Page 37 - IDF Journal 2023

Long COVID
The Mater Hospital Dublin Experience
Professor John Lambert
The COVID-19 pandemic
has been an unprecedented public health emergency, and the longer-term health effects are becoming increasingly clear. Persistent COVID-19 complications have been classified into diagnoses
of ongoing symptomatic COVID-19 (4-12 weeks post infection) and post-COVID-19 syndrome or ‘Long COVID’ (symptoms lasting > 12 weeks). Enduring COVID-19 symptoms are many and diverse, including fatigue, fever, joint/muscle pain, skin/hair problems, and disruption to the respiratory, cardiac, and neurological functions1,2,3. Therefore patients’ care needs should be met using continual, holistic, and multidisciplinary care approaches, the kind which are advocated by multi- morbidity and chronic care models4,5, and are routinely provided in primary care1,6,7.
While it is understood that individuals admitted to hospital with COVID-19
may have delayed complications such
as myocarditis, pulmonary fibrosis, encephalitis, thromboembolic events, and psychiatric illness, as well as persisting symptoms such as dyspnoea, cough
and fatigue, little is known about how often such post-acute complications occur in individuals who do not require hospitalisation8. A 2021 study from Denmark by Lund et al looked at Danish COVID-19 infected individuals who did not require hospitalisation. In this group, they identified an increased risk of
health care encounters as a function of dyspnoea. These patients also accessed primary care more frequently than a matched negative cohort9. A 2021 review by Shin Jie Yong et al10, discussed
the pathogenesis of Long COVID (LC) neurological symptoms. While the possible causes of LC include long term tissue damage, viral persistence, and chronic inflammation, the authors of this review advocate that persistent brainstem dysfunction may be involved.
In May 2020, during the first wave of COVID-19 infections in Ireland, Professor Lambert, Infectious Diseases Consultant at the Mater Misericordiae University Hospital (MMUH), received a Health Research Board (HRB) grant to assess the longitudinal impact of COVID-19 in patients. The Anticipate COVID-19 Study used the 12-item Short Form Survey (SF-12) score, a Health Related Quality
of Life tool to describe symptomatology and ascertain predictors of developing Post COVID-19 Syndrome (PoCS) at one year. A dedicated post-COVID clinic was established to provide a research platform for the Anticipate COVID-19 study as
well as providing a clinical care centre11. 155 patients were recruited and were administered study tools at 2 separate time points. The study concluded that participants had reduced Physical Composite Score (PCS) of the SF-12. Participants with PoCS had considerably lower scores than those without symptoms at 1 year follow up, and scores for these patients did not improve at Time 2. Predictors of PoCS at 1-year were lower PCS, and higher baseline heart
rate (HR) at clinical review 3 months after infection. Lower PCS scores and higher resting HR can be used in the weeks after COVID-19 to help indicate those at risk of PoCS12.
The Anticipate research group also examined enduring mental health issues and problematic alcohol use among LC patients attending the post-COVID clinic. Outcomes with respect to participant demographics, acute COVID-19 healthcare use, mental health, and alcohol use were examined. The baseline cohorts (n = 153) median age = 43.5yrs (females = 105 (68.6%)). 67 of 153 patients (43.8%) were admitted to hospital at
the time of COVID-19 infection, 9/67 (13.4%) were admitted to ICU, and 17/67 (25.4%) were re-admitted post hospital discharge. 17 of 153 participants (11.1%) had a pre-existing affective disorder. The frequency of clinical range depression, anxiety, and PTSD scores at Time 1
and Time 2 (n = 93) ranged from 12.9% (Time 1 anxiety) to 22.6% (Time 1 PTSD). Problematic alcohol use was common at Time 1 (45.5%) and considerably more
so at Time 2 (71.8%). Clinical range depression, anxiety, and PTSD scores were pointedly more frequent among acute COVID-19 hospital admission and GP attendance (30 days) respondents,
as well as among those with lengthy ICU admissions, and those with a previous affective disorder diagnosis. Enduring psychiatric symptoms and problematic alcohol use in LC cohorts are concerning and these issues may be more dominant among individuals with severe acute COVID-19 infection and /or pre-existing mental illness13.
The Anticipate group also piloted the use of Low Dose Naltrexone (LDN) in patients with LC. Patients were recruited through a post-COVID clinic, were administered
a baseline quality of life questionnaire, were prescribed 2 months (1mg in month one, 2mg in month two) of LDN and repeated the questionnaire at the end of treatment. Of the 52 patients who took part in the study 40 (76.9%) were female. The median age was 43.5 years. The largest occupational cohort represented were healthcare workers n=16 (34.8%). The median time from
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