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Fatigue lasting months most common long Covid symptom, finds NIHR review


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At least one in ten patients experience ongoing symptoms three months after Covid-19 infection – with the most commonly reported problem being fatigue, a wide-ranging review has found.

In its second review of the evidence, a team at the National Institutes for Health Research (NIHR) said that figure may well increase and long Covid was affecting people’s ability to work as well as their finances and relationships.

In a survey of more than 3,000 patients done to support the NIHR review, a third said they had not been able to access all the healthcare they felt they needed.

The review also repeated its earlier findings that long Covid may be as many as four different syndromes and said the lack of consistency in definition is making it difficult to understand emerging evidence and hindering clinical consensus.

Syndromes that fall under the umbrella term include post-intensive care syndrome, post-viral fatigue syndrome, long-term Covid syndrome and permanent organ damage.

More recent evidence suggests that some people long Covid seems to be an active disease with ongoing inflammatory responses, lingering viral activity and/or blood clotting disorders, the review found.

For some, long Covid is not a static condition and may deteriorate over time highlighting the importance of early assessment and ongoing monitoring, the authors said.

More than 300 academic articles were looked at for the review which found between 50-89% of patients had at least one enduring symptom after two months.

Of those not admitted to hospital, 20-30% experience at least one ongoing symptom around one month later and at least 10% three months later.

NIHR researchers reiterated guidance from NICE that the development of long Covid is not predicted by initial severity of the disease and that anyone with enduring symptoms should be fully assessed.

The review also said long Covid appears to be more prevalent in women and in young people – including children – than might have been expected

There is also increased evidence of organ impairment in both people who were admitted to hospital and those who stayed at home.

They called for more research into the 30% of people who suffer from anxiety and/or depression at one to three months after they’ve cleared the virus.

But they said there is some indication that ‘brain fog’ – a recurring pattern of symptoms reported in patients with long Covid has a neurological rather than a social cause.

There are currently 67 post Covid clinics across the country, a recent bulletin from NHS England said.

Review author Dr Elaine Maxwell said more data was needed about the prevalence of each syndrome and their causes and on how long symptoms last.

‘It appears that at least 10% of people are experiencing at least one long Covid symptom three months after diagnosis, but limitations in the way data is collected means this may not be a comprehensive reflection and we may see estimates increase.’

Chief medical officer Professor Chris Whitty added that long Covid was highly debilitating for some patients.

‘It is important that we work out what exactly the various elements of “long Covid” are and then we can target research at these parts in order to prevent and treat it,’ he said.

Health minister Matt Hancock said it was vital we do all we can to improve the understanding of long Covid and develop more effective care and treatments.

He said: ‘Today‘s report, on top of the £20m research funding to support innovative projects, and establishment of clinics across the country will all help improve understanding and treatment of long Covid.’

It comes as GPs in Essex were recently told they would need to manage patients for six weeks while long Covid clinics were suspended due to the virus spike.