UCLH leads the way with service to treat Covid-19 patients with lingering symptoms

UCLH has developed a post-Covid-19 service to help survivors of the virus with their long-term recovery.

The multidisciplinary team behind the clinic at University College Hospital have conducted some 1,000 appointments since they started seeing patients in person in May.

Clinic lead and integrated respiratory physician Melissa Heightman said: “We established the service at pace in response to concerns about the clinical safety of patients, given a growing appreciation of early and late post-Covid-19 complications and symptoms.

“We have tried to respond to patient need at a time when it has been difficult for patients to access healthcare and when post-Covid-19 complications were poorly understood.

“From the outset, we have accepted referrals from primary care and we have offered follow-up to patients discharged from our own emergency department. These patients have been assessed in the same way as those who were discharged from our hospitals.

“Wherever possible, we have aimed to offer a one-stop assessment by a doctor and therapist in person, with access to diagnostics and exercise testing.

The clinic, which is held three times a week, is led by integrated respiratory physicians and brings together multidisciplinary and multi-professional expertise including physiotherapists, respiratory physiologists, psychologists, cardiologists, neurologists and infectious disease doctors.

Consultant respiratory physician Toby Hillman, who sees patients at the clinic, said: “We have identified a number of post-Covid-19 phenotypes, or symptom groupings, and we are supporting national groups in developing a case definition and approach to investigations.

“We have partnered closely with allied health professionals to understand the nature of support needed by patients and their safety to engage with it. We are increasingly concerned by the severity and nature of prolonged post- Covid-19 symptoms and we feel the need to understand the mechanism of these, and treat them better.

“Patients affected are often of working age and their quality of life has been seriously impacted. Many are NHS staff who have struggled to access adequate care through the usual routes.”

UCLH supports the need for urgent research into the mechanisms underlying post-Covid-19 symptoms.

This is why we are participating in the PHOSP-COVID study (Post-Hospital Covid), a major UK research study looking at the long-term health impact of Covid-19,” said infectious diseases consultant Dr Michael Marks, who is leading the UCLH component of the national study.

“We will use techniques such as advanced imaging, data collection and analysis of blood and lung samples to create a comprehensive picture of the impact of the viral infection.”

Around 10,000 patients across the UK are expected to take part, making it the largest comprehensive study in the world to understand and improve the health of survivors after hospitalisation from Covid-19.

Physiotherapy assessment is a very important part of the clinical assessment and the therapies team is led by Rebecca Livingston, who was also lead physiotherapist on the UCLH Covid-19 CPAP unit earlier in the year.  

The physiotherapy team assess unexplained breathlessness and fatigue, as well as screening for other rehabilitation needs. Her team treat those with identified breathing pattern disorder following Covid-19 and have been working closely with community services to develop understanding and link patients in with suitable rehabilitation.

One of the patients who has been through the clinic is Suji Yathindra, a 45-year-old doctor who worked through the height of the pandemic in an Emergency Department, staying in a hotel away from his wife and children to allow him to work without fear of infecting them.

He developed symptoms of Covid-19 in mid-May. He was assessed at his own hospital and another, with multiple investigations that returned normal results. He suffered a lot of psychological stress as he felt so ill but had no identifiable reason for this.

He was unable to return to work as he could not perform CPR without being exhausted. Testing at UCLH revealed a very abnormal physiological response to exercise, and further investigations are being planned to characterise this and a rehabilitation plan has been developed for him

Suji said: “The clinic helped validate my illness. The team understood how frustrated I was and helped me get back on track. They organised an exercise routine and encouraged me throughout my journey back. They continue to organise investigations to look for a possible cure to my ongoing muscle pain and are in regular contact with me with helpful solutions. Without the clinic I am not sure I would have been able to return to work.”

To access the clinic, patients experiencing post-viral symptoms are encouraged to see their GP and request a referral to UCLH.

Full referral information for GPs

UCLH now has three clinics for patients with long Covid. The main clinic is under respiratory medicine but we also run two specialist clinics for neurological complaints and anosmia.

GPs within North Central London STP can refer through the NHS e-Referral Service and patients will be triaged to the service most suited to help with their symptoms. GPs outside the North Central London STP can use the advice and guidance service on eReferrals. Patients outside North Central London STP can find a clinic closer to home from this list.

To refer a patient to this service on eRS please choose:

·         Specialty – Respiratory Medicine

·         Clinic type – Not otherwise specified

·         Organisation – University College Hospital

·         Service name - Post COVID Multi-specialty Follow Up Service - UCLH RRV

To send an advice and guidance request on eRS please choose

·         Specialty – Respiratory Medicine

·         Clinic type – Not otherwise specified

·         Organisation – University College Hospital

·         Service name - Post COVID Advice and Guidance Service - UCLH RRV

To refer a patient to the Covid Neurology Clinic on eRS please choose:

·         Specialty – Neurology

·         Clinic type – Neuromuscular

·         Organisation – National Hospital for Neurology and Neurosurgery

·         Service name – Neuromuscular – NHNN – UCLH – RRV

To refer a patient to the anosmia clinic on eRS please document anosmia clearly in the referral letter and choose:

·         Specialty – ENT

·         Clinic type – Nose

·         Organisation – Royal National ENT and Eastman Dental Hospital

·         Service name – ENT Nose/Rhinology Service – RNTNE – UCLH – RRV