COVID-19 is a new disease so information on it, its features, incidence and its course are still emerging. The natural history, clinical course and consequences of COVID19 are still not completely understood. It is recognised that most patients with COVID-19 return to baseline after acute infection with SARS-CoV-2, but a proportion report ongoing health issues.
The number of people that are affected with longer term sequelae after acute COVID-19 remains unknown, but published reports indicate that approximately 10– 20% of COVID-19 patients experience lingering symptoms for weeks to months following acute SARS-CoV-2 infection.
Several organisations and societies have proposed different definitions based upon the constellation of symptoms that affect people after acute SARS-CoV-2 infection. To aid recognition and management of those affected, the WHO has recently through a global consensus process proposed a working clinical case definition of Post COVID-19 syndrome occurring 3 months from the onset of COVID-19, with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction and others which generally have an impact on everyday functioning. Symptoms may be new onset, following initial recovery from an acute COVID19 episode, or persist from the initial illness. Symptoms may also fluctuate or relapse over time. However, the WHO notes that this definition may change as new evidence emerges and our understanding of the consequences of COVID-19 continues to evolve.
COVID-19 in children is usually asymptomatic or manifests as a mild illness of short duration. However, concerns have been raised regarding prolonged illness in some children, with no clear resolution of symptoms several weeks after onset, as is observed in some adults and this is an area of ongoing research. Studies to date have identified that that long illness duration after SARS-CoV-2 infection in school-aged children does occur but is uncommon and less common than is reported in adults. In most studies of children affected, symptoms are reported to have resolved or significantly decreased over time, providing reassurance about long-term outcomes. Additionally, studies suggest that the symptom burden in children with what has been termed long COVID-19 was not greater than that in children with long illnesses due to causes other than SARS-CoV-2 infection.
Patients with persistent symptoms following COVID-19 infection may be followed up by their GP or in hospital settings as clinically appropriate. People in the community who are concerned about persistent symptoms following Covid-19 should contact their GP in the first instance. Treatment is currently focused on management of specific symptoms.
Specific guidance on the treatment of 'Long COVID' is presently under development both here and internationally. The HSE is currently assessing need and the best way to care for those impacted by Long COVID to ensure the appropriate supports are in place. As part of this work on post-COVID care, the HSE is examining how it can model the possible numbers that will be affected, noting that this will take time as more evidence emerges. I understand that the HSE has also been in touch with a group of people who are suffering post-COVID symptoms to inform understanding. You may wish to note, that a Programme Manager/Implementation Lead and Clinical Leads have been identified within the HSE who will be key stakeholders in driving this programme of work.
My Department, through the Health Research Board, continues to fund research into the clinical impacts of COVID-19. My Department will also continue to develop an understanding of the implications of Long COVID to inform policy as appropriate.