SEM and Long Covid Clinics

The Faculty of Sport and Exercise Medicine (FSEM) fully supports the plan to establish 40 ‘long covid’ clinics within NHS England (1).   

SEM and long covid clinicsAs we approach the end of another national lockdown, we have recorded close to 1,600,000 cases of COVID-19 (2). Based on data from the UK COVID Symptom Study app – which has more than 4 million users – one in 20 (5.1%) will continue to experience symptoms for 8 weeks and one in 45 (2.2%) for 12 weeks or more (3). A recent NIHR review identified that – regardless of hospitalisation status, – such patients can experience a wide range of fluctuating symptoms affecting the respiratory and cardiovascular systems, the brain, kidneys, liver and skin (4).  Severe fatigue is reported in up to 50% of patients suffering from long covid and unrelated to the severity of the initial infection (56). A significant proportion of patients affected by these symptoms will become increasingly de-conditioned and, in turn, functionally impaired. This has a profound impact on employers and healthcare systems, where the demand for rehabilitation outstrips the current available resources. It is postulated, for instance, that approximately 50% of patients hospitalised by COVID-19 could have significant musculoskeletal (MSK) and neurological de-conditioning requiring substantial care and support (7). 

Given the multi-system nature of long covid a holistic multi-disciplinary approach is needed to optimise patient recovery (4). The value gained by integrating Sport & Exercise Medicine (SEM) physicians into a wider multi-disciplinary team consisting of specialists in respiratory medicine, rehabilitation medicine and psychiatry to name a few has previously been highlighted by the ‘The Stanford Hall consensus statement for post COVID-19 rehabilitation’ and British Society of Rehabilitation Medicine amongst others. 

Although a relatively small and young speciality, Sport & Exercise Medicine consultants are perfectly suited to support patients in their recovery from COVID-19 by addressing complex rehabilitation needs through expertise in MSK medicine and exercise prescriptionThis could facilitate further SEM involvement within the NHS beyond traditional MSK clinics, thereby creating a legacy.  

 

©Faculty of Sport and Exercise Medicine UK –  Published December 2020.

Author: Dr Dionisio Izquierdo, FSEM Registrar Representative and Clinical Advisory Group member

References: 

  1.  https://www.england.nhs.uk/2020/11/nhs-launches-40-long-covid-clinics-to-tackle-persistent-symptoms/ 
  2. https://coronavirus.data.gov.uk/ 
  3. https://covid.joinzoe.com/ 
  4. NIHR. Living with covid-19. A dynamic review of the evidence around ongoing Covid-19 symptoms (often called Long Covid). October 2020. https://evidence.nihr.ac.uk/themedreview/living-with-covid19. 
  5. Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One. 2020;15(11):e0240784. 
  6. Carfì A, Bernabei R, Landi F. Persistent Symptoms in Patients After Acute COVID-19. Jama. 2020;324(6):603-5. 
  7. Faghy MA, Ashton RE, Maden-Wilkinson TM, Copeland RJ, Bewick T, Smith A, et al. Integrated sports and respiratory medicine in the aftermath of COVID-19. Lancet Respir Med. 2020. 
  8. Phillips M T-SL, Wade D, et al. Rehabilitation in the wake of Covid-19 – A phoenix from the ashes.  British Society of Rehabilitation Medicine, 2020. https://www. bsrm. org. uk/ publications/ latest- news/ post/ 39- covid- 19- bsrm- position- onrehabilitation  2020 
  9. Barker-Davies RM, O’Sullivan O, Senaratne KPP, Baker P, Cranley M, Dharm-Datta S, et al. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med. 2020;54(16):949-59.