WHO officially recognises long COVID

Anastasia Tsirtsakis

12/10/2021 1:45:19 PM

It is hoped the clinical case definition will help doctors diagnose the condition, which affects more than one in three people infected with COVID-19.

Young woman struggling with long COVID.
Long COVID symptoms can have a big impact on people’s everyday functioning.

The World Health Organization (WHO) has formally recognised long COVID – now officially named post-COVID-19 condition – with a definitive clinical case definition.
‘Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually three months from the onset of COVID-19 with symptoms and that last for at least two months and cannot be explained by an alternative diagnosis,’ the definition reads.
Common symptoms include fatigue, shortness of breath and cognitive dysfunction among others, which have an impact on everyday functioning.
‘Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time,’ according to the WHO.
At this stage, a diagnosis does not require a minimum number of symptoms, though the WHO notes that ‘symptoms involving different organ systems and clusters have been described’.
Dr Michael Clements, who facilitated a live presentation on long COVID at the RACGP’s GP20 conference, said GPs are well aware of the challenges long COVID will present in the months to come, and that having a clinical definition is a first step in supporting both doctors and patients.
‘This step will help in the initial phase for us to identify those patients that meet this criteria and it will then support us in helping explain to patients what it is, because for many of the patients with these syndromes, they often want to know why,’ he told newsGP.
‘Sadly, right now, we don’t necessarily know what to do with that label and we don’t have clear guidance, nor can we give our patients a clear expectation of their recovery.
‘But we should be grateful that this is the first step and will lead to clearer management plans moving forward.’
The rates of people affected with longer term sequelae post-COVID is not currently known, but published reports indicate approximately 10–20% experience lingering symptoms and a recent University of Oxford study indicates it could be even higher.
Among more than 270,000 people diagnosed with COVID-19, more than one in three (37%) were found to have at least one symptom 3–6 months after their initial diagnosis, the most common being breathing problems, abdominal symptoms, fatigue, pain and anxiety/depression.
But even though the acknowledgement of long COVID has been hailed as a step in the right direction, Dr Clements says the broad and non-specific symptom profile suggests the condition is going to be ‘very difficult’ to manage.
With further spread of COVID-19 anticipated through the community as public health measures ease, he said ensuring patients continue to get tested when they develop cold and flu symptoms will be key to surveillance and diagnosis of long COVID.  
‘GPs are used to dealing with people with chronic and unexplained symptoms and this may be one of the important things that we can use,’ he said.
‘But this data now actually shows what kind of challenges GPs are going to have 6–12 months from now.
‘The symptom list that’s described is actually quite extensive and many people will already have those symptoms even without a COVID infection, which may cause some diagnostic uncertainty and may cause some people to wonder if they’ve ever caught COVID, even if they haven’t tested positive before.
‘So the best advice we can give right now is, obviously, that people get vaccinated so that this is a lower risk, and that people should test, test early and test everything … just to see whether they’ve had COVID.’
Dr Anna Brooks, a cellular immunologist and senior research fellow at the Maurice Wilkins Centre at the University of Auckland, said she hopes the clinical case definition will see more patients receive the care they need.
She said it has been ‘incredibly distressing’ to hear of people in New Zealand who fit the WHO’s criteria previously being dismissed by doctors.
‘This, in part, may also be due to the similarities that long COVID has with myalgic encephalomyelitis/chronic fatigue syndrome [ME/CFS], another poorly-understood and often dismissed condition that can occur following viral infection,’ she said.
‘We hope that the international attention on long COVID, including the announcement of a clinical case definition, will result in all post-viral conditions being taken seriously so that medical care and treatments can be developed once research is undertaken to address this global health burden.’
While there are currently no diagnostic tests or treatments for long COVID, evidence suggests vaccination against COVID-19 significantly lowers the burden.  
Research led by King’s College London and published last month found breakthrough infections are rare, with just 0.2% of those fully vaccinated (2370 out of 971,504) contracting COVID-19, and that the odds of developing symptoms that last longer than four weeks were reduced by 50%.
Dr Clements said it is clear one of the best preventions for long COVID is vaccination.
‘Even if they’ve had COVID in the first place,’ he added.
‘And, again, the best prevention of this syndrome comes from getting vaccinated before that infection so that we don’t have to deal with this.’
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