Nursing in Practice Autumn 2021 (issue 121) - Page 34



Debunking common patient myths and misconceptions

‘ People with long Covid symptoms are just anxious and need to be encouraged to get moving again ’

The reality Fatigue is the most commonly reported symptom in long Covid but there may be a number of reasons for this . Some people with long Covid have a still active disease that needs full investigation and treatment , and others have exercise intolerance meaning activities may make symptoms worse . Long Covid is the term coined by patients to describe signs and symptoms that continue or develop after the acute phase of Covid-19 , defined by NICE as signs and symptoms up to four weeks after the initial infection . NICE uses the term ‘ ongoing symptomatic Covid-19 ’ for signs and symptoms from four to 12 weeks and ‘ post Covid-19 syndrome ’ for those that continue beyond 12 weeks and are not explained by an alternative diagnosis . 1 NICE recommends considering referral to a multidisciplinary assessment service ( if available ) any time from four weeks after the start of acute Covid-19 .
Long Covid acts as an umbrella term for a wide range of symptoms with potentially different pathology 2 , so it is important to understand what ‘ type ’ of long Covid a patient has before encouraging a return to normal activity .
People who had a ‘ mild ’ initial infection can also be affected by long Covid 3 ; the severity of symptoms is not directly related to the intensity of treatment for the infection . 4 Unlike hospital admission for the virus , long Covid is most common in working-age women , 2 suggesting it is not simply a long tail of recovery from a critical illness . Children and older people do report long Covid symptoms but in smaller numbers . 2
The virus appears to trigger a number of responses , including systemwide inflammation , micro-embolism and autoimmune dysfunction . It can also result in multi-organ impairment ( and it remains unclear whether this is reversible ). 2 , 5 , 6 New symptoms can emerge up to six months after the initial infection 7 and some experience relapses , 2 – the so-called ‘ coronacoaster ’. A large US study 8 examining clinical records demonstrated increased use of analgesics , antidepressants , antihypertensives and oral hypoglycaemics in the six months after Covid-19 infection , compared with a control group who had not been infected .
A person who presents after a Covid-19 infection with palpitations and dizziness on exertion may have deconditioned muscles , myocarditis , a thromboembolism , postural-orthostatic tachycardia syndrome ( POTS ), exercise intolerance or a panic attack . Telling them to exercise without understanding what lies behind their symptoms may be harmful . Routine diagnostic tests may not help – one study showed people with long Covid may have normal chest X-rays but interstitial lung damage on subsequent MRI . 9 Any exercise should be ‘ symptom titrated ’ 2 to the individual .
Around 30 % of people reporting long Covid symptoms experience anxiety and / or depression 2 , with some evidence this is neurological as well as psychological . 10 Anxiety is an entirely normal response to having alarming symptoms no one can explain , let alone treat , and is intensified when people feel they are not listened to by health professionals . Symptoms should therefore be assumed to have a physical basis until proved otherwise . Research is under way into the different disease pathways and potential treatments but in the meantime , nurses can support patients in a number of ways . Since an estimated 14 % of those who have had Covid-19 will have symptoms at least six months later , 7 community nurses in all settings are likely to see these patients at some point .
Nurses can provide initial assessments and triage , and provide advice on self-monitoring , pacing activities and recording any effect on symptoms . Detailed reports of symptoms may be of particular help when accessing specialist secondary care clinics . As experts in long-term conditions , nurses can also help patients understand ‘ red flag ’ changes and when to see a medical practitioner .
Nurses can also offer information on living with symptoms , such as breathlessness , muscle pain and ‘ brain fog ’. Autonomic disorder symptoms can be very distressing and people need help to develop coping strategies , together with plans for a staggered return to work . Nurses can also give patients advice on how to risk-assess interventions shared anecdotally online but which have yet to be researched .
Dr Elaine Maxwell Scientific advisor at the National Institute for Health Research
Go to bit . ly / 3BWWHjq for the article with references
nursinginpractice . com Autumn 2021