Approximately 10% of mild coronavirus cases who were not admitted to hospital have reported symptoms lasting more than 4 weeks. This is commonly known as ‘Long Covid’ following substantial research and development into the impact of Covid-19. As a result, it was announced in December that 69 sites would be established to support Long Covid patients access specialist help. There is a real opportunity to capitalise on this infrastructure, to provide an upscaling of support for other chronic illnesses, particularly post-viral illnesses such as Chronic Fatigue Syndrome (CFS) which share clinical and symptomatic similarities.
Around 15 million people in England have a long-term condition, for which there is no cure and which can be managed with drugs and other treatment. Chronic illnesses have a significant adverse impact on the individual, families, friends, community and the wider economy. They also present difficulties in the availability of healthcare resources to provide adequate support. However, the establishment of Long-Covid centres ought to be capitalised on in a more strategic, long-term, and holistic way. Rather than a rehashing of an ineffective ‘quick fix’, or a sticking plaster, a primary aim of these centres should include to understand the chronicity of the longer-term problems posed by chronic illnesses. Although those with Long-Covid will require wraparound support and the provision of this service is much needed, without considering how similar chronic illnesses and post-viral illnesses, such as CFS, could be included in this wraparound support would be an opportunity missed. There is also an opportunity to shift and learn from pre-existing conceptions and barriers to services which sufferers of post-viral illnesses face on a daily basis, in accessing healthcare services and referral to community and outreach services.
To demonstrate how this could be achieved, I will focus in on CFS, which is a long-term illness with a wide range of symptoms including sleep problems, extreme tiredness, headaches, among others. There is an expanding amount of research, operating at pace, which suggests that there are similarities between CFS and Long Covid, in their sharing of similar symptoms such as extreme tiredness, brain fog, muscle pain and continuing headaches. For decades, many people with CFS have been dismissed by their doctors, employers and even families with accusations of exaggeration or these being psychosomatic ailments. A significant minority of those with CFS remain housebound or even bedbound, and this presents a significant social issue with consequences for the wider economy, society, and environment.
It is unfortunate, albeit thoroughly encouraging, that the acceptance and shift in public attitudes and clinical research into longer-term illnesses may arrive as a result of Long-Covid. Nevertheless, the social and built infrastructure that will be established as a result needs to account for the symptoms experienced by Long-Covid patients and include a wider cohort of people who experience very similar day-to-day symptoms.
With viral pandemics potentially becoming a more common occurrence, to be managed across society, the Long-Covid Centres ought to be in place for the long-term, and facilitate the investment in research and development to provide the three following pro-active channels of response:
1. Wraparound care and support for those with Long-Covid AND other chronic illnesses, or those who present chronic symptoms, to invest in long-term solutions to tackle and manage their illness and/or symptoms;
2. To invest in biomedical and clinical solutions and understand the chronicity of the various symptoms to tackle the status quo, which provides a significant social challenge and the removal of a significant cohort of the community from society, and the economy;
3. Invest in research and development to fully understand the drain on healthcare resources and the economy of chronic illnesses, including the emerging Long-Covid, to understand how government action can respond and support those with chronic conditions and ensure that there is a ‘open door’ policy so that no one is turned away from services based on unhelpful beliefs, a lack of research and the theory of ‘deconditioning’.
The experience of CFS has presented a number of weaknesses in behavioural and psychological interventions, which have often proven ineffective at best, and potentially destructive and counter intuitive. Highlighting CFS as a case study helps to learn from other chronic illnesses to avoid a similar path, provide an evidence base to support the effort against Long-Covid, and potentially future viral pandemics. Investment in biomedical and clinical research is essential to develop a robust information base, and which has arguably shone a light on a weakness in the approach of healthcare policy towards longer-term conditions.
To ensure that the healthcare system is robust and can withstand the potential for a substantial increase in more working-age people experiencing chronic illnesses, it must capitalise on the opportunity that Long-Covid Centres present in understanding the experiences of patients and significantly investing in a long-term response.
1009-11