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The after-effects of Covid-19 are not to be underestimated – and healthcare systems need to sit up and take note.

That’s the message from a rehabilitation consultant based in the UK, who estimates that for up to a million people, the after-effects of the virus could last for a very long time. 

Dr Manoj Sivan, associate clinical professor at the University of Leeds and a consultant in rehabilitation medicine in NHS Trusts, said: “Most [infected by the virus] will have experienced a mild illness but a sizeable minority, up to one million, will have after-effects that will last for many months and possibly years.”

Previous outbreaks of Spanish flu, SARS and Ebola have shown up to a third of survivors can suffer from long-term problems, particularly chronic fatigue, which has implications on family life, work and health economy.  

“With Covid-19, there is an opportunity to intervene early, provide timely specialist rehabilitation, and ensure people have the best functional recovery and return to their vocation as early as possible,” said Dr Sivan.

Healthcare systems around the world now need to develop ways of supporting people recovering from Covid-19, he said. If they don’t, there’s a risk people experiencing long-term symptoms – a phenomenon dubbed long Covid – will get worse and put additional strain on already-stretched health resources.

Although Covid-19 starts as an acute infection of the lungs, it can develop into a “multi-system illness” leaving people with symptoms including breathlessness, fatigue, weakness, cardiac problems, as well as cognitive and psychological problems. 

Dr Sivan has helped develop a rehab programme for people recovering from Covid-19 in the community in Leeds, alongside the University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds Community Healthcare NHS Trust and NHS Leeds Clinical Commissioning Group.

This acts as a complement to NHS England’s ‘Your COVID Recovery’ website, which offers guidance for people struggling with a longer tail of symptoms.

Leeds Covid-19 rehabilitation teams have created a telephone screening and referral service, where people who have been severely ill with Covid-19 are contacted either by their GP or a specialist member of the hospital’s team, six and 12 weeks after recovering from the acute phase of the illness.

They’re asked a series of questions about – and scored on – persistent symptoms and how well they’re functioning. The screening identifies symptoms that need to be urgently assessed by relevant healthcare professionals. Services include respiratory medicine, pulmonary rehabilitation, physiotherapy, occupational therapy, psychology or combined multidisciplinary clinics.

The hope is that this screening could be rolled out nationally – even globally – to help support those who are still suffering.

Research by Dr Sivan and colleagues earlier in the summer identified the common longer-term symptoms experienced by Covid-19 survivors who were severely ill in hospital with the disease. The top three were fatigue, breathlessness and psychological distress.

MPs from a cross-party coronavirus group recently identified 16 symptoms of long Covid, some of which included lasting breathing problems, purple toes and cognitive problems.