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At Cromwell Hospital’s Long Covid Clinic, a multidisciplinary team of consultants are learning lessons from the virus that are overturning years of received wisdom.
When Dr Brian O’Connor (opens in a new window), a consultant in respiratory medicine, developed acute Covid for three weeks early in the pandemic he felt “deeply unwell”, but as a clinician responsible for treating patients with the virus, it afforded him a valuable new perspective.
“It gave me empathy with people who were presenting symptoms that might have previously been considered trivial. At the start of the pandemic, the general consensus among the medical and scientific community was that if you weren’t ill enough to be in hospital, then it was no worse than any other virus,” he says. “From my experience, the impact of Covid was greater than I could ever have imagined.”
As a senior consultant at Cromwell Hospital in London, Dr O’Connor also works in its recently opened Long Covid Clinic (opens in a new window), which treats patients who have continued to experience problems long after the acute phase of the virus has passed.
Post-acute Covid-19 syndrome, commonly referred to as long Covid, is a condition that includes symptoms such as fatigue, breathlessness, joint and muscle pain, palpitations, mental health issues such as anxiety or depression as well as headaches and cognitive problems — frequently referred to as “brain fog”.
A recent government-funded REACT-2 study1 showed the breadth of long Covid, estimating that 37.7 per cent of the people in England who had self-isolated with symptomatic Covid experienced at least one symptom lasting 12 weeks or more — the equivalent of 2m people. Almost 15 per cent had experienced three or more persistent symptoms.
“These are not people who had any pre-Covid vulnerabilities. These are robust people who were living life to the full and are floored by the virus to varying degrees,” says Dr O’Connor.
So how have these otherwise healthy individuals been affected by long Covid while others have only experienced mild symptoms? The findings suggested that the prevalence of long Covid increases with age, with a 3.5 per cent increase in likelihood with each decade of life. The study also showed that rates of long Covid are higher among women, people who are overweight or obese, who smoke, live in deprived areas or had been admitted to hospital.
“Our findings paint a concerning picture of the longer-term health consequences of Covid, which need to be accounted for in policy and planning,” said Paul Elliott, director of the REACT programme. “Long Covid is still poorly understood, but we hope our research can contribute to better identification and management of this condition.”Alongside Dr O’Connor, consultant psychiatrist Dr Rajeev Dhar (opens in a new window) is part of the multidisciplinary Long Covid team at Cromwell Hospital. “We established the clinic because, between the various consultants, we recognised we had an increasing number of mutual patients who had symptoms that didn’t add up,” he explains. “You’d have patients with psychological symptoms, such as low-grade levels of anxiety and depression, but they would also display odd physical symptoms such as palpitations or breathlessness when they lay down.”
The collaboration between consultants across the fields of respiratory medicine, cardiology, neurology and psychiatry has allowed them to pool information and recognise symptom patterns quickly. A factor that often helps define long Covid is that its symptoms arrive like a shocking “bolt from the blue” in people who have never experienced them before.
“The fascinating thing about Covid is that it is potentially a multi-system issue. That means that if you’re thinking in a multidisciplinary way, you should become more comfortable in operating in a holistic way,” says Dr Dhar. “Where the real skill lies is in understanding the interface between the medicine, the psychiatry and the psychology, between what’s physical and what’s not.”
By the time patients are seen at Cromwell’s Long Covid Clinic, they may have been suffering from symptoms for some time, so rapid and correct diagnosis is imperative, says Dr Dhar. “Another three months of the wrong medication will mean they’ve been unwell for a very long time, and then it becomes even more difficult for people to get back to work.”
Both Dr O’Connor and Dr Dhar believe the holistic, multidisciplinary treatment being delivered at the clinic could have a longer-term effect — one that involves a fundamental change in attitudes and perspective.
“Medicine often focuses on treating symptoms,” Dr Dhar explains, “but long Covid has made us think about how we help people to function better. Our approach is now focused on how people are functioning, because that tells us how well we’re managing the symptoms.”
This newfound, holistic focus on patient performance and functionality not only informs the Cromwell’s approach to patient care, but also the new understanding of fast-track and proactive ‘Lifecare’ that sits at the heart of Private Client by Bupa, the latest premium private health insurance offering from Cromwell’s parent company, Bupa.
Focused on wellbeing rather than illness, and on pre-empting an individual’s health and wellbeing needs rather than reacting to unfortunate episodes of treatment, hospitalisation or illness, Private Client by Bupa not only provides its clients with access to a wide range of preventive treatments but to the best medical expertise around the world, wherever it can be found.
This article was featured online in the Financial Times’ ‘How to Spend It’ section in September 2021.
The study is based on self-reported data from 508,707 adults aged 18 and above who took part in REACT-2 rounds 3 to 5 carried out between September 2020 and February 2021.
Private Client by Bupa is a premium service providing expertly curated health and wellbeing plans insured by Bupa Global.