The latest data from the Real-time Assessment of Community Transmission (REACT) study suggests that more than two million people in England may have had symptoms of “long Covid”.

Patients are diagnosed with long Covid when they experience one or more persistent symptoms (lasting 12 weeks or more) of Covid-19. These symptoms include fatigue, shortness of breath, chest pain or heaviness, fever, palpitations and cognitive impairment.

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The REACT study asked more than half a million adults in England about their prior history of Covid-19 and the presence and duration of 29 different symptoms.

The study found a high prevalence of persistent symptoms lasting 12 weeks or more. Nearly 38% of participants reported at least one symptom of Covid-19 lasting 12 weeks or more, while almost 15% said they had three or more symptoms which lasted for 12 weeks or more.

From these figures, the researchers estimate that 5.8% of the population experienced one or more symptom of Covid-19 for 12 weeks or more, which equates to approximately 2 million adults in England. Furthermore, they estimate that 2% experienced three or more persistent symptoms, equating to just under 1 million adults in England.

The results also found that almost a third of people (30.5%) who had at least one symptom lasting 12 weeks or more reported having severe Covid symptoms which had a “significant effect on daily life”.

The study confirmed that long-term problems were more common in women than in men, which multiple studies have previously suggested. Additionally, obesity, smoking or vaping, hospitalisation, and deprivation were associated with a higher probability of persistent symptoms, while Asian ethnicity was associated with a lower probability.

Tiredness and fatigue were among the most commonly reported long Covid symptoms. However, in people who were severely ill with Covid, shortness of breath and other respiratory problems were the most dominant long-lasting symptoms.

How is long Covid treated?

As so many long Covid patients experience extreme tiredness and fatigue, the debate over how to treat those with chronic fatigue has resurfaced. Now, a recent report by the BMJ has found that some doctors are being challenged for speaking out about how to treat the condition.

The controversy began when a PACE trial in 2011 found that both cognitive behavioural therapy (CBT) and graded exercise therapy (GET) led to greater improvements in some participants with ME (myalgic encephalomyelitis) than medical care alone. However, the results were controversial as some ME advocates object to suggestions that their illness has a psychological element.

Respiratory consultant Paul Whitaker, who set up the first long Covid clinic in Yorkshire, said: “For my longstanding patients with long Covid who fulfil the criteria for CFS [ME] they do seem to get worse with strenuous aerobic exercise. However, long Covid is a very diverse group and there are many others who do need an exercise-based regimen.” Defining which groups will benefit from exercise remains a challenge, he adds.

Beyond the controversy however, some clinicians see an opportunity for long Covid to progress the understanding of post viral syndromes and to acknowledge they are a very real condition.

What is being done to tackle long Covid?

The NHS has pledged £100 million for long Covid services. While £70 million has been set aside for children and young people with long Covid, the remaining £30 million will go to GPs to improve diagnosis and care for those with the condition.

Dr Gail Allsopp, Clinical Lead for Clinical Policy for the Royal College of GPs, said the funding is encouraging and should give GPs better access to specialist services that can be of “real benefit” for patients. She continued: “What we now need to see is increased access for GPs and our teams for appropriate diagnostic tools in the community, to speed up the initial investigatory phase that GPs undertake to rule out other potential serious conditions or illnesses, before making a diagnosis of post-Covid syndrome.

“Perhaps most importantly, we need government to expand and fully fund rehabilitation services, in addition to the assessment clinics already in place, so GPs have better access to these services and are able to refer patients to receive the care and treatment that they need quickly.

“The College has also been working to develop its own resources, such as an e-learning course on post-Covid syndrome, and held webinars to ensure GPs and their teams are kept up to date with emerging evidence, to improve the care delivered to our patients. These resources are free, and available to all healthcare professionals on our website.

“As a College we will continue to work towards equity of care for everyone suffering the long-term effects of Covid-19 where ever they live across the UK.”