General Practice and Primary Care

Long COVID research

When the COVID-19 pandemic changed our lives in 2020, researchers at General Practice & Primary Care turned their attention to supporting the pandemic response.

Early work included a study about contact tracing for COVID-19 and input to the Scottish Intercollegiate Guideline Network (SIGN) guidance on Assessment of COVID-19 in primary care evidence review (SIGN 162).

As well as the impact of the virus on acute illnesses, hospitalisations and death, it soon became evident that some people were experiencing longer-lasting symptoms (known as Long COVID). GPPC researchers Prof Kate O’Donnell and Dr David Blane were involved in the first qualitative study in the UK exploring the experiences of people with Long COVID which highlighted the range of challenges faced. A related study of doctors with Long COVID found similar issues.

Since then, researchers at GPPC have been involved in three other studies related to Long COVID:

• Long-COVID in Scotland Study (Long-CiSS)
• Remotely-delivered weight management trial for people with Long COVID (ReDIRECT)
• Supporting access to care for people with Long COVID

Long Covid in Scotland Study (CiSS)

Led by Prof Jill Pell, the Long-COVID in Scotland Study used the Scottish PCR test result database to identify every adult in Scotland who had had a positive PCR test for COVID-19 and a comparison group of people who had a negative test only. Study participants completed questionnaires at 6, 12, 18, and 24 month follow-up and this information was linked to their routine health data on medications, hospital admissions and deaths.

The study found that self-reported Long COVID was:

• very common – following symptomatic infection 42% reported that they had only partially recovered and an additional 6% said they have not recovered at all.
• more common among people who had to hospitalised for their COVID infection, women, people living in deprived areas and those with pre-existing health conditions (especially multimorbidity).
• associated with worse quality of life, impairment across all aspects of daily living and a wide range of symptoms.

However, the "true" frequency of long-COVID was much lower than the self-reported frequency.  Apart from altered taste and smell, the symptoms of long-COVID are non-specific and therefore may have occurred irrespective of infection. Therefore, whilst 64.5% of the people in this study reported at least one symptom 6 months following SARS-CoV-2 infection, this was also true of 50.8% of those never infected. The "true" prevalence of long-COVID (percentage of people who had one or more symptom that would not have occurred anyway) was 6.6%, 6.4% and 10.3% at 6, 12 and 18 month follow-up.

ReDIRECT study

Co-led by Dr Blane, the NIHR-funded Remote Diet Intervention to Reduce Long COVID Symptoms (ReDIRECT) study was designed to assess whether a remotely delivered, structured weight-management intervention could improve symptoms in people with Long COVID who are living with overweight or obesity. The rationale was that some symptoms of Long COVID overlap or might be exacerbated by excess weight (e.g. fatigue, breathlessness, systemic inflammation), and that intentional weight loss might help alleviate symptom burden.

The intervention – total diet replacement (TDR) (~850 kcal/day) with porridge, soups and shakes for 8-12 weeks, followed by structured food reintroduction and weight maintenance support – was based on the Counterweight-Plus programme used in the DiRECT study, and was delivered fully remotely with dietitian support.

The results were encouraging, with significant improvements at 6 months seen in fatigue, breathlessness, and anxiety/depression (but not in pain) in the intervention arm versus control. 

An economic evaluation evaluated cost-utility over the 6-month trial period and found that the intervention was likely to be cost-effective under typical UK willingness-to-pay thresholds. Using a societal perspective (which includes productivity losses, food costs, etc.), the intervention might even be cost-saving, i.e. 'dominate" usual care, thanks to reductions in lost work and participant-borne costs.

Priority setting

Dr Blane has also been involved in a research priority setting project for Long COVID. This is led by Aileen Grant at RGU, working alongside people living with Long COVID and researchers from across Scotland.

Patient and Public Involvement

Involving public and patients is a key aspect of research that ensures it is meaningful and has a societal impact. SHW researchers and the MVLS Public and Patient Involvement and Engagement (PPIE) Steering group met with Chris White from Long Covid Scotland in 2020 to establish the MVLS PPIE COVID group to develop PPIE activities in Covid research. They held a series of public events in 2021 and 2022 and have been active contributors throughout the research process.

The PPI group, with Dr Tracy Ibbotson as PPI Lead, provided an opportunity for dialogues with public and patients in COVID research studies across the School, including the studies highlighted above. The PPIE group continues to meet regularly.