Latest on Long Covid 19

By Michael Nicolaou, osteopath

The following information is collected from a webinar hosted by the Institute of osteopathy (Io) in association with the National Council for Osteopathic Research (NCOR) which took place on 24th March 2021.

How common is Long Covid 19?

Around 1 in 5 people testing positive for Covid 19 exhibit symptoms for a period of 5 weeks or longer, and around 1 in 10 exhibit symptoms for a period of 12 weeks or longer. That equates to approximately 420,000 (and rising) people in the UK presenting with long Covid.

What are the risk factors?

Increasing age, higher BMI and being a female. There is also emerging evidence that, like adults, children are at risk from persisting symptoms – in other words, long covid.

The severity of Covid in the first instance does not predict long Covid 19.

How does it present?

Long Covid sufferers usually present with clusters of symptoms, which can fluctuate and change over time and can affect any system in the body. 86% reported relapses, irregular symptom patterns, multiple triggers.

Commonest symptoms: a persistent cough, low grade fever and fatigue which is often be disabling . 
Less common symptoms : shortness of breath, chest pain, muscle pains and muscle weakness, headaches, neurocognitive difficulties, GI upset, metabolic disruption, thromboembolic conditions, depression and other mental health conditions as well as skin rashes.

What are the causes of long covid?

Causes are : post viral fatigue, the immune response itself rather than the virus (aftermath of cytokine storm), viral persistence, organ impairment, thrombosis, embolism risk increase, biological sex different responses to the virus, neurological changes such as damaged nerve cells and psychological overlay affecting recovery.

How to best assess someone with long Covid ?

An osteopath will systematically organise a first pre-session screening of potential covid infected patients. It is the right place to find out if the patient has had Covid in the past, or is still suffering from post-covid issues.

Firstly, any acute or life threatening complications need to be ruled out, and symptoms need to be evaluated to ascertain if they are likely to be caused by ongoing symptomatic covid, long covid or a new unrelated issue.

Potentially life threatening signs and symptoms for immediate referral are :

  • severe hypoxaemia or oxygen desaturation on exercise,
  • signs of severe lung disease,
  • cardiac chest pain,
  • multisystem inflammatory syndrome (especially children).

How can someone with long Covid be treated osteopathically ?

A holistic assessment for a bespoke care management plan is needed first, including a physical, cognitive and a psychological assessment.

Care might involve referral to common specialist routes of care including : lung disease services, sleep clinics, cardiac services, rehabilitation services, psychological care such as CBT and other mental health services.

Managing long covid will entail:

  • The use a holistic, person-centred approach,
  • Refraining from prognosing the severity and trajectory of long Covid: we have lots to learn,
  • There is no ‘one standard approach’ to assessment,
  • Recommending using an integrated approach rather than a symptom by symptom management approach.

Take home message :

There is very little or no research, specific to care and management of long Covid 19. What is advised so far:

  1. The use physical care and touch, 
  2. Activity/ rehabilitation advice and tailor made exercises within the patients activity level capacity,
  3. Advice guidance on self management and care,
  4. Well being promotion, 
  5. Monitoring and support.  

Many such patients recover spontaneously (if slowly) with holistic support, rest, symptomatic treatment, and gradual increase in activity, according to the American Family Physician Journal, with an article by Trisha Greenhalgh and Matthew Knight.

Addition to Michael Nicolaou’s article: in parallel to osteopathic treatment, long covid sufferers can also get “everyday life” support from the youtube channel of fellow long covid sufferer Gez Medinger, “Pre-Covid, film producer and director. Now, an investigative science journalist travelling down the rabbit hole of Long Covid

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