Monday, January 24

I lead a long Covid essay: Britain has clearly underestimated its impact | Amitava banerjee

DDespite apprehension about the high rates of Covid-19, my family’s Christmas in Yorkshire was wonderful. Unfortunately, the following week was marred by a headache, fever, and general malaise. And a PCR test confirmed the worst: He had Covid-19 for the second time. My second encounter has been dominated by intense fatigue and reduced concentration, which although improving, have not yet been resolved more than two weeks later. Worryingly, what I know about prolonged covid suggests that this could persist for several months, or longer.

World Health Organization define long Covid as continuous symptoms “three months from the start of Covid-19”. In December, Office of National Statistics (ONS) estimated that more than 1.3 million people in the UK had symptoms for four weeks or more after COVID-19, of which 892,000 people (70%) had symptoms that persisted for at least 12 weeks and 506,000 (40%) for at least one year. Dr. Melissa Heightman, who directs the London University College Hospital The specialist Covid Long Clinic says that dyspnea, fatigue, cough, myalgia, chest pain, headache, “brain fog” and palpitations are the most commonly reported. But many other symptoms may be present.

Despite this evidence, Covid has long been absent from government briefings on Covid-19 over the course of the pandemic. This is a major failure and shows the difficulty that clinicians and legislators often have in identifying and treating chronic conditions. Throughout the pandemic, our reporting, media, funding, and research have focused on acute effects such as infections, hospitalizations, and deaths, not chronic ones, such as long-term covid cases and referrals.

Because of this, we may not even know the magnitude of the problem. ONS estimates for long-term Covid are based on an ongoing survey and may not be representative of the entire population. Although important research studies have been funded by the National Institute for Health Research, a long national and international surveillance of Covid is lacking. In each successive wave, we have looked for short-term solutions for covid-19 and long-term covid. Reasons for this include short news stories and political cycles, chronic underfunding, and a lack of priority in prevention – all long-standing matters in UK health policy.

The prevailing mindsets in science, healthcare, and policy haven’t necessarily helped either. For example, an outdated classification distinguishes diseases as “organic” or “functional.” Organic conditions, such as heart attacks, rheumatoid arthritis, and bowel cancer, are the ones that cause changes detectable by investigations such as blood tests or scans.

Functional conditions, such as irritable bowel syndrome and chronic fatigue syndrome, do not necessarily cause changes detectable by tests, or the correct test may not yet be available. The stigma and misconceptions that arise from this classification can lead to the functional conditions being overlooked, which is surely familiar to many with long covid.

The monitoring and prevention of mortality -death- has always been prioritized over morbidity -the general suffering caused by the disease-. But there have been attempts to change this. A measure called “disability-adjusted life years”(DALYs), conceived in 1990, attempts to capture the impact of disease on people’s lives, and led to the Global burden of disease study, comparing morbidity and mortality between diseases and countries. Methods that have created accessible daily and cross-country comparisons of COVID-19 mortality should also be applied to protracted COVID.

The ways we train healthcare professionals, which are similar to when I was in medical school, still tend to focus on bogus binaries that lock up our thinking and prevent us from seeing the big picture. Viewing the disease as “acute (immediate) vs. chronic” or “communicable vs. non-communicable” means that we neglect conditions like long-term Covid, a chronic condition that arises from an acute communicable infection. We must bring together patients, healthcare professionals and researchers with experience in chronic diseases as part of preparing for and monitoring a pandemic.

In the UK, 90 dedicated long-term Covid clinics have been established, but research and data are needed to inform patient services in real time. I’m leading the team that leads the Stimulate-ICP (Symptoms, Pathways, Inequalities, and Management: Long Covid Understanding to Address and Transform Existing Integrated Care Pathways), which involves a trial to evaluate a community-based study, complete MRI to rule out multi-organ involvement caused by Covid-19 and digitally enhanced rehabilitation, which includes personalized information and recovery plans, and connection with relevant specialists through an app, which will inform future care. Another trial will reuse existing drugs, including antihistamines (loratadine and famotidine), blood thinners (rivaroxaban) and anti-inflammatories (colchicine) to measure the effects of the three-month treatment on prolonged covid symptoms, mental health, return to work and other outcomes. important.

This is a start, but we must do more. Long Covid, like all diseases, would benefit from prevention and public health perspectives, and “integrated care”Across specialties and disciplines. Isolating our thinking about the disease and focusing on the short term has held us back, and patients have been alone for far too long. Lere Fisher, a patient advocate I know through the study, told me that he had to “take care of himself to get back to health.” Another, Lyth Hishmeh, says that patients and healthcare professionals “continue to face difficulties knowing what to do for a long time Covid.” Patients originally named and recognized this new disease. It’s time for our healthcare systems to tell about it.

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