THE HSE IS finalising a national model for the management of prolonged illness following a Covid-19 diagnosis.

Speaking at the HSE briefing today, Dr Colm Henry, Chief Clinical Officer, said the knowledge about Long Covid is evolving, but as many as 10% of those diagnosed with Covid-19 could end up with longer-term effects.

He said that some clinics in individual hospitals have been established, but the HSE is now finalising a formalised community-based model for the management of Long Covid, with a pathway for patients who require specialist care.

Longer term symptoms can range from fatigue and breathlessness to organ damage, gastrointestinal problems, musculoskeletal pain and neurological issues. 

Professor Paddy Mallon, infectious diseases consultant at St Vincent’s Hospital in Dublin, told The Journal that dedicated Long Covid clinics established in individual hospitals were set up within existing services, as there is no specific funded programme for the management of this condition. 

He said there is now an “extensive waiting list” of people, with new referrals to Vincent’s Long Covid clinic coming in every week that are triaged by severity. 

“It will depend on severity of symptoms and details in the letter, we try to bring in the sickest people soonest, but even then we have finite resources depending on the number of referrals we’re receiving,” he said. 

The clinic at St Vincent’s was established after clinicians noted that patients presenting with prolonged symptoms were often being linked into several other departments including cardiology, neurology and physiotherapy. 

As part of the process for these patients, an initial assessment and physical examination is done and then a programme of treatment is catered to each person based on their symptoms. 

“Every individual is in some ways different, their presentations can be different. Some require more test and investigation than others,” Mallon said.

He said patients are assessed every two to three months and the vast majority show improvements each time they are assessed. 

“How long the recovery will be, or whether they’ll recover completely, we just don’t know, but it is encouraging to see those improvements. And people might not feel like they’re getting better because for them it’s slight improvements all the time, but we see it,” he said.

Wide ranging symptoms

The first dedicated Long Covid clinic in the country was established at the private Beacon Hospital, as clinicians there – like those at St Vincent’s – realised they were looking at “wide ranging and multiple system problems”, Professor Seamus Linnane, consultant in resporatory medicine told The Journal. 

“Covid affects pretty much most organs so there needed to be something to recognise this as a separate entity,” he said. He said there has been a strong demand at the clinic.

“I’ve just finished our Covid clinic for this morning and I had eight people just this morning. We had another clinic yesterday and there’ll be two next week.”

Professor Linanne said the clinic is seeing a lot of people who had mild infections when they were originally diagnosed with Covid-19 and were able to manage their illness at home. 

“They really have a lot of things going on now. They managed not to require hospitalisation initially but now they are really struggling six or 12 months later.”

Last week a number of nurses who are suffering with Long Covid described the profound impact it has had on their lives, as some have been out of work for over a year.

27-year-old Eilish was working on a Covid ward when she was diagnosed with Covid-19 last April. Although she was not hospitalised, she was breathless during the initial phase and after a number of weeks her symptoms had not improved. 

After ten months and various different tests to check for organ damage, it was discovered that Eilish had pericarditis, a swelling of the tissue surrounding the heart.

“I used to not be on any regular medication and now I’m on a lot of different medication and inhalers,” she explained.

“I used to be able to run 5km but for a while a ten minute walk was a struggle through long Covid, now I’m up to 30 minutes and I’m doing cardiac rehab as well. It does take a lot to accept how your body is now. I’m only 27, I shouldn’t be like this.”

Immune response

Researchers  at University College Cork’s APC Microbiome Ireland research centre recently completed a study which suggested that an over-active immune response may be one reason why some patients develop long-term post Covid symptoms. 

Professor Liam O’Mahony, principal investigator at the research centre, told The Journal that they noted “quite peculiar immune responses that you wouldn’t expect”. 

“We think that the microbiome – the bacteria that are living in us and on us and that are half the cells in your body actually – these are very disrupted by this disease,” he explained. 

“And these have a huge impact on your immune function and your overall metabolism, fatigue, and all of these things.

“What I’m really working on right now is trying to come up with ideas for how do we intervene, or how do we speed up this recovery process by targeting the immune system, by targeting the microbiome, not just through clinical interventions, but also some non-clinical, lifestyle interventions like diet for instance, or probiotics.”

He said there are no clear indicators in research so far to suggest why one person may develop prolonged issues and another would not. 

“That’s what we’re really looking at. A key might be in the microbiome and some of the factors that are part of our lifestyle – even though we haven’t identified what those are yet,” he said.

“Another research line is people are looking at long-term persistence of the virus in some people – and there are some hints of that, but whether that correlates with long Covid is not clear.”

Professor O’Mahony said some people may have an “incomplete clearance” of the virus due to an immune system difference. 

“We just don’t know, but these are the kinds of ideas that we are all investigating.”

Have you been experiencing longer-term impacts after a Covid-19 diagnosis? We want to hear from you. Email michelle@thejournal.ie.