Managing Long COVID Syndrome

Description

Over ten percent of people infected with the COVID virus will suffer with long COVID syndrome. Up until now, more than one million people have been affected with this syndrome in the United Kingdom alone, and the incidence worldwide is estimated to be more than 35 million people, although this may be the tip of the iceberg. The World Health Organization has highlighted a need for the “three Rs” — Recognition, Research and Rehabilitation. Long COVID syndrome can be frustrating and disabling, even many months or years after the infection; sufferers complain of fatigue, pain, post-exertional malaise, cognitive dysfunction and many other systemic symptoms. It can be challenging for healthcare professionals to recognise the disease and for patients who are suffering from the condition it can have a wide and far-reaching impact on their lives and day-to-day activities. Being a relatively new condition, many healthcare professionals, now more than ever, need to have the requisite knowledge to recognise and manage this severely debilitating disease. This book will be useful to all frontline healthcare professionals to help diagnose, manage and direct patients to the available resources. General practitioners, physiotherapists, pain therapists, nurses, surgeons, physicians, junior doctors, psychologists, medical students and other clinicians will be able to update their knowledge on long COVID syndrome with this easy to read book. Patients will also find the book useful to understand the basis of the disease and how they can seek help. This comprehensive treatise covers a wide variety of topics on long COVID syndrome including the aetiopathogenesis, recognition, systemic involvement, investigations, guidelines on management, available resources, systemic management and pain/fatigue management. This book will be handy for candidates preparing for various examinations conducted by the Royal College of General Practitioners, UK (MRCGP), Royal College of Anaesthetists, UK (FRCA), Faculty of Pain Medicine, UK (FFPMRCA), College of Anaesthesiologists of Ireland (FCAI), European Society of Anaesthesiology and Intensive Care (EDAIC), Australian and New Zealand College of Anaesthetists (FANZCA), World Institute of Pain (FIPP/CIPS), National Board of Examinations of India (Dip NB), and the American and Canadian board examinations, as well as other examinations conducted by medical boards across the globe. Cover Title Page Copyright Contents Preface Foreword Abbreviations Section I: Long COVID syndrome Chapter 1: Coronavirus disease Introduction Aetiology Variants of SARS-CoV-2 Delta variant Omicron variant (PANGO lineage B.1.1.529) Key Points References Chapter 2: What is long COVID syndrome? Introduction Presentation of long COVID syndrome Health impact of long COVID syndrome Definition of long COVID syndrome Recognising and managing long COVID syndrome Key Points References Chapter 3: Epidemiology of long COVID syndrome Introduction Prevalence in the United Kingdom Prevalence after hospital discharge in the UK Prevalence in other countries Demographics Predictors and risk factors Key Points References Chapter 4: Aetiopathogenesis of long COVID syndrome Introduction Long-term immunological changes Post-intensive care syndrome Persistent inflammation Vascular and autonomic nervous systems Pulmonary fibrosis Organ damage Psychosocial factors Dysregulation of the renin-angiotensin-aldosterone system Energy substrate depletion Cellular changes Key Points References Chapter 5: Prolonged clinical manifestations of post-acute COVID-19 Introduction Signs and symptoms of long COVID syndrome The REACT-2 study on long COVID symptoms Other studies Postural orthostatic tachycardia syndrome Psychological impact Social impact Key Points References Chapter 6: Problems after intensive care stay in COVID-19 patients Introduction Post-intensive care syndrome: long-term sequelae following intensive care stay Problems specific to COVID-19 illness Sleep disturbances and delirium Cognitive impairment Lessons learnt from past experience: SARS outbreak Critical care neuropathy Critical care myopathy Prone positioning in intensive care to improve oxygenation Chronic pain after COVID-19-related intensive care admission Key Points References Chapter 7: Risk factors for developing long COVID syndrome Introduction Type and number of symptoms in early infection Illness severity during acute infection Age Gender Socioeconomic status High body mass index Other systemic illnesses associated with long COVID syndrome Prediction models of long COVID syndrome Long COVID syndrome and symptom relapse Key Points References Chapter 8: Effects of long COVID syndrome on economy and society Introduction ‘Long economic COVID’ Costs due to mental health impairment Costs due to disruption of children’s education Costs on vital social issues Costs due to job losses Burden of long COVID syndrome Delayed care and associated costs Impact of abnormal sense of smell in long COVID syndrome Costs due to COVID-induced disability Challenges in estimating costs Tackling long COVID syndrome in the UK’s National Health Service Key Points References Section II: Symptoms and investigations Chapter 9: Respiratory problems Introduction Aetiopathogenesis of respiratory problems Acute COVID-19 and lung damage Long COVID syndrome and the lungs Respiratory signs and symptoms in long COVID syndrome Presentation of multiple comorbidities Key Points References Chapter 10: Cardiovascular problems Introduction Aetiopathogenesis of cardiovascular problems Acute COVID-19 and cardiac damage Long COVID syndrome and the heart Long COVID syndrome and the vascular system Cardiovascular signs and symptoms in long COVID syndrome Postural hypotension Cardiovascular effects of antiviral medications Key Points References Chapter 11: Neurological problems Introduction Incidence of neurological problems in long COVID syndrome Aetiopathogenesis of nervous system involvement Neurological signs and symptoms in long COVID syndrome Classification of neurological involvement Brain fog Stroke in COVID-19 illness Encephalitis Complications from intensive care stay Mental health problems Sleep problems Peripheral nerve and muscle problems Key Points References Chapter 12: Pain problems Introduction Chronic pain in long COVID syndrome Aetiopathogenesis of pain problems in long COVID syndrome Risk factors for chronic pain in COVID-19 illness Pain presentations and sequelae in long COVID syndrome Neurological conditions causing persistent pain in long COVID syndrome Neuropathic pain in long COVID syndrome Mood, fatigue and pain Exacerbation of chronic pain due to disruption of services Key Points References Chapter 13: Mental health problems Introduction Aetiopathogenesis of mental health problems in long COVID syndrome Epidemiology of mental health problems due to long COVID syndrome Signs and symptoms of mental health problems in long COVID syndrome Mental health of families and carers Key Points References Chapter 14: Taste and smell problems Introduction Incidence of taste and smell problems Aetiopathology of taste and smell problems in long COVID syndrome Symptoms of smell and taste dysfunction Objective measurements vs. self-reporting of symptoms of smell dysfunction How long do symptoms of abnormal smell and taste sensations last? Consequences of taste and smell problems Key Points References Chapter 15: Other problems found in long COVID syndrome Introduction Prevalence Other signs and symptoms in long COVID syndrome Fatigue and extreme tiredness in long COVID syndrome Key Points References Chapter 16: Differential diagnosis Introduction Ruling out other respiratory causes Ruling out cardiac causes Ruling out rheumatological causes Ruling out neurological causes Ruling out endocrine causes Key Points Chapter 17: Investigations in long COVID syndrome Introduction Confirmed or suspected COVID-19 illness Urgent referral in the presence of life-threatening symptoms Patient-tailored investigations NICE guidelines on investigations Exercise tolerance test Tests for postural symptoms Chest X-ray Further respiratory investigations Cardiovascular assessment Psychiatric assessment Psychological assessment Referral to specialist services Key Points References Section III: Guidelines and policies Chapter 18: NHS England plans for long COVID syndrome Introduction Long COVID syndrome: NHS plan for 2021/2022 Five-point plan (October 2020) Ten key steps from June 2021 Care pathways and resource projection for patients with long COVID syndrome NHS Long COVID Taskforce Key Points References Chapter 19: NICE guidelines on long COVID syndrome Introduction NICE criteria for long COVID syndrome Identifying people with long COVID syndrome Assessment Investigations and referral Care planning Management Follow-up and monitoring Controversies in the NICE guideline Key Points References Chapter 20: ME Association guidelines on long COVID syndrome Introduction Key messages from the ME Association on long COVID syndrome Long COVID syndrome and myalgic encephalomyelitis/ chronic fatigue syndrome Patient self-reporting on long COVID syndrome Red flag symptoms Management guidelines from the ME Association Prognosis of long COVID syndrome Key Points References Chapter 21: American guidelines for long COVID syndrome Introduction CDC guidance on long COVID syndrome Interim guidance on post-COVID conditions National Institutes of Health guidelines on long COVID syndrome Key Points References Chapter 22: Guidelines from other health organisations Introduction Guidance from the World Health Organization (Europe) Guidance from the Scottish Intercollegiate Guidelines Network on long COVID syndrome Guidance from the European Agency for Safety and Health at Work Health systems and policy analysis guidance from the World Health Organization Key Points References Section IV Management of long COVID syndrome Chapter 23: Management principles for long COVID syndrome Introduction Course of recovery Self-management Patient-specific management plan Exclusion of serious complications Pacing of patient recovery Mental health Referral to specialist rehabilitation services Pulmonary rehabilitation Management of fatigue Exercise rehabilitation recommendations Pathways Encouraging patients to ‘own’ their recovery Key Points References Chapter 24: Long COVID assessment centres Introduction Initial start of assessment centres Expansion of specialist services to include children and young people Long COVID: the NHS plan for 2021/22 Commissioning for long COVID assessment clinics Core features of long COVID support services Modelling demand for specialist services Key Points References Chapter 25: Online recovery and rehabilitation platforms Introduction ‘Your COVID Recovery’ online support Online self-management digital tool Features of ‘Your COVID Recovery’ platform Practicalities of ‘Your COVID Recovery’ platform Other online platforms Key Points References Chapter 26: Patient education and explanation Introduction Fear of the unknown Patient-centred rehabilitation Record keeping and patient diary Explanation of the pathways Explanation of prognosis and future Patient engagement in using rehabilitation apps Key Points References Chapter 27: Biopsychosocial model Introduction The biopsychosocial model Awareness of psychosocial issues in the COVID-19 pandemic Integration of the biopsychosocial model in rehabilitation programmes Importance of the biopsychosocial model in rehabilitation Long-term benefits of the biopsychosocial model Controversies and arguments Key Points References Chapter 28: Managing fatigue Introduction Sequelae of fatigue in long COVID syndrome Rest and relaxation during the initial recovery period Being kind to self Proper planning Keeping active Activity diary Sleep hygiene Nutrition Relaxation strategies Distraction strategies Referral to specialist services Controversy on the use of exercise in fatigue management Post-exertional malaise Key Points References Chapter 29: Managing breathlessness Introduction Explaining breathlessness to patients Ruling out sinister or treatable causes of breathlessness Pacing and planning Breathing control technique Other breathing strategies Posture and breathlessness Management of cough Key Points References Chapter 30: Managing sleep Introduction Sleep problems in long COVID syndrome Insomnia and oversleeping Strategies before bedtime Sleep time and sleep hygiene Blue light filter Proper planning Cognitive behavioural therapy Post-traumatic stress disorder Role of melatonin Is good sleep the answer to preventing long COVID syndrome? Key Points References Chapter 31: Managing memory problems Introduction Sequelae of memory problems in long COVID syndrome Domains of neuropsychological deficits Acceptance of memory problems Pacing and planning Relaxation Sleep hygiene and adequate rest Nutrition Keeping a diary and work scheduling Association with long-term problems Key Points References Chapter 32: Managing mental health and mood problems Introduction Patient self-management Fear and anxiety Dealing with loss and bereavement Pathways for mental health support Self-help strategies Talking about mental health Improving access to psychological therapies Cognitive behavioural therapy Acceptance and commitment therapy Mindfulness-based approaches Multimodal strategies in rehabilitation Urgent referral for mental health support Group therapy Support to family Psychiatric referral Going back to work Key Points References Chapter 33: Managing nutrition Introduction Balanced diet Enhanced diet for recovery Symptoms of nutritional deficiencies caused by COVID Vitamins and minerals Trials in nutrition Key Points References Chapter 34: Managing other symptoms Introduction Managing orthostatic hypotension Managing loss of smell and taste Managing headache Managing nausea and vomiting Managing persistent fever Managing loss of appetite Managing gastrointestinal reflux Managing tinnitus Managing diarrhoea Managing itch and skin problems Key Points References Section V: Pain management in long COVID syndrome Chapter 35: Managing pain in long COVID syndrome Introduction Joint and muscle pain Widespread neuropathic sensations Biopsychosocial model Multimodal strategies Gradual pacing Physical therapy Stretching exercises Getting help Referral to specialist services Problems specific to COVID times Problems due to delayed access to pain services Key Points References Chapter 36: Physical therapy Introduction Role of the physiotherapist Safety first Excluding cardiac and respiratory impairment Personalised approach Activity diary Gradual pacing Breathing exercises and support Stretching exercises Holistic approach How to manage post-exertional malaise Safe rehabilitation approach Key Points References Chapter 37: Massage and hot and cold therapies Introduction Massage therapy Heat therapy Cold therapy Aromatherapy Hydrotherapy Key Points References Chapter 38: Simple medications Introduction Paracetamol Non-steroidal anti-inflammatory drugs Key Points References Chapter 39: Neuropathic pain medications Introduction Tricyclic antidepressants Gabapentinoids Serotonin and noradrenaline reuptake inhibitors NICE guidelines for neuropathic pain Key Points References Chapter 40: Harmful effects of opioids Introduction Opioid pharmacology Common opioids Common side effects Warnings of long-term use of high-dose opioids Harm from long-term opioid use Harm specific to long COVID rehabilitation Key Points References Section VI: Complementary therapies and pain clinic approach Chapter 41: Acupuncture Introduction Mechanism of action Evidence base Case report on acupuncture use Guidance on acupuncture use in long COVID syndrome Key Points References Chapter 42: Transcutaneous electrical nerve stimulation Introduction Mechanism of action Evidence for use Published studies on the use of TENS in COVID-19 Practicalities of using TENS in long COVID syndrome Key Points References Chapter 43: Psychology Introduction NICE guideline on long COVID syndrome Controversies over the role of psychology Yellow flags Cognitive behavioural therapy Acceptance and commitment therapy Mindfulness-based approaches Approach to psychology Key Points References Chapter 44: Pain clinic approach Introduction Need for pain clinic referral The biopsychosocial model Structured approach Management plans offered in pain clinics Specialised pain interventions in long COVID syndrome Outcomes and evaluation Communication with other teams Role of the patient Key Points References Section VII: Novel pain therapies in long COVID syndrome Chapter 45: Intravenous lidocaine infusion Introduction Mechanism of action Other supporting evidence for the use of lidocaine in COVID-19 The role of lidocaine in pain relief in long COVID syndrome Dosages and side effects of intravenous lidocaine Key Points References Chapter 46: Nerve blocks Introduction The role of regional anaesthesia and nerve blocks Common injections used by pain services for long COVID syndrome Avoiding steroid use in long COVID syndrome Key Points References Chapter 47: Botox treatment for headache Introduction The impact of the COVID pandemic on patients with headaches Botulinum toxin and its use Mechanism of action of botulinum toxin The current evidence and guidance on the use of Botox® as headache treatment Usage practicalities Botox® and the COVID-19 vaccine Key Points References Section VIII: Long COVID in children Chapter 48: Long COVID syndrome in children Introduction Prevalence of long COVID syndrome in children Symptoms of long COVID syndrome in children Risk factors for long COVID syndrome in children Management Key Points References Section IX: Patient support groups for long COVID syndrome Chapter 49: Patient support groups for long COVID syndrome Introduction LongCovidSOS Long COVID Support Long COVID Wales Long COVID Scotland Patient-Led Research Collaborative on long COVID syndrome Body Politic COVID-19 Support Group Other long COVID patient experience and support groups Key Points References Section X: New research interventions Chapter 50: Research on long COVID syndrome Introduction Government initiatives in the United Kingdom Other prominent studies on long COVID syndrome Epidemiological studies Themed reviews on long COVID syndrome Research on long COVID syndrome in the United States Key Points References Chapter 51: New medications under investigation in trials Introduction CCR5 inhibitors Tocilizumab Colchicine Ivermectin Recombinant DNase Therapies for autoantibodies Other experimental medications Key Points References Chapter 52: Other experimental therapies Introduction Neuromodulation therapy Hyperbaric oxygen Nanoparticle technology Key Points References Index Back cover