'We don't know how to help': How Long Covid is piling pressure on NHS doctors
‘I think we are seeing a lot of people with unrecognised and undiagnosed Long Covid symptoms, who are not getting the right support and who are made to feel like they’re making up the symptoms,’ says Dr Qian Xu.
Qian works as an A&E doctor at St Helier Hospital and says she sees people coming into the emergency department with chronic chest pain or tightness, shortness of breath, fainting episodes and palpitations.
Often, Long Covid patients will come to A&E because they haven’t managed to get a face-to-face appointment with their GP. A recent report from Healthwatch shows 75% of patients reported issues with accessing GPs, which is an issue only exacerbated by the pandemic.
But Qian stresses her department only deals with emergencies, so Long Covid (which is chronic by definition) is not a term used by her team.
So, desperate patients with nowhere else to go are turning up on her doorstep – when doctors are already being stretched to their limit.
A&E is not the right place for Long Covid patients
‘We don’t diagnose Long Covid in the emergency department – we just rule out all the acute things,’ Qian explains.
‘We do all the tests and if everything comes back normal, we just send them home. But, obviously, it doesn’t help them because they’re still very much symptomatic.
‘A lot of the time we are seeing people who present in A&E with sort of GP-type problems that have been going on for weeks and months – and that’s frustrating for us as well.
‘Sometimes there will be a five-hour wait time in A&E, and I’ll see a patient who is having these non-specific chest pains and everything comes back normal on their tests.
‘I sometimes feel like we are wasting each other’s time – why did you sit for five hours for something that you’ve been having for two weeks?
‘I just wish there was a better way we could help them.’
Qian says the other difficult thing is that people expect a cure or a proven treatment for Long Covid – something that doesn’t currently exist. Some Long Covid patients come to A&E expecting a diagnosis or a ‘miracle treatment’ – and doctors can’t provide either.
With a report last year showing A&E wait times are at their longest ever (more than four hours), these desperate Long Covid patients are an additional strain on an already-stretched system.
The endless unknowns of Long Covid
Diagnosing and treating Long Covid is difficult for medical professionals for a whole host of reasons.
‘The problem with Long Covid is that it’s very new. We’ve seen it being compared to things like flu, ME, and chronic fatigue – but the problem is there’s no diagnostic test,’ explains Dr Rebecca Brady, a practicing GP and medical director at HCML Rehabilitation Solutions.
While there are certain criteria for recognising Long Covid – symptoms can be so varied and wide-spread.
Rebecca adds: ‘People have more common symptoms or less common symptoms, but they’re very unpredictable: they can change from day to day, even sometimes from month to month.
‘We are at the early stage of knowing about Long Covid but can’t possibly know all of the classifications – we just use the knowledge that we have.’
The current diagnostic guideline for Long Covid is a patient that has persistent symptoms (usually shortness of breath, chest pain and fatigue) for 12 weeks, after the initial acute illness of Covid.
But it’s not always that simple – especially for GPs, who initiate the treatment and referral process.
Dr Jeff Foster, who works part of the week as a GP and the other half at a men’s health clinic, explains that it’s important not to assume a symptom is Long Covid without ruling out other medical problems.
He says: ‘Some patients will have quite a clear idea that they think they have Long Covid – they will come in saying “I had Covid for X days, and it’s five weeks later, I still feel rubbish and I still don’t feel right.”
‘So that’s quite easy because you know what the underlying problem is.
‘The bigger difficulties have been the patients that are maybe 8-10 weeks later, who don’t have classic symptoms of Long Covid – we then have to spend a lot of time ruling out all the other stuff.
‘We spend all of our time making sure there’s no other medical reason for them to have all these symptoms. It’s like a diagnosis of exclusion.’
Jeff adds it’s also important not to jump to conclusions about Long Covid too quickly.
‘We love, as humans, to attribute something to something – but it doesn’t mean that’s always the case,’ he explains. ‘And certainly with Long Covid that’s a really common problem.
‘If you assume it’s Long Covid and, in fact, they are menopausal, and you send them off to a Long Covid Clinic – then the respiratory team there won’t treat them for that and they won’t get any better. Then they come back to you a year later with exactly the same thing.’
Jeff stresses that while lots of patients come to him looking for a Long Covid diagnosis, GPs have to make sure their symptoms aren’t actually down to something else. In his men’s health clinic, for example, patients assume their fatigue is from Long Covid, but it can actually be because they have low testosterone – or another issue altogether.
‘We were probably missing other medical problems, because we’re attributing it all to Long Covid – because that’s what most people are thinking of,’ adds Jeff.
Because of how numerous and varied Long Covid symptoms are (and the fact they overlap with other conditions), some things are a case of trial and error in order to get the correct diagnosis – and this means additional referrals and appointments.
Backlog of appointments
The other problem doctors are facing with Long Covid, is the additional strain and backlog it’s putting on the NHS.
Despite dedicated Long Covid clinics existing across the country, not all areas have them – and the waiting times for them mean that desperate patients are going back to their GPs – or heading to A&E.
A survey conducted by Long Covid Support (LCS) showed patients are typically waiting five to six months for a first Long Covid clinic appointment – after being referred by their GP.
Jeff stresses that this backlog of appointments for secondary care (hospitals and specialists), is impacting primary care, too (GPs, community clinics etc).
‘When secondary care gets more and more backlogged (as it is now) that falls back onto us, because we have to retain care of the patients until they are seen by secondary care,’ he continues.
‘If a Long Covid clinic waiting list is six months, that patient will keep coming to a GP every week, or every two weeks, until they are seen at the hospital. So they take up more appointments in primary care, because they’re not getting the secondary care appointment – and all of that scales up.’
Jeff also says Long Covid clinics are only suitable for patients with certain symptoms – mainly respiratory issues. So, other Long Covid patients that don’t fit that criteria need to be referred to other specialists with long wait times.
But what’s the solution for an NHS that’s already at breaking point?
Jeff suggests: ‘I think you need to have a dedicated Long Covid clinic for those that suffer the classic symptoms. We do have those and the ones that are running (at least locally) have done really well: the process is very slick, and the feedback has been really good.
‘But for the ones that don’t match that typical pattern, then you can only refer to the speciality that the symptoms hit and hope that over time, they will get seen and helped.
‘But, ultimately, there is no single treatment – you can’t cure someone for Long Covid.’
Dr Rebecca Brady is hopeful that the answers will come with time and with various studies and research – as currently, there is still so much that remains unknown when it comes to understanding and treating Long Covid.
She adds: ‘I suppose as GPs, we find it a lot easier to deal with the uncertainty – because we’re used to dealing with uncertainty all time.
‘That makes it easier for me to approach the whole Long Covid situation, but it would be great to have a better understanding about it. That will come in time.’
Until then, the difficulties around diagnosing and treating Long Covid remain as an additional strain on the NHS.
Long Covid – what you need to know
Most infections with Covid resolve within the first four weeks. Long Covid is a term commonly used to describe symptoms that continue or develop after you’ve had the initial virus.
An estimated 1.5 million people in the UK (2.4% of the population) have reported experiencing Long Covid symptoms.
The recovery time is different for everyone. The length of your recovery is not necessarily related to the severity of your initial illness, or whether you were in hospital.
According to the latest reports, Long Covid is most common in people aged 35-69 years, women, people living in more deprived areas, those working in health care, social care, or teaching and education, and those with another activity-limiting health condition or disability.
Common Long Covid symptoms include:
- Extreme tiredness (fatigue)
- Shortness of breath
- Chest pain or tightness
- Problems with memory and concentration (“brain fog”)
- Difficulty sleeping (insomnia)
- Heart palpitations
- Dizziness
- Pins and needles
- Joint pain
- Depression and anxiety
If new or ongoing symptoms do occur and they are causing you concern, you should always seek medical advice and support.
For more information and support you can apply to join the Long Covid Support Group on Facebook, which currently has more than 50,000 members.
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