Community and primary care services are helping to treat people with long-Covid

Notes

• Long-Covid services are accessed via primary and community services following a referral from GP.
• All services provide direct, streamlined referrals to diagnostic tests and investigations, secondary care specialists and referral or collaboration with all other allied healthcare professionals and rehabilitation services close to people’s homes as possible.
• In every service, people are directed to, or provided with, the right advice, treatment, investigations, rehabilitation, specialist care and treatment to suit their own particular needs. These include:
  • A comprehensive assessment of the impact for each person.
  • Advice, personalised self-help programmes or signposting to web or online resources.
  • Guided self-management.
  • Specific programmes and exercises such as breathing or pacing exercises, anxiety or fatigue management techniques.
  • Personalised treatment plans for specific symptoms.
  • Community-based rehabilitation including; psychology, occupational therapy and physiotherapy support and treatment
  • Direct referral to secondary consultants and clinical teams for specific complications that require specialist assessment and care.
  • GP review clinical assessment, diagnostics and medicines management.
• The CEDAR report contains the results of a cross-sectional survey carried out between 1 September and 31 December 2021 of people accessing long-Covid services in Wales.

Case Studies

The following are anonymised case studies of two service users who have benefited from the long-Covid service and the Adferiad investment:

Case Study 1: Mr R 

Mr R is a 59-year-old man. He lives alone. He usually works full time in a physically demanding job which requires shift work. His pre-existing illnesses include hypertension, asthma, back pain, depression, hypercholesterolaemia. He has daily contact with his adult children and his grandchildren. He usually enjoys golf and walking.

Mr R developed Covid-19 in January 2021. He was admitted to intensive care in his local hospital as a result of this illness. He was ventilated for 57 days and discharged three months later. He was referred to the long-Covid service by pulmonary rehabilitation team.

Mr R presented at his initial assessment with the following symptoms – breathlessness and noisy breathing, voice changes and altered sense of taste and smell, dizziness, feeling faint (varying blood pressure as an inpatient), fatigue and post exertional malaise, joint pain and impaired mobility, altered sleep pattern and night terrors, depression, anxiety, trauma relating to experience of his intensive care admission and effect of experience of Covid-19 (both acute and chronic impacts on his life), itching and discomfort around tracheostomy scar, occasional chest pain – upper left chest tightness, sharp and radiating to his shoulder, cognitive difficulties including poor concentration, short-term memory difficulties, word-finding and difficulties following a conversation and headaches. He had a range of investigations but cardiac and respiratory investigations were noted to be normal.

Mr R has been on sick leave from his physically-demanding job since his acute Covid-19 infection almost 12 months ago and he is still unable to return to his role. Although his employer is supportive and his situation is currently financially stable, Mr R is anxious about his long-term potential to return to work.

Mr R is only able to walk for short distances and although managing most tasks of daily living (with support from his adult children who live locally); he is significantly impaired by fatigue and cannot manage tasks without considerable rest periods. Mr R feels his low mood and difficulties with motivation are a consequence of his struggles with fatigue and sleep. He reports that his low mood, anxiety and experience of psychological trauma impacts on his motivation to engage in social connection.

Mr R participated in a comprehensive multi-professional assessment. He requires the professional expertise of psychology, physiotherapy and a GP. His treatment includes psycho-education and support for the impact of long-Covid on mind and body; fatigue management, pacing and post-exertional malaise; sleep hygiene. acceptance and commitment therapy (ACT) and a therapeutic programme to improve mood, reduce anxiety and psychological trauma; B12 injections and medication review; education and support for breathing pattern disorder, fatigue management and pacing.

Mr R has engaged well with each of these interventions so far and his support from the long-Covid service is ongoing.

Case Study 2: Ms D

Ms D has worked in the NHS for 29 years, and at 48, was healthy and active. She caught Covid-19 five weeks into lockdown, a busy time, with the NHS recruiting significant numbers of additional staff. After two weeks off, Ms D arranged to return, but by the time she had got to work, her legs were like jelly, and she couldn’t get up from her desk. She tried working from home, but soon had to stop altogether.

In October 2020 she started back at work, but on very reduced hours and alternative responsibilities. She felt that the GP was not able to help, because little was known about long-Covid then. “There was no specific support the GP could give me at all…. every time I spoke to them, I would end up absolutely distraught”.

In January 2020, she was assessed and joined the first group session for the new long-Covid rehabilitation service. “That first conversation with Rachel, it was just like, a breath of fresh air for me, because I knew somebody was eventually now going to help me…. It was just like the light bulb moment, really, for me, my recovery, and the turning point…from that first conversation”.

This made a huge difference both in having people listen to her needs and concerns and knowing that other people were also having similar experiences. Ms D was taught new techniques to help her learn how to pace her recovery and manage her symptoms. 

“I've quickly realised that the strategy that I was using was completely wrong. I was trying to push myself to… walk a little bit further.” Using the techniques, Ms D returned to work on reduced hours. A year later, Ms D is still in work, and building up towards her previous responsibilities, but she says, “I have to pace myself in everything I do, both in work and outside of work”, and finds her recovery can be dramatically set