Dr Mark Toshner

What will it take to tackle long Covid?

What will it take to tackle long Covid?
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With just under 500,000 patients admitted to hospitals in Britain since the start of the pandemic, we need to talk about 'long Covid'. Why? Because while the vaccine rollout is undoubtedly saving many lives, there is going to be a forbidding secondary impact from this virus on the nation’s health, the scale of which is only just becoming apparent. 

What does 'long Covid' conjure in your mind? For many, it has become synonymous with fatigue and brain fog, symptoms which are fairly common. But what is less well known is that the impact of Covid-19 on patients can extend far beyond these symptoms alone. Alongside some of the mental health problems from the pandemic, this presents a huge challenge for the coming months, given the sheer numbers of people who have been affected. 

Covid-19 does not stop the day you leave the hospital. More than one in ten patients are dead within three months of being discharged. Just under one in three end up back in hospital. Around ten per cent have a new respiratory diagnosis and one in 20 a major cardiac event. 

Yet such patients are the untold stories of this pandemic. That may be about to change with multiple post-hospital discharge studies due to report soon. 

The raw numbers involved are daunting for the clinicians and health care workers on the frontline. For a start, though all medics are now effectively amateur Covid-19 physicians now, there is not really a special Covid-19 setup to look after patients in the medium or long-term, nor clear funding in place for this. 

Hospitals are a mix of in-patient and out-patient specialities carved up by body systems; they are a patchwork of fiefdoms. Yet none of them alone are able to deal with the many complications of Covid-19. We almost certainly need a mix of team members to tackle the issue of long Covid, but this won't happen easily. The doctors and nurses needed for this are the same people trying to clear the backlog of under-served acute and chronic diseases that have taken a backseat while we fought the raging forest fire of the pandemic. It is going to be challenging to try to recover activity back to normal, never mind address this once-in-a-lifetime new disease burden.

The next challenge is what do we treat them with? In the UK we have done some genuinely innovative and world-leading research in acute treatments for Covid-19. The RECOVERY trial is going to be a case study in pandemic research response for years to come, having defined the world’s two most successful therapies to date (dexamethasone and tocilizumab). 

Just as importantly it has given definitive answers on what doesn't work, preventing millions of patients from getting useless and potentially harmful treatments. There is little out there however to address the chronic problems that are emerging. Here the world’s first trial that will take the pioneering approach of RECOVERY and extend it to longer-term treatment of patients after they are discharged from hospital will help. The HEAL-COVID trial, which is launching this week, will aim to address some of the emerging Covid complications. It will do this by attempting to clarify which treatments improve patient outcomes as they move into their recuperation period and beyond. 

We are not short of problems to address, from ongoing inflammation, clot formation, fibrosis, reinfection, kidney and heart complications and the possible development of diabetes to name just a few. Funded by the National Institute of Health Research, HEAL-COVID is an example of the capabilities of a national research infrastructure that has provided a rare bright spot in the UK pandemic response. 

The government has rightly heralded this achievement. It has recently committed to placing science at the centre of policy in its integrated review. Though the government has vowed to increase spending to 2.4 per cent of GDP in the coming years, will this be enough? There is anxiety that a year of suspended activity and funding diverted to Covid-19 is going to have significant impacts if this funding is not realised without delay. The HEAL-COVID trial is a good example of research that not many countries can do. 

Brexit was partly sold on the UK forging a path in areas where we have depth and talent. And though there are not many positives from the pandemic, one good thing could emerge: an expansion of this ambition for our next generation of scientists.