Long covid—looking across data, diseases, and disciplines

By the summer of 2020, I had seen several patients in clinic with ongoing cardiac issues after SARS-CoV-2 infection, from arrhythmias to myocarditis. The term “long covid” was coined on Twitter in May 2020 to describe persistent post-covid symptoms. In the following months, it became clear that the impact of the pandemic was far beyond the direct and indirect effects. Long covid, or post-covid syndrome, is estimated to affect 10% of those infected from Office for National Statistics (ONS) data. 

It was also through Twitter that I began collaborating with Ben Humberstone (ONS) after our team’s research on high risk groups for severe covid-19 disease, including cardiovascular disease, chronic kidney disease, and diabetes, was published. My friend and mentor, Kamlesh Khunti (University of Leicester) was separately working with ONS through his policy roles in SAGE and Independent SAGE, and he was interested in new onset diabetes post-covid. Over the past year, we have worked with a team at ONS, including Dan Ayoubkhani, Vahe Nafilyan, Tom Maddox, and Ian Diamond, mainly on time sensitive, national data analyses to inform policy, such as recent work on ethnicity and the impact of lockdown

In our study of 201 symptomatic, mostly non-hospitalised and mostly low risk (in terms of comorbidities and age) individuals four months after initial SARS-CoV-2 infection, the most commonly reported symptoms were ongoing fatigue, muscle ache, and shortness of breath and headache, regardless of hospitalisation status. Multi-organ MRI assessment confirmed mild organ impairment in the heart (32% of patients), lungs (33%), kidneys (12%), liver (10%), pancreas (17%), and spleen (6%). Prior hospitalisation for covid-19 was associated with multi-organ impairment. 

In hospitalised individuals, we realised that linked data could be used to look at post-covid syndrome and multi-organ complications. Dan and the ONS team led the statistical and epidemiological analyses, and Kamlesh and I provided clinical academic input. Over an average follow-up of 140 days, we showed that nearly a third of the 47,780 individuals discharged from hospital after acute covid-19 were readmitted, and more than 1 in 10 died after discharge. Those with covid-19 were three times more likely to have major cardiovascular events or chronic liver disease, 90% more likely to have chronic kidney disease, and 50% more likely to have diabetes after hospital discharge, than matched controls.

Long covid is yet another impact of the pandemic, which patients and their families, strained health systems, and exhausted health professionals could do without. Undoubtedly, our findings add to the argument for infection suppression policies at a population level. The importance of long term chronic conditions such as diabetes and cardiovascular disease is underlined, not only as risk factors for hospitalisation and mortality from covid-19, but also as medium to long term complications of infection in hospitalised individuals after recovery. Investigation and treatment of long covid will need integrated models of care. The detailed effects on multi-organ function in non-hospitalised individuals over time at a population level need to be further investigated and characterised. Care for people with long covid will require new approaches and collaborations across data, diseases, and disciplines—like our research. 

Amitava Banerjee, Associate Professor in Clinical Data Science, University College London and Honorary Consultant Cardiologist, UCLH and Barts Health NHS Trust. Twitter: @amibanerjee1

Competing interests: none declared