This week’s Blog is written by our Editor-in-Chief Alison Twycross (@alitwy) and Dr Jake Suett, a staff grade doctor in Intensive Care, (@jakesuett) who both have suspected “Long Covid”. In the Blog they discuss what Long Covid is and discuss some of the employment related issues health care professionals may encounter. #CountLongCovid @EBNursingBMJ
As of the 3rd September 2020 there have been approximately 340,000 confirmed cases of COVID-19 in the UK. Given the lack of available testing during the peak incidence of cases alongside the number of false negative tests, it is likely that the number of people who have had COVID-19 is much larger. Healthcare workers are likely to represent a significant proportion of that number. We know that many health care professionals caught COVID-19 because of their exposure to the virus at work. Indeed, a recent study in The Lancet stated “…front-line health-care workers had at least a threefold increased risk of reporting a positive COVID-19 test and predicted COVID-19 infection, compared with the general community…”. An article in the Independent reports that between 10th April – 10th August 2020, 6,550 cases of health and social care staff being infected at work were reported to the Health and Safety Executive and that of these, 110 sadly died. NHS medical examiners are reviewing the deaths of 625 health and care worker deaths from COVID-19 to try and determine which staff may have been infected at work.
For many people COVID-19 is a mild illness and they recover within 10 days or so. However, up to 10% of people do not recover within three weeks, and many are still experiencing debilitating symptoms months later (Dr Tim Spector on BMJ webinar on Long COVID, 3rd September 2020 – https://youtu.be/zTrIl52jV0s ). People experiencing these long-term symptoms and the media have termed this “Long Covid”. A recent paper in the BMJ defined post-acute COVID-19 as extending beyond three weeks of initial symptoms and chronic COVID-19 as extending beyond 12 weeks. Importantly, the paper also states that, as many people weren’t tested and because of the number of false negative tests, a positive test is not a pre-requisite for diagnosis. The paper says that post-acute COVID-19 symptoms vary widely, but the following are listed:
- Cough
- Low grade fever
- Fatigue
- Shortness of breath
- Chest pain
- Headaches
- Neurocognitive difficulties
- Muscle pains and weakness
- Gastrointestinal upset
- Rashes
- Metabolic disruption (such as poor control of diabetes)
- Thromboembolic conditions
- Depression and other mental health conditions
Perhaps this describes you, or you know of someone in your department who has been affected like this?
We still do not know what is causing these prolonged symptoms in some people. The BMJ paper says “persistent viraemia due to weak or absent antibody response, relapse or reinfection, inflammatory and other immune reactions, deconditioning, and mental factors such as post-traumatic stress may all contribute.” The British Society of Immunologists have also recently stated that “… it appears that SARS-CoV-2 can likely do long-term damage in different parts of the body, through direct effects of viral infection and tissue damage (fibrosis), through collateral damage from excessive inflammation, through post-viral autoimmunity, and through the consequences of thrombotic complications.”
Throughout the pandemic, positive test results and deaths due to COVID-19 have been reported and have been how the damage caused by this virus has been communicated and measured. Unlike deaths due to COVID-19, the number of people living with the debilitating effects of Long Covid are not currently being recorded. This was highlighted in a BMJ Blog by @Dr2NisreenAlwan who stated “Death is not the only thing to count in this pandemic, we must count lives changed. We still know very little about COVID-19, but we do know that we cannot fight what we do not measure.” We urgently need to record the number of people who are being left with long-term effects of COVID-19, both to help those individuals and to inform ourselves of the real risks of the disease.
We don’t know much about how to treat/manage Long Covid. Indeed, the first time, Alison googled “post viral syndrome” and COVID-19 just after Easter, there were no results! Many patients have reported that pacing is important. Pacing means balancing mental, physical and emotional exertion. This means that it is important for health care professionals with on-going Long Covid symptoms not to rush back to work. However, being off sick long term raises several employment related issues. We are keen to hear from nurses, midwives and other health care professionals with Long Covid about the issues they are facing. Posts on several of the Long Covid Facebook groups suggest that these issues include:
- Being denied full sick pay because they haven’t had a positive test for COVID-19 (despite the unavailability of tests and relatively high incidence of false negatives).
- Employers only applying the COVID-19 enhanced sick pay to staff in the acute phase of illness.
- Being expected to use annual leave for a phased return to work.
For those staff due to revalidate with the Nursing and Midwifery Council, guidance is needed for those not well enough to sign that they are fit to practise.
If you are experiencing Long Covid, please let us know about your experiences and the issues you are facing. Seek support from your GP or other primary care provider and occupational health department. We would encourage you to write to your union to raise your concerns, ask them to count their members affected, and to lobby for more research and assistance on behalf of healthcare workers experiencing Long Covid. It’s important that people affected are counted. You may find joining a support group such as www.longcovid.org helpful.