Long COVID: A global problem needing a global solution

Professor Amitava Banerjee turns our thoughts towards Long COVID, a global problem needing a global solution

After two years of the pandemic, daily dashboards of cases, hospitalisations and deaths have become routine in most countries for health professionals, policymakers and the public. However, monitoring and planning for COVID-19 continue to largely ignore Long COVID.

Long COVID is defined by the World Health Organization as 12 weeks or more of symptoms after initial SARS-CoV2 infection. In November 2021, an estimated 1.2 million individuals in the UK were affected by persistent symptoms more than four weeks after their first infection, with 71% and 35% reporting more than 12 weeks and more than one year of symptoms, respectively. With over 260 million COVID-19 cases and 5.2 million deaths to date, even assuming a conservative 3% rate of long COVID among all cases of COVID-19, at least 7.8 million people are currently affected worldwide.

Long COVID in the UK

In the UK, over 80 dedicated Long COVID clinics have been set up, but urgent research is needed at the same time as service development to meet this major burden. The National Institutes of Health (NIH) in the U.S., the National Institute for Health Research (NIH) in the UK and other national and international research funders are now funding research in Long COVID at scale.

The STIMULATE-ICP (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways), funded by the NIHR, will deliver knowledge to clinicians and scientists, evidence to policymakers, and improved care to patients while collecting real-world data at scale.

Long COVID – looking ahead

Over the next two years, the STIMULATE-ICP team will provide data and evidence regarding current care, identify and tackle inequalities in access to care and test treatments for Long COVID. The findings have global relevance. Regular updates will be available at https://www.stimulate-icp.org/

The team at STIMULATE-ICP

Amitava Banerjee, Professor of Clinical Data Science and Consultant Cardiologist at University College London is leading the STIMULATE-ICP team as Chief Investigator, with researchers, health professionals, patients and industry partners from over 30 organisations in the largest clinical study of Long COVID to date. “Long COVID in the community, in people who have not been hospitalised, needs a coordinated response across research and clinical practice, and across the patient pathway. Otherwise, we will be too late in tackling what is likely to be the largest impact of the pandemic in the long run,” says Banerjee.

Amitava Banerjee: https://twitter.com/amibanerjee1

The University College London Hospitals NHS Foundation Trust was the first dedicated Post-COVID assessment service in the UK, including non-hospitalised Long COVID patients since April 2020, and is led by Dr Melissa Heightman, Consultant Respiratory Physician and also, National Specialty Advisor for Long Covid, NHS England. Dr Heightman feels there is a lot we can learn from integrated care of other conditions, such as chronic obstructive pulmonary disease, adding, “There are lessons from Long COVID which we can apply to other chronic diseases beyond the pandemic.” As Clinical Lead and Co-Principal Investigator for STIMULATE-ICP, she is leading work to evaluate and improve current services and to reduce inequalities in Long COVID care.

Melissa Heightman: https://twitter.com/melheightman

Mrs Denise Forshaw is Deputy Director of the Lancashire Trials Unit, which is leading a trial of a novel integrated care pathway, involving a full-body MRI scan, Coverscan™, to rule out any organ impairment, and a digitally enhanced rehabilitation programme, Living with COVID Recovery™. The trial aims to recruit over 4,500 patients with Long COVID, starting in six centres around England: Hull, Liverpool, Leicester, Derby, London and Exeter. “Our cluster-randomised study design at the level of primary care networks around geographically diverse sites takes equity of access to care into account,” says Mrs Forshaw.

Denise Forshaw

“We have seen chronic, post-viral syndromes before, but not at this scale and pace,” says Dr Emma Wall, Consultant in Infectious Diseases at University College London Hospital and Senior Clinical Research Fellow at the Francis Crick Institute. “Long COVID is a new syndrome and we are still finding out about possible mechanisms and potential treatments.” Dr Wall is leading an embedded drug trial platform within the STIMULATE-ICP trial, to repurpose and test existing drugs such as antihistamines and anticoagulants in the management of Long COVID.

Emma Wall: https://twitter.com/dremmacbw