Respiratory and Long COVID Clinics

Draft_Ruth Barlow featured image_15_12_23

Ruth Barlow (Phys Dip Ed, MSc), is a trained physio who’s our long COVID team lead for mid and south Essex, a Mid and South Essex Integrated Care System (MSEICS) funded service delivered through the Mid and South Essex Community Collaborative (made up of three partnership organisations – EPUT, NELFT and Provide Community.

Ruth was instrumental in setting up the service in December 2020, as well as recruiting the long COVID team members. Prior to this project she was the respiratory team lead in mid and south Essex, which gave her the invaluable experience she needed to establish this essential service for our residents.

Managing the impact of Long COVID for our residents

For some of our residents in mid and south Essex, long COVID continues to impact their lives on a day-to-day basis. Most people who have COVID-19 start to feel better within a few days or weeks of their first symptoms and go on to make a full recovery within 12 weeks. Unfortunately, for 1.9 million people across the UK symptoms have lasted longer, which is affecting the work force as some people cannot work and others are experiencing job loss.

As a result of this emerging issue, long COVID clinics were set up across the UK to boost services to residents with long COVID and provide a more personalised approach to treatments, to support their long-term recovery.

Getting to Grips with long COVID

Long COVID is a really debilitating condition. The main symptom is fatigue, with 50% of people experiencing breathlessness as well as other often reported symptoms such as pain, insomnia, anxiety etc. In fact, there are over 200 symptoms that would be attributed to long COVID.

In the UK, it’s though that 2.9% of people have long COVID, with most of the people we see having not been admitted to hospital. While there are studies ongoing to see if we can predict who is likely to develop long COVID what we do know is that being male and having the vaccine makes you less likely to develop the virus. In fact, twice as many women, mainly 45-65 white British females, compared to men have the condition (Kessler 2023). There are several studies predicting severity for COVID-19, but fewer for long COVID as it’s a new condition and is still being studied. However, multimorbidity is known to impact COVID-19 severity and mortality as well as the risk of long COVID (Thompson 2022).

This is a national issue as the most recent Office for National Statistics data (March 2023) estimate that 1.9 million people living in private households in the UK (2.9 percent of the population) were experiencing self-reported long COVID. This means that their symptoms have continued for more than four weeks after first confirmed or suspected COVID-19 infection.

Of this group 69 percent of these people were still reporting symptoms after more than a year and 41 percent after more than two years.

So, applying these figures to the area covered by our service in mid and south Essex, 2.9 percent of the population is 34,783 people, of which 24,000 will still be living with long COVID symptoms after a year and 14,261 after two years.

Long term support for residents

The service, which is available for adults and children, had a rapid increase in referrals, nearly 3,000, when we started the long COVID service in December 2020. The team also increased in size to meet this challenge, so we now have a team that consists of psychologist, occupational therapist, physiotherapists, nurses, GPs, and support staff.

Long COVID is treated through manage symptoms, so we give advice about fatigue, which helped by adding frequent rests, pacing, and avoiding boom and bust. We offer a lot of group sessions via MS teams and as well as face to face exercises and education groups.

A patient’s assessment is made through taking a history of their symptoms and this can be completed in a virtual environment. However, some people do need further tests so we can also offer:

We also have twice weekly multidisciplinary team (MDTs) meetings that are held virtually, where we discuss our more complex patients.

Narrowing the gap on inequalities and long COVID

Fortunately, we’ve seen a drop in referrals in the last year and we know we can help a lot more people, so we’re focusing our efforts on our residents who experience health inequalities.

Just as COVID-19 adversely affected people experiencing health inequalities, it’s the same long COVID (NHSE 2023). We’re therefore focusing on accessing these groups, by going to traveller sites, working with teams where there are health inequality projects, attending learning disability forums and BAME community events etc.

A lot of this work has been through using the repurposed vax van that was set up during the pandemic, as part of our outreach wok, to help reach under-served groups and increase uptake of the COVID-19 vaccination.

Taking our team on the road

The van has covered a wide geographical area, which means that we’ve been able to access people who would not normally engage with our NHS services. It’s been used in lots of innovative ways, giving us the ability to engage with people from different ethnicities, with learning disabilities, and people not registered with a GP.

When we go into the community, we talk about how to recognise signs of long COVID and, as a minimum, we’ve one of our nurses on the van. However, we do try to collaborate with local teams and ask them to come along to talk about their services as well.

One of our projects included visits to static traveller sites, which we prepare for by working with the Essex County Council and liaison officers. The project has enabled us to have good engagement with the people on the sites, where we visit with other health professionals. As is often the case, travellers don’t have access to health services and some people aren’t registered with a GP. Therefore, we work with health workers who can register people, making sure they’re the knowledge, care, and treatment they need to avoid serious life-limiting illnesses.

We plan to continue to use the van to access seldom reached groups and hope to increase our referrals as a result, as it’s important that people recognise signs of long COVID and can get the correct help.