiredness, trouble sleeping, shortness of breath and headaches.
Older teenagers, females, and youngsters from the most deprived areas were less likely to have recovered.
Professor Peter Openshaw, a respiratory physician and immunologist at Imperial College London, said the findings were consistent with what has been found already in adults, but added that the mystery over why a significant subset of young people fail to recover "warrants further study and support".
Dr Nathan Cheetham, a data scientist King’s College London, noted that the "trends in long Covid by deprivation were seen whether or not the young person’s first infection was before or after the roll-out of Covid-19 vaccinations".
A separate review, published in the British Medical Journal at the end of November, evaluated 24 randomised control trials looking at the benefits of drug and non-drug treatments in long Covid.
It concluded that there was "moderate" evidence to support the use of cognitive behavioural therapy and combined physical and mental rehabilitation, but with 239 other trials still ongoing or unpublished we remain in the early stages of understanding what works.
Somewhat clearer were the interventions that showed no benefit: for example, dietary supplements and hyperbaric oxygen chambers.
However, Dr Janet Scott, a consultant in the NHS Highlands long Covid service, said the bottom line is that each patient requires "holistic and individualised management", including a full medical assessment.
She added: "Many of our patients have underlying health conditions that, while not explaining all their long Covid symptoms, need proper medical attention to ensure the best possible outcomes.
"We have no magic bullet yet, but we regularly use proven symptomatic treatments that won’t appear in long Covid trials precisely because they’re already standard medical care.
“With 239 trials registered but not yet reported, we’re likely to see much more evidence about potential treatments emerging soon."