Managing Long COVID Syndrome

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