Some notes from me (relevant sections with key bits highlighted)
I was struck by how much lung/breathing/cardiac issues were common - so very different from ME/CFS in that respect (I suspect co-morbidities were different too). Also many similarities, and I have focused on things that look relevant to ME/CFS and also on patient participation in the paper.
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What are the symptoms?
Post-acute covid-19 symptoms vary widely. Even so-called mild covid-19 may be associated with long term symptoms, most commonly cough, low grade fever, and fatigue, all of which may relapse and remit.
47 Other reported symptoms include shortness of breath, chest pain, headaches, neurocognitive difficulties, muscle pains and weakness, gastrointestinal upset, rashes, metabolic disruption (such as poor control of diabetes), thromboembolic conditions, and depression and other mental health conditions.
424 Skin rashes can take many forms including vesicular, maculopapular, urticarial, or chilblain-like lesions on the extremities (so called covid toe).
25 There seems to be no need to refer or investigate these if the patient is otherwise well.
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Referral to a specialist rehabilitation service does not seem to be needed for most patients, who can expect a gradual, if sometimes protracted, improvement in energy levels and breathlessness,
aided by careful pacing, prioritisation, and modest goal setting. In our experience, most but not all patients who were not admitted to hospital recover well with four to six weeks of light aerobic exercise (such as walking or Pilates), gradually increasing in intensity as tolerated.
Managing fatigue (mentions patient responses to cochrane)
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The profound and prolonged nature of fatigue in some post-acute covid-19 patients shares features with chronic fatigue syndrome described after other serious infections including SARS, MERS, and community acquired pneumonia.
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The sportsperson returning to exercise (summarised from Stanford-Hall statement43)
- After recovery from mild illness: 1 week of low level stretching and strengthening before targeted cardiovascular sessions
- Very mild symptoms: limit activity to slow walking or equivalent. Increase rest periods if symptoms worsen. Avoid high-intensity training...
There is much debate and controversy about the role of graded exercise in chronic fatigue generally (
see patient responses to a recent Cochrane review47) and in covid-19 in particular (see a
recent statement from the National Institute for Health and Care Excellence (NICE)48). Pending direct evidence from research studies, we suggest that exercise in such patients should be undertaken cautiously and cut back if the patient develops fever, breathlessness, severe fatigue, or muscle aches. U
nderstanding, support, and reassurance from the primary care clinician are a crucial component of management.
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Advice for patients
Encouraging stuff here:
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Implications for the primary care team
From the limited current evidence, we anticipate that many patients whose covid-19 illness is prolonged will recover without specialist input through a holistic and
paced approach.
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If 10% of covid-19 survivors experience post-acute disease, and we assume (conservatively) that half of all cases were not formally diagnosed, this translates to
around 60 000 people in UK with post-acute covid-19 (around six per general practice).
Patients, many of whom were young and fit before their illness, have described being dismissed or treated as hypochondriacs by health professionals.4 They have rightly contested the classification of non-hospitalised covid-19 as “mild.”5 In these uncertain times, one key role that the primary care practitioner can play is that of witness, “honouring the story” of the patient whose protracted recovery was unexpected, alarming, and does not make sense.75
Patient participation
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How patients were involved in the creation of this article
A patient contributed to the description in box 1. The paper was read by four additional lay people with experience of covid-19 in themselves or their friends or relatives, and extensively modified in response to their feedback before submission. Peer reviewers included people with post-acute covid-19.
The main changes in response to patient feedback were in relation to management of fatigue.
