‘Allowing covid to circulate has major & ongoing long term adverse impacts on the way we run society eg over 10k #NHS frontline workers off sick to acute & long consequences’
2/
@Kit_Yates_Maths
- enter a countrywide 🌊 *3rd in 6 months* & rising prevalence now 2% in all ages (worryingly high in 50+ maybe as no 2nd booster & >70s more at risk) & 30% sharp rise in hospitalizations in different age groups
— hints of increased severity (int care)
3/
Caveat: ‘more ‘with’ covid than ‘for’ though may underlie some of the ‘with’ figures… can be hospital acquired or 2nd diagnosis such as stroke —> *but may be induced by #covid*
- slight uptick in mechanical ventilation suggests increased severity
4/
Hospital Key Performance Indicators report this week —> doesn’t make headline news but #NHS is in serious bother in many ways —> ‘blocked pipeline’ affects all services
Wait times alarming: patients dying —> must fund better
5/
Healthcare Safety — so concerned they issued early report (as aren’t meant to report until later in the year) on #NHS crisis
~2 million (1 May) worrying rise in impacts (little to much) across society, significantly greater in most deprived communities, as we allowed transmission
—> can see outcome of each wave, harm by variant #Omicron highest!
- #longcovid is a patient defined term for symptoms 4 or 12 weeks past infection
—> lots of symptoms can overlay baseline of extreme fatigue eg
brain fog 😶🌫️ can’t remember or use higher mental functions; palpitations, heart symptoms
9/
Symptoms:
1) Top bar — cardinal feature most people get is FATIGUE, general feeling of complete exhaustion; inability to exercise (poor exercise tolerance) & post exercise symptom exacerbation (immediately after or next day ‘crash’) is very typical of #longcovid
10/
2) Body of slide — shows extra symptoms e.g. some have altered breathing, symptoms in their guts or allergic rashes
—> fluctuates, relapses & remissions ‘boom & bust cycle’ —> you think you’re getting better, go back to work for a couple of days then in bed with same exhaustion
1) 10-30% have #POTS (postural tachycardia syndrome) —> when stand up ❤️ rate shoots up. Ten minute stand test finds *pulse normal at rest at 70 when stand up it’s 160* —> dizzy, sick, must sit —> must test everyone!
2) Also see a lot of new rashes, urticaria, itching & flushing gastrointestinal symptoms —> Mast Cell Activation Syndrome #MCAS is a condition we don’t know much about —> aberrant immune response, mast cell produces histamine which causes symptoms in any system of the body…
Doctors should check:
1) blood, liver, autoimmune diseases, cortisol to ensure not missing anything other than #longcovid, chest X-ray, ECG for palpitations — *ten minute stand test for POTS is the most important* — nearly half your patients’ pulse almost doubles if they stand
2) patients can self-check with a blood pressure monitor — cardiologists should manage #POTS (but don’t always) & generalists can give beta blockers as a first line of treatment
—> need better education of generalists & specialists
‘#longcovid conditions not well understood by many doctors as they’ve suddenly exploded in how common they are — we haven’t got the education or the awareness right. @drclairetaylor shows you can do this in primary care with the right knowledge & skills…’
16/
@amibanerjee1
— *we’re increasing long term problems* only thing we know works is *to avoid #covid which we’re not doing at scale*
💉 no panacea
—> must streamline services across country & disciplines (cardiology, respiratory, gastroenterology *all look 👀 out for #longcovid
What long term impacts?
@amibanerjee1 we lack insight into any one pathophysiological mechanism eg ?
- inflammation of blood vessels —> why so many organ systems & rise in heart attacks, strokes, diabetes?
- mast cell activation, microclots?
18/
What state of research?
- many studies (eg NIHR funded, Stimulate ICP) but slow process/lack prioritization of chronic disease & fewer staff also to #longcovid
—> should speed as a priority large scale problem + gives insights into treating other systemic/chronic diseases
19/
@trishgreenhalgh Locomotion study so
- *every #longcovid clinic in the country delivers current best practice*
- people self-manage & monitor their symptoms with technology & checklists
- crucial collection/registry of data to categorize symptoms & treatment
⚠️ prevent; no cure
Public Q&A
- biomarkers to prove #longcovid esp after delay?
@amibanerjee1@drclairetaylor
- no as don’t understand unifying mechanism; fluctuations challenging — need trials & to act fast
- frustrating tests normal! @BinitaKane best is to believe esp children…
21/
- frustration at slowness of research into new diseases in this country when lots of leads eg on viral persistance —> need doctors to follow this science
- @trishgreenhalgh you can try antihistamines etc but *try one thing at a time, keep a diary to record symptoms*
22/
‘some people get #longcovid on reinfection, will infections several times a year erode our health esp those already suffering #longcovid?’
@Daltmann10 how reinfection contributes to the unknown cause of #longcovid is even more difficult but critical
@SGriffin_Lab outcomes come from 🦠 your immune status & environment. All three in flux still why we have these waves, why different symptoms & outcomes from disease.
So it’s really difficult & like rolling a dice. Need to understand more & reduce ridiculous levels of infection
@trishgreenhalgh is working on summaries for busy doctors to know what to test for & attitude eg believing this is a biological disease regardless of biomarkers
@drclairetaylor *document everything* (covid, doctors’ visits, symptoms..) as hard to get disability insurance
devastating impact on #NHS after years of underfunding & staff shortages: long waits for emergency services, operations postponed, delayed cancer treatment & difficult to secure doctor & dentist appointments.
Why & how can we help?
2/
@Dr_D_Robertson sparse data now; dashboard only England 🏴
First thing to watch as it impacts our future is growth of variants:
Three increase fast in 🇬🇧
each at 4-5% of sequenced samples —> watch this space to see what will happen in the weeks & months ahead…
Great 🧵 asking Switzerland 🇨🇭 for data not just on hospitalizations & deaths but morbidity; those still suffering after hospital, #LongCovid#longcovidkids — a #longcovidregister… frequency & effect of reinfections; organ damage to the brain, heart, liver, kidneys etc
- little data now on infections, @ONS survey shows #Omicron cases fall (except maybe N Ire) positivity ~6% Wales, 4% other home nations
- falls in every age (good news after Jan high primary school infections) & falls in major cities first eg London
Hospital admissions fall & number still in hospital accumulating wave after wave since June should at last decline in next weeks…
🚨 England suffers one-hour 🚑 delays
🚨 over 1k deaths/week involving #covid —> still relatively high so #CovidIsNotOver by any means
Swiss 🇨🇭 #longcovid data is hard to come by, but seems vaccines protect at best 50% + partially eg not so well vs cognitive trouble
- Risk drops from 10-30% to 5-15%, even boosted can get long covid… high waiting times for consultation… ~150 new invalidity requests a month 1/3
We’re just beginning to see #Omicron has a #longcovid impact & expect to see more in coming months to high waves we’ve had. March invalidity requests (~150/month)
- 54,7% women
- 36,9% 56-65 yos
- 31,9% 46-55 yos
- 17,7% 36-45 yos
- 10,5% 26-35 yos
- 2,9% under 26 yos
2/
Prevention is better than cure — Invalidity is hard to get & doesn’t cover much
@globalhlthtwit 🦠 still soars, highest-ever hospitalization since 2nd wave.
ONS yesterday *record 2,7%* suffer #longcovid, yet gov ending of protective measures & crucial data collection means an environment of uncertainty prevails..
- highest-ever prevalence to #BA2 🌊 at 6,37-7%, maybe peaking but will cases come down or stay high?
- led by unvaccinated 1ry school kids (8,8%) & elderly (7,2%)
- 2000 hospital admissions/day
- 7% NHS staff absences
- 12% 🚑 handovers longer than 1hr
Mental health of ICU workers — after large wave 50% suffer mental illness (depression, anxiety, post traumatic stress)
—> we’re asking so much of all NHS incl social care
🚨 We’ve had ‘winter pressure’ for almost a year, still ongoing & backlog is continuing — NHS needs support