Long-COVID: understanding what it means for clinical practice and research

The World Health Organization (WHO) states in its What we know about long-term effects of COVID‑19 report that symptoms of COVID‑19 that may persist long-term include fatigue, cough, congestion, shortness of breath, loss of taste or smell, headache, body aches, diarrhea, nausea, confusion, and chest pains. The WHO also notes that more severe long-term outcomes may include: 1) heart damage and heart failure; 2) lung tissue damage and restrictive lung failure; 3) loss of smell, stroke and cognitive impairment; 4) anxiety, depression, post-traumatic stress disorder and sleep disturbance; and 5)pain in joint and muscles and fatigue. One Long-term clinical outcomes in survivors of SARS and MERS coronavirus outbreaks after hospitalisation or ICU admission meta-analysis states that one shouldanticipate long-term outcomes similar to those observed among MERS and SARS survivors, including lung function abnormalities and mental health impacts. It is recommended that COVID‑19 be considered holistically, acknowledging the psychological and social long-term impacts, and international and multidisciplinary groups of researchers are needed to investigate long-term effects. In its pre-print, Long Covid: what is it, and what is needed? report, The Royal Society emphasizes the need for a working definition of long-COVID to be established and that more large-scale cohort studies need to be established to study different aspects of long-COVID. The “Long Covid”: evidence, recommendations and priority research questions report recommends that a four-tier approach to organizing services for patient care should be implemented, involving 1) resources and support for self-care, 2) generalist care including therapeutic relationship in general practice and a community-based interdisciplinary rehabilitation service led by allied health professionals, 3) specialist care including system-based investigation, management and rehabilitation, and 4) specialist management of specific complications. The Management of post-acute COVID‑19 in primary care guidance suggests that care should emphasize a multidisciplinary intervention based directly on patient evaluation, that should include education, exercise training and behavioural modifications such as breathing techniques. The National Institute for Health Research also concluded in its Living with Covid-19 review that discussion from focus groups should make clear and realistic expectations for the ongoing effects of COVID‑19 and that special attention should be given to populations disproportionately affected by COVID‑19 as additional support may be required.

Various cohort studies to understand the long-term impacts of COVID‑19 are being conducted internationally including the Canadian COVID‑19 Prospective Cohort Study (CANCOV) in Canada, the Post-Hospitalisation COVID‑19 Study (PHOSP-COVID) in the United Kingdom, and the Innovative Support for Patients with SARS COV-2 Infections Registry (INSPIRE) in the United States of America. These studies all aim to understand the impacts of COVID‑19 through the involvement of thousands of COVID‑19 patients.

The International Development Research Centre has contributed to the funding of a project that will study 35,000 adults from 13 countries within an existing prospective cohort study to examine the risk factors of COVID‑19 and the long-term cardiovascular and respiratory health effects. A large group of neuroscientists is teaming up to understand the direct and indirect effects of COVID‑19 on the brain. This is a collaborative project between Western University’s Brain and Mind Institute, The Owen Lab, The University of Toronto and Sunnybrook Health Sciences Centre. Those who had COVID‑19 are asked to join from all over the world to help scientists understand how to best treat the neurological impacts of COVID-19.