Long term respiratory complications of covid-19
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3001 (Published 03 August 2020) Cite this as: BMJ 2020;370:m3001Read our latest coverage of the coronavirus pandemic
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Dear Editor
Prioritising rehabilitation when mortality figures dominate the headlines.
The article highlights the urgent need to establish post COVID-19 physical and psychological rehabilitation pathways in the NHS. In many cases, these pathways will need to be designed from scratch or re-purposed from existing ICU follow up clinics and rapidly expanded at scale. This is a novel challenge and one that will require healthcare systems to act flexibly, as they plan to create sufficient capacity to meet the ever-expanding demand of post COVID-19 rehabilitation. Uncertainty about the clinical course of recovery is one barrier, particularly in those patients with milder symptoms, and whom are not hospitalised.
One study from the Centre for Disease Control, reported that 35% of symptomatic (COVID-19) patients from an outpatient setting were not back to their usual state of health 2-3 weeks later (telephone follow up), despite only 7% of them being hospitalised (1). Further studies have reported the presence of debilitating long COVID symptoms, in otherwise fit and healthy individuals with no underlying conditions (2). Primary care physicians are often left to manage these patients, in the community without direct access to rehabilitation services putting them at risk of physical deconditioning.
Future rehabilitation pathways will therefore need to cater for (non-hospitalised) patients as well as those who are captured via the traditional hospital follow up pathways. This will require significant funding and a commitment to prioritise preventing long term morbidity, alongside reducing mortality from COVID-19.
1. Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network — United States, March–June 2020. MMWR Morb Mortal Wkly Rep 2020;69:993-998. DOI: http://dx.doi.org/10.15585/mmwr.mm6930e1
2. Mahase Elisabeth. Covid-19: What do we know about “long covid”? BMJ 2020; 370 :m2815
Competing interests: No competing interests
Dear Editor
This alarming eye-catching heading does not, I'm glad to say, seem to be justified by the substance of the article, which refers mainly to, and extrapolates from, a variety of lung diseases other than Covid-19. Direct evidence of prolonged dyspnoea following recovery from Covid-19 so far seems confined to the minority who have suffered a severe illness.
The Editorial headline itself, which is neutral, is all that's required.
Competing interests: No competing interests
C19-YRS screening tool and an integrated COVID-19 rehabilitation pathway
Dear Editor
Re: Long term respiratory complications of covid-19 (by Emily Fraser)
As highlighted by Dr Fraser in this article, there is an urgent need for screening COVID-19 survivors for longer term symptoms and prepare services to deal with the tsunami of after-effects in this pandemic. Two recent studies have demonstrated troublesome persistent symptoms in more than half of the survivors 2 months after contracting the illness (1,2). Post-illness fatigue, weakness, breathlessness, post-traumatic stress, joint pain and cognitive problems comprise the so called "Post-COVID syndrome". It has become obvious COVID-19 is a multi-system illness and the residual symptoms are complex and span the physical, mental and social domains of the health condition. We know from previous coronavirus outbreaks that these symptoms persist for years after the illness (3).
The newly developed C19-YRS screening tool is one such comprehensive brief and pragmatic tool that can be used to identify COVID-19 persistent symptoms that can determine rehabilitation needs (4). An integrated COVID-19 rehabilitation pathway is needed that provides targeted intervention to survivors based on their symptoms and needs. Needs in isolated health domains are met by unidisciplinary services whereas complex needs in multiple domains require a multidisiplinary team that has representation from hospital specialists and rehabilitation professionals in the community. Such a novel and smart pathway is likely to prove cost-effective in managing the bulk of cases in the community yet enabling the best functional recovery for each of the survivors. This pandemic can be successfully managed only when survivors can return back to their pre-illness functional level as early as possible.
References
1. Carfi A, Bernabei R, Landi F, et al. Persistent Symptoms in Patients After Acute COVID-19. JAMA 2020; e2012603
2. Halpin SJ, McIvor C, Whyatt G, et al. Post-discharge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation. J Med Virol 2020 doi: 10.1002/jmv.26368. Online ahead of print
3. Ahmed H, Patel K, Greenwood D, et al. Long-term clinical outcomes in survivors of Severe Acute Respiratory Syndrome and Middle East Respiratory Syndrome coronavirus outbreaks after hospitalisation or ICU admission: a systematic review and meta-analysis. J Rehabil Med 2020; 52
4. Sivan M, Halpin SJ, Gee J. Assessing long-term rehabilitation needs in COVID-19 survivors using a telephone screening tool (C19-YRS tool). Advances in Clinical Neurosciences and Rehabilitation 2020; 19: 14‐17.
Competing interests: No competing interests