Tag: long covid management

Antihistamines for Postacute Sequelae of SARS-CoV-2 Infection

Abstract:

Postacute sequelae of SARS-CoV2 (PASC) infection is an emerging global health crisis, variably affecting millions worldwide. PASC has no established treatment. We describe 2 cases of PASC in response to opportune administration of over-the-counter antihistamines, with significant improvement in symptoms and ability to perform activities of daily living. Future studies are warranted to understand the potential role of histamine in the pathogenesis of PASC and explore the clinical benefits of antihistamines in the treatment of PASC.

Source: Melissa D. Pinto, Natalie Lambert, Charles A. Downs, Heather Abrahim, Thomas D. Hughes, Amir M. Rahmani, Candace W. Burton, Rana Chakraborty. Antihistamines for Postacute Sequelae of SARS-CoV-2 Infection. The Journal for Nurse Practitioners, 2022, ISSN 1555-4155, https://doi.org/10.1016/j.nurpra.2021.12.016.
https://www.sciencedirect.com/science/article/pii/S155541552100547X  (Full text)

Long COVID in general practice: an analysis of the equity of NHS England’s enhanced service specification

Introduction:

On 5 September 2021, 1.7% of the UK population reported suffering from prolonged symptoms 4 weeks after COVID-19 infection, the syndrome becoming known as long COVID,1 most commonly causing fatigue, headaches, and attention difficulties.2

Despite the vaccination programme, in the autumn of 2021 approximately 40 000 COVID-19 cases were still being recorded daily, of which an estimated 3.0–11.7% will subsequently develop long COVID.3,4 Therefore, long COVID will continue to be a problem into the future.

Deprived populations have a greater prevalence of diseases, which render them at greater risk of serious illness with COVID-19, as well as social factors that increase viral exposure such as dense housing or occupational exposure.5 Meanwhile, the inverse care law means these populations have more limited access to healthcare services, demonstrated in part by the lower numbers of GPs per patient in deprived populations,6,7

General practice is the first point of contact of the NHS for these patients. Therefore, the commissioning and funding of services in general practice for patients with long COVID needs to take account of these factors to prevent a continuation or exacerbation of the disproportionate COVID-19 impact on deprived populations.

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Source: Hutchinson J, Checkland K, Munford L, Khavandi S, Sutton M. Long COVID in general practice: an analysis of the equity of NHS England’s enhanced service specification. Br J Gen Pract. 2022 Jan 27;72(715):85-86. doi: 10.3399/bjgp22X718505. PMID: 35091414. https://bjgp.org/content/72/715/85.full (Full text)

Using condition specific patient reported outcome measures for long covid

Management expert Peter Drucker’s famous words “if you can’t measure it, you can’t manage it” holds good for post-covid syndrome, or long covid, which affects an estimated two million individuals in the UK 1 and extrapolated prevalence data suggests more than 50 million individuals may be affected worldwide.2 Long covid is a multisystem condition with over 200 symptoms reported across most of the organ systems, often with a chronic fluctuating pattern of presentation.3 With up to 30% of covid-19 health burden being related to covid induced disability, long covid presents substantial challenges for healthcare systems worldwide.4 Management of this complex syndrome, in part, requires new integrated long covid services with expertise drawn from a range of specialists across disciplines from both primary and secondary care.56 Healthcare services globally are investing in these new pathways of care, but there are no agreed measurement metrics yet to comprehensively capture patient experience or the effectiveness of treatments, partly due to lack of clear biomarkers for the condition.

Patient reported outcome measures (PROMs) are questionnaire tools to ascertain patients’ views of their symptoms, their functional status, and their health-related quality of life.7 PROM use in other routine clinical contexts have been shown to facilitate communication, engage patients in their care, tailor care to individual patients’ needs, and show value for money for those investing in the services.89 Clinical outcome assessments should include clinically important concepts that define the disease in the target population, assess the impact of disease, and reflect the lived experience of those with the condition. Given the large scale, relative novelty, and multifariousness of long covid syndrome, coupled with shortcomings in understanding viral-onset illness, it is unsurprising that standardised assessments of functioning, disability, and health are lacking.1011

Currently long covid services are using PROMs developed for other conditions such respiratory conditions (Medical Research Council Dyspnea Scale), anxiety disorder (Generalised Anxiety Disorder Assessment) and depression (Patient Health Questionnaire) and a range of other symptom-specific PROMs that have not yet been validated for use with long covid. However, this approach has several limitations. Such measures, in our experience, are cognitively burdensome to long covid patients, do not comprehensively capture the spectrum of symptoms, cannot directly engage with the underlying biological mechanisms, and are reported not to be meaningful by patients, families, and clinicians. Using a range of symptom specific measures makes it challenging to repeat the measures frequently to capture day by day fluctuations and are difficult to implement in busy services overburdened with managing such a large caseload of patients. There is the added danger of misleading management, for example individuals scoring highly on anxiety scores may get diverted to psychological services when their anxiety is being driven by underlying dysautonomia (increased heart rate) which needs medical optimisation.

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Source: Sivan M, Wright S, Hughes S, Calvert M. Using condition specific patient reported outcome measures for long covid. BMJ. 2022 Jan 28;376:o257. doi: 10.1136/bmj.o257. PMID: 35091425. https://www.bmj.com/content/376/bmj.o257 (Full text)

Chronic Fatigue and Postexertional Malaise in People Living with Long COVID: An Observational Study

Abstract:

Objectives: People living with long COVID describe a high symptom burden, and a more detailed assessment is needed to inform rehabilitation recommendations. The objectives were to use validated questionnaires to measure the severity of fatigue and compare this with normative data and thresholds for clinical relevance in other diseases; measure and describe the impact of postexertional malaise (PEM); and assess symptoms of dysfunctional breathing, self-reported physical activity, and health-related quality of life.

Methods: This was an observational study with a cross-sectional survey design (data collection from February 2021 to April 2021). Eligible participants were adults experiencing persistent symptoms due to COVID-19 that did not predate the confirmed or suspected infection. Questionnaires included the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F) and the DePaul Symptom Questionnaire-Post-Exertional Malaise.

Results: After data cleaning, 213 participants were included in the analysis. The total FACIT-F score was 18 (SD = 10) (where the score can range from 0 to 52 and a lower score indicates more severe fatigue), and 71.4% were experiencing chronic fatigue. Postexertional symptom exacerbation affected most participants, and 58.7% met the PEM scoring thresholds used in people living with myalgic encephalomyelitis/chronic fatigue syndrome.

Conclusion: Long COVID is characterized by chronic fatigue that is clinically relevant and at least as severe as fatigue in several other clinical conditions. PEM is a significant challenge for this patient group. Because of the potential for setbacks and deteriorated function following overexertion, fatigue and postexertional symptom exacerbation must be monitored and reported in clinical practice and in studies involving interventions for people with long COVID.

Impact: Physical therapists working with people with long COVID should measure and validate the patient’s experience. Postexertional symptom exacerbation must be considered, and rehabilitation needs to be carefully designed based on individual presentation. Beneficial interventions might first ensure symptom stabilization via pacing, a self-management strategy for the activity that helps minimize postexertional malaise.

Source: Twomey R, DeMars J, Franklin K, Culos-Reed SN, Weatherald J, Wrightson JG. Chronic Fatigue and Postexertional Malaise in People Living with Long COVID: An Observational Study. Phys Ther. 2022 Jan 13:pzac005. doi: 10.1093/ptj/pzac005. Epub ahead of print. PMID: 35079817. https://pubmed.ncbi.nlm.nih.gov/35079817/

Global surveillance, research, and collaboration needed to improve understanding and management of long COVID

The scale of chronic ill health and disability after COVID-19 has been described as the next big global health challenge. Prevalence estimates of a post-COVID-19 condition, long COVID, or post-acute sequelae of SARS-CoV-2 vary according to definition, methodology, and population. A recent systematic review reported persistent symptoms at 3–6 months in a median of 57% (range 13–92) of hospitalised patients (six studies) and 26% (2–62) of non-hospitalised patients (ten studies). This study and other reviews identified few studies from low-income settings, but with more than 245 million SARS-CoV-2 infections reported globally, millions of people are likely to already be experiencing long-term illness. While COVID-19 vaccines have reduced the risk of severe COVID-19 and death, continued high rates of SARS-CoV-2 infection will lead to further disability, having a huge impact on individuals, their families, health services, and society.

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Source: Ward H, Flower B, Garcia PJ, Ong SWX, Altmann DM, Delaney B, Smith N, Elliott P, Cooke G. Global surveillance, research, and collaboration needed to improve understanding and management of long COVID. Lancet. 2021 Dec 4;398(10316):2057-2059. doi: 10.1016/S0140-6736(21)02444-2. Epub 2021 Nov 10. PMID: 34774190; PMCID: PMC8580495. (Full text)

Symptoms and management of long COVID: A scoping review

Abstract:

Aim: This scoping review aims to describe published work on the symptoms and management of long COVID conditions.

Background: Symptoms and management of COVID-19 have focused on the acute stage. However, long-term consequences have also been observed.

Methods: A scoping review was performed based on the framework suggested by Arksey and O’Malley. We conducted a literature search to retrieve articles published from May 2020 to March 2021 in CINHAL, Cochrane library, Embase, PubMed and Web of science, including backward and forward citation tracking from the included articles. Among the 1880 articles retrieved, 34 articles met our criteria for review: 21 were related to symptom presentation and 13 to the management of long COVID.

Results: Long COVID symptoms were described in 21 articles. Following COVID-19 treatment, hospitalised patients most frequently reported dyspnoea, followed by anosmia/ageusia, fatigue and cough, while non-hospitalised patients commonly reported cough, followed by fever and myalgia/arthralgia. Thirteen studies described management for long COVID: Focused on a multidisciplinary approach in seven articles, pulmonary rehabilitation in three articles, fatigue management in two articles and psychological therapy in one study.

Conclusion: People experience varied COVID-19 symptoms after treatment. However, guidelines on evidence-based, multidisciplinary management for long COVID conditions are limited in the literature. The COVID-19 pandemic may extend due to virus mutations; therefore, it is crucial to develop and disseminate evidence-based, multidisciplinary management guidelines.

Relevance to clinical practice: A rehabilitation care plan and community healthcare plans are necessary for COVID-19 patients before discharge. Remote programmes could facilitate the monitoring and screening of people with long COVID.

Source: Chiyoung Cha PhD, RN,Gumhee Baek Master Candidate, RN. Symptoms and management of long COVID: A scoping review. First published: 15 December 2021. https://doi.org/10.1111/jocn.16150