Islington medic ‘anxious’ at post-Covid impact

Coronavirus cell

Report by Ed Sheridan, Local Democracy Reporter

Leading medics in north-east London have spoken of anxiety at the numbers of people who could present with post-Covid syndrome following the latest surge of the virus.

In a presentation to a local authority health committee about post-Covid syndrome, Dr Katie Coleman, the chief clinical information officer for Islington Clinical Commissioning Group, predicted “significantly higher” diagnoses given the higher numbers of people testing positive in January.

Post-Covid syndrome, commonly called ‘long Covid’, is defined as those experiencing signs and symptoms that develop either during or following an infection consistent with Covid-19 which continue for more than 12 weeks and are not explained by any other diagnosis, with many experiencing generalised pain, fatigue, persisting high temperature and psychiatric problems.

Dr Coleman added: “It does make us feel quite anxious, because currently I would say that we do not have capacity in the system, so one of the pieces of work we are currently doing is to try to get a granular understanding of the demand and the level of presentation in the community.

“The thing that we are struggling with at the moment is that there are no codes for post-Covid syndrome or long Covid in our clinical systems. So it is quite difficult for us to be getting a really accurate measurement.

“Those codes are imminent and that will help us get a much clearer understanding of the demand coming through the system.”

Across Barnet, Camden, Enfield, Haringey and Islington, there were 7,535 people in January with chronic Covid who had not recovered within twelve weeks. In the same geographical area, 1,507 people as at November last year had serious debilitating Covid, to the point of not being able to take part in normal daily life.

Dr Coleman said there was little confidence around the numbers presented, however, as they are only based in the cases they have had to date based on people who have tested positive with Covid.

According to a series of interviews with more than 100 patients experiencing long Covid presented by Dr Coleman, patients can feel dismissed or are told there’s nothing wrong with them or are anxious, particularly if they have no positive test, experience fragmented care or need to be persistent to organise appointments and access care.

Respiratory specialist Dr Melissa Heightman said: “This is a multi-system disease, and it is a new specialty for secondar care.

“Although we were the first to try and embrace these patients as respiratory physicians, we are used to looking after multi-system disease, and what works better is rather than referring on to lots of different specialties, is that you wrap the specialties around the patient.”

Dr Heightman added that cardiology, neurology, gastro, rheumatology, allergy, children and young people, respiratory and therapies teams all need to be involved, adding: “You really need to put all your thinking together – this is not a respiratory disease, so we are very sited on that.

“It would be awful for patients to be bounced around the NHS waiting for appointments in lots of different sub-specialty clinics who might not have an understanding or oversight of the whole condition. I definitely want to move away from thinking of it as a respiratory disease, but that does not mean respiratory clinicians are not quite adept at dealing with these scenarios.

“What we want to make secure is that the right patients are looked after at the right point of care, and that we find those patients who are not presenting to their GP – that is something that I worry about. We now need funding, and NHS England has started talking about funding coming through after March – we are very keen to fund our communities services. We have brilliant expertise in North Central London, but we need more of them.”

GPs in both Camden and Islington are now being asked to call everyone who tested positive with Covid at six weeks to identify if they are experiencing ongoing symptoms, in order that they can be assessed earlier rather than later and get them into services that might prevent more long-enduring symptoms.

Medics warned that they were not seeing an adequate proportion of black, Asian and minority ethnic (BAME) patients being referred, with councillors attending a joint health overview and scrutiny committee on health for both boroughs told that doctors are seeing “probably 20%” fewer people from this cohort than would be expected from the local population.

It is understood that councillors sitting on the committee will now be writing to the wider NHS calling for more funding for different types of therapies to run in parallel with specialist clinincs in the area.

Dr Heightman added: “We have not got enough workforce with the right skillset, as these are very precious people and they have been redeployed in large part due to the surge. So spreading the right skillset and training, and then the funding issue which I think will partly have to rely on NHS England.”