26 January 2021

WHO recommends that patients who have COVID-19 - both confirmed and suspected - should have access to follow-up care if they have persistent, new or changing symptoms.

This is one of the recommendations made by WHO in revised clinical management guidelines.

Evidence was gathered on the post COVID condition, so-called ‘long COVID’, where people who have recovered from COVID-19 continue to have longer-term issues like extreme fatigue, persistent cough and exercise intolerance.

Understanding this condition is one of WHO’s priority areas of work. In February 2021, WHO will organize a series of consultations to reach consensus on a description of this condition and its subtypes, and case definitions. This scientific understanding will inform the name of the condition. The consultations will include a broad range of stakeholders, including patient groups.

For COVID-19 patients at home, WHO suggests the use of pulse oximetry to measure oxygen levels in the blood. This needs to be coordinated with other aspects of home care, such as education for the patient and care provider and regular follow-up of the patient.

For hospitalized patients, WHO suggests the use of low dose anticoagulants for preventing the blood clots forming in blood vessels (thrombosis).

For hospitalized patients who are taking supplemental oxygen (including high-flow nasal oxygen) or non-invasive ventilation, WHO suggests positioning patients on their stomachs to increase oxygen flow (awake prone positioning).

The guidelines also include recommendations on the use of care bundles to systematize care provision for COVID-19 patients, as well as a recommendation to favour clinical judgement over models in making decisions for the patient’s care.

The recommendations were made by an independent panel of experts, the Guideline Development Group, on the basis of detailed rapid reviews of all available evidence.

The guidelines are a living document, updated regularly as more data becomes available.

Understanding this condition is one of WHO’s priority areas of work. In February 2021, WHO will organize a series of consultations to reach consensus on a description of this condition and its subtypes, and case definitions. This scientific understanding will inform the name of the condition. The consultations will include a broad range of stakeholders, including patient groups.

It is time to start solving the mystery of Long Covid, an aspect of the pandemic blighting millions of lives, the World Health Organization's leader on post-Covid conditions told AFP.

Little is known about why some people, after coming through the acute phase of Covid-19, struggle to recover and suffer ongoing symptoms including tiredness, brain fog, cardiac and neurological disorders.

At this stage of the pandemic, the world is fixated on vaccine roll-out and new, more contagious variants of the coronavirus.

However, Long Covid deserves similar urgent attention, said Janet Diaz, the clinical care lead in the WHO's emergencies programme, ahead of a push for a globally-unified approach to the problem.

"We still don't fully understand what Long Covid is," Diaz told AFP in an interview outside the WHO's headquarters in Geneva.

"There's quite a bit to learn, but I am confident that the scientific community is really rallying around."

Tellingly, Long Covid does not yet have a proper name.

The WHO currently calls it post-Covid condition, while other terms in circulation include post-acute Covid syndrome and Covid long haulers.

- Building up a picture -

The WHO is hosting a first global seminar on Long Covid on February 9. It will bring scientists, experts and clinicians together to define the condition, give it a formal name and harmonise study methods.

"It's a condition that needs further description, further understanding of how many are affected and further understanding of what is causing it, so we can better prevent, manage and treat it," said Diaz, 48, a US respiratory physician and intensive care doctor.

She said British and other studies suggested potentially one in 10 cases may have prolonged symptoms one month after infection, but there was no picture yet of how long those conditions might persist.

The elderly and those with underlying conditions are most at risk of serious disease from Covid-19.

But the profile of Long Covid patients does not match. It affects people with varying degrees of severity of disease and "seems to potentially also include younger people", including children, said Diaz.

While the pandemic response priority remains preventing people from catching the virus and falling ill, treating coronavirus cases "must also now include care after the acute illness... until you get back to full health", Diaz said.

- Cracking the code -

Diaz said fatigue seemed to be the most common symptom, with others including post-exertional malaise, cognitive dysfunction or brain fog, shortness of breath, heart palpitations and neurological problems.

"How these are all related -- that's what we don't understand. Why would one person get this, and the other person get that?" asked Diaz, saying researchers needed to crack the underlying mechanisms of the disease that were causing these persistent symptoms.

"Is it something due to the virus? Due to the immune response? If we had a better idea, we could start to target some interventions to reduce symptoms."

Diaz said a "tremendous amount" of research was underway, largely classic observational studies following discharged patients.

The first Covid-19 cases were discovered in China in December 2019. But it was only when Long Covid started appearing on the radar months later that mystified sufferers began reaching out and joining the dots themselves.

"That's been a tremendous movement," said Diaz, who took on the Long Covid remit in October.

In the first wave of the pandemic, struggling health care systems got patients through the acute illness, "but then didn't realise they weren't recovering to their previous health".

She said the patient-led research had driven scientists to do further studies, and "collaboratively we should get to an answer quicker".

- 'Stay hopeful' -

The February 9 seminar, at which scientists will present their latest findings, will be the first in a regular series.

"Right now, we probably have enough descriptive data to start to bring it all together," said Diaz.

Besides agreeing a definition and a name, the meeting will launch a standardised data collection methods for monitoring patients, and start opening doors towards clinical prevention and management.

"We quickly have to build our understanding from each other's experiences," Diaz said.

Crucially, donors will be taking part, and are "really aware" of the pressing need for Long Covid funding, she added.

In a message to the potential millions still suffering long after they are officially considered recovered, Diaz said: "Stay hopeful".

"People may have prolonged symptoms, but we do know people are recovering. It may take a long time, but they are still recovering to previous health. We're with you."

“Long-haul” COVID, long COVID, post-COVID: it’s an illness still without an official name. But for people whose COVID-19 symptoms linger for months, the effects can be devastating and debilitating. Their symptoms range from the mundane to the bizarre: brain fog, shortness of breath, fatigue, tremors, tooth loss, racing heart, glaucoma, among others. In this episode of “America, Interrupted,” PBS NewsHour correspondent Stephanie Sy talks with three “long haulers” about their experiences battling this mysterious illness, and Dr. William Li, a vascular biologist who is trying to unravel this medical mystery through his research.

The February 9 seminar, at which scientists will present their latest findings, will be the first in a regular series.

"Right now, we probably have enough descriptive data to start to bring it all together," said Diaz.

Besides agreeing a definition and a name, the meeting will launch a standardised data collection methods for monitoring patients, and start opening doors towards clinical prevention and management.

"We quickly have to build our understanding from each other's experiences," Diaz said.

Crucially, donors will be taking part, and are "really aware" of the pressing need for Long Covid funding, she added.

In a message to the potential millions still suffering long after they are officially considered recovered, Diaz said: "Stay hopeful".

Summary

Official statistics indicate there are currently hundreds of thousands of people living with Long Covid in the UK. Many of those who contracted Covid-19 at the start of the pandemic are still experiencing significant symptoms almost a year on from their initial infection; some have already passed that grim milestone.

Meanwhile, we can expect case numbers of Long Covid to rise significantly as people continue to become infected; recent data shows that at least 1 in 10 people still experience symptoms 12 weeks after initial infection.[1]

The implications of Long Covid for individual patients, our health service and wider society are multifaceted, complex and likely to be long-term. There has been some progress to put in place support for people with Long Covid, but many are yet to receive help.

As an aside, is an admin not just a mod with elevated privelages? e.g. They are all mods?

Runs for the dugout, tin hat ON!

BTW, when I said "Since I'm an admin, not a mod..." I was teasing as I'm sure that Steve was also.

I got that at the time, i'm teasing back at you... whether you are an admin or a mod, the fact remains that both have the power to moderate posts in a Forum, naturally you have the power as an admin to set what powers any mod might be given, but the fact remains that whether an admin or a mod, both can moderate to some degree, hence i chose to use the word mod other than admin in my post.

Ya, I know.

BTW, when I said "Since I'm an admin, not a mod..." I was teasing as I'm sure that Steve was also.

I sometimes wonder about our sanity, which is the more sane?