Clinics for New Zealanders who suffer ill-health months after catching Covid-19 are badly needed, experts say, with cases of "long Covid" expected to sky-rocket as the Delta outbreak grows.
Long Covid clinics are operating overseas, including in England, although often cannot meet the large demand. People referred by their GP are helped by a team of health professionals, including specialists, doctors, occupational therapists and physiotherapists.
Most people with Covid-19 recover completely, but some report a wide range of long-lasting symptoms. These can persist for weeks or months, vary from mild to severe, and commonly include fatigue, shortness of breath, headaches, "brain fog" and anxiety. Organs can be damaged including the heart and lungs.
Dr Sarah Rhodes, a cardio-respiratory physiotherapist and lecturer at the University of Otago, said urgent funding for dedicated clinics and treatment pathways was needed, and couldn't wait the months and years needed for research to catch-up. Researchers and clinicians were already considering how Long Covid clinics could work in New Zealand, she said.
"Because the impacts are across different body systems, it's highly likely that the most effective clinic is the one that has a multidisciplinary team," said Rhodes, who has a clinical leadership role with Physiotherapy New Zealand.
"That includes psychology input for anxiety and depression, occupational therapists for the rest and recovery aspect, and physiotherapy for managing things like muscle weakness and when exercise is appropriate - because in some patients it severely exacerbates their symptoms."
Many viral and bacterial infections result in ongoing symptoms, but there's very limited knowledge about how SARS-CoV-2 does this, although research is rapidly expanding.
That includes in New Zealand, where University of Auckland cellular immunologist Dr Anna Brooks is studying the immune dysfunction experienced by Kiwi "long-haulers", and Long Covid's relationship with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), another poorly-understood condition that can happen after viral infection.
She expects more than 100 people with Long Covid - an umbrella term for what's likely a range of conditions - will participate.
"There are lots of immunology questions, such as whether one of the reasons people experience Long Covid is because something went wrong with their immune response, and therefore it didn't quite clear out the viral debris.
"Currently, there are no routine diagnostic tests or treatment options for these post-viral, chronic conditions, which is why biomedical research is urgently needed."
A number of Long Covid sufferers overseas have reported improvement after getting a Covid-19 vaccine, Brooks said, and her observational research would track some participants after vaccination. One theory is that vaccination might "kick the immune system back into gear", she said. However, that clearly didn't happen for everybody.
Viruses can also cause dysfunction in the part of the nervous system that works automatically to regulate bodily functions, including heart rate and blood pressure.
Brooks will use highly specialised testing to locate B and T cells that have a "memory" of encountering Covid - something that will confirm a past infection, when more commonly used antibody tests often don't.
"If we had our antibodies to everything we need to fight off floating around our blood, it would be like glue. You have to have an immune response, and then it settles down, leaving behind the memory cells. They are sitting waiting, and they respond faster and harder," Brooks said.
"Essentially, we find the memory cells that responded to the virus, and then we look for markers on those cells to understand if there's a dysfunction there."
Hunting out memory cells could reveal more Covid cases than were officially recorded, Brooks said. For example, she suspects the cluster of cases around Marist College in Auckland, which was officially closed in June 2020, was bigger than testing showed.
The prevalence of Long Covid in Aotearoa isn't known. That could change, thanks to longitudinal research funded by the Ministry of Health to look into the experience of all people who have had Covid-19 in New Zealand.
Epidemiologist Dr Mona Jeffreys, who is the lead researcher along with her colleague at Victoria University of Wellington, Dr Lynne Russell (Ngāti Kahungunu, Rangitāne, Te Wainui ā Rua, Kai Tahu), told the Herald she suspected that more than 15 per cent of that group will have Long Covid.
The severity will vary, but finding out their needs will be crucial to ensuring health and social support services are resourced and in place to help them.
Jeffreys has ME/chronic fatigue syndrome and is interested in the similarities and differences between the conditions. The work will have an in-depth focus on Māori, Pasifika, people with a disability, and those infected when at work.
Delta's spread will greatly increase participant numbers, she said, including more young people; there are more than 40 babies under 1 year old infected in the current outbreak, and several hundred under 10 years old.
• If you have had Covid-19 and want to participate in the study led by Dr Mona Jeffreys and Dr Lynne Russell, please contact them at firstname.lastname@example.org