The health minister’s Covid-19 advisory committee has made its first recommendations about long Covid, at the same time admitting there are more questions than answers about the condition.

In a memo to minister Joe Phaahla dated May 27, committee heads Koleka Mlisana and Marian Jacobs said a study of adults hospitalised with Covid-19 found more than two-thirds reported an incomplete recovery three months after their acute illness.

Long Covid symptoms had also been detected in up to a third of patients who had mild  infections.

“While most symptoms appear to abate over time, the natural history of the condition is not yet known,” they said.

“The impact of long Covid on quality of life can be severe, with significant limitations to social and occupational functioning. These have been found to have a substantial negative impact on quality of life, ability to work and carry out daily activities.

“On average, individuals experiencing long Covid function at 59% of their pre-Covid abilities, and more than 20% of individuals are unable to return to work. Poor quality of life is associated with prior ICU admission and fatigue.”

Risk factors for long Covid include advancing age, female sex, pre-existing comorbidities (including obesity, hypertension, diabetes mellitus and asthma), and immunodeficiency (including HIV and cancer).

However, Mlisana and Jacobs said: “There are presently no registered or evidence-based therapeutic interventions available for treatment of long Covid. There is no widely accepted definition for the condition in children.”

In the absence of evidence-based clinical guidelines or treatments, the advisory committee recommended a battery of tests doctors can use to diagnose long Covid and said: “Treatment strategies should be guided by the individual clinical presentation, and aimed at ameliorating symptoms until more directed therapies are available.

“Identification and optimisation of the management of existing comorbidities, new comorbidities and complications of acute Covid-19 are important goals in the management of patients with long Covid.”

The experts encouraged patients with long Covid to be vaccinated and to join clinical research programmes “to permit the generation of local data and provide access to emerging therapies”.

“Establishing multi-disciplinary specialist clinics (or clinics with the potential for specialist interdisciplinary collaboration/referral) will be needed for the assessment and management of complex cases on a referral basis. Regional clinical experts should be identified to lead such efforts.”

The committee also suggested long Covid should be recognised as a medical condition by the health department, which should lead the effort to develop evidence-based clinical guidelines for the condition.

“The National Institute for Communicable Diseases should be requested to establish a surveillance system to establish the incidence and prevalence of long Covid,” it said.

The experts also said:

• the health department should prepare courses on long Covid for doctors;
• the College of Medicine should be approached to consider a diploma in the management of Covid and long Covid; and
• the SA Medical Research Council should be asked to issue a call for proposals looking at the epidemiology, pathophysiology, diagnosis and management of long Covid.

TimesLIVE