Expert Forum on secondary COVID-19 impacts

Virtual Expert Forum with internal and external experts addressed the diagnosis, management, and prognosis of the most common lasting symptoms of COVID-19.
Event Quickinfo
16 - 17 Feb 2021
Location Online

Long COVID is a term to describe the long-term health effects of COVID-19 that persist for weeks or months after the typical convalescence period of the illness. In addition, significant short-term disruptions in care delivery were observed during the pandemic, which may have long-term consequences in morbidity and survival implications for patients and otherwise healthy individuals.

The Swiss Re Institute hosted an Expert Forum on secondary COVID-19 impacts and invited leading experts to talk about the latest insights and findings of ongoing long-term secondary COVID-19-related health research. The experts addressed the diagnosis, management, and prognosis of the most common lasting symptoms of COVID-19 and presented their view on long-term consequences of patients affected by deferred acute treatments and preventive diagnostics and in individuals suffering from mental health difficulties during extended lockdown periods.

Interviews from the sessions

Agenda of the event

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20210216

Date:

Time Local time zone is CEST Topic Speaker Presentation Recording
14:00-14:10 Introduction and welcome Direct long.term impacts of the pancemic Download this recording
14:10-14:40 Long-haulers and chronic fatigue Trends in fatigue due to Secondary COVID Syndrome
14:40-15:10 Covid-heart I. Research into the effects of COVID-19 on the heart
15:10-15:30 Break
15:30-16:00 Post-hospitalisation Recovery rates, re-hospitalization, age, diseases Download this recording
16:30-17:00 Covid-lung Trends in lung fibrosis following COVID-19 infection Download this recording
17:00-17:30 Boston University collaboration COVID-19 mortality across sociodemographic and health characteristics Download this recording
17:30-17:40 End of event - closing the day

Summary by Daniel Eckhart ​Summary by Daniel Eckhart

SRI Advocate, Swiss Re Institute

Further reading

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Summary of event by Daniel Eckhart

I've been able to attend several of these export forums in the past and the level of insight is always staggering.

The event, featuring a total of eleven external experts from various fields, was a fantastic opportunity for our own experts to expand their knowledge and help Swiss Re stay at the top of the game. With this many speakers, it won't surprise that this will be a slightly longer post. Still, I'll just try to give a sense and a few glimpses at the many insights – for full details, we'll link to the presentation slides and video recordings.

What is the "Post-COVID-19 Syndrome"

It essentially refers to signs and symptoms, developed during or after COVID-19 infection, that continue for more than 12 weeks and are not explained by an alternative diagnosis. A current estimate suggests that between five and ten percent of patients are affected by Long-COVID – and there is a higher prevalence among older patients and women. At current, the most common Long-COVID symptoms are fatigue, shortness of breath as well as joint and chest pains.

Michael Sharpe, Professor of Psychological Medicine at Oxford University, reported on initial findings from the post-COVID clinic that has been set up in Oxford. This notion of dedicated multi-disciplinary post-COVID clinics was echoed by several other speakers over the course of the two-day exchange. While Long-COVID research is still in its infancy, there is already agreement on a number of things, among them: fatigue is the most common symptom; the syndrome has no single cause and is no single condition; and a considerable number of Long-COVID patients are unable to go back to work.

Scientists are looking at three areas as possible causes for the syndrome – they are biological, psychological and social. Physical and mental health are firmly linked. Heightened anxieties can lead to unhealthy coping behaviors, and social factors are known to worsen already fragile conditions. Among these, unsurprisingly, is the negative impact by news – whether factual or misinformation. As we learned, even support groups, while well-intentioned, may cause more harm than good. The reason being that those on the mend will likely leave the group again, while those still affected, remain and continue to share in an increasingly unhealthy cycle.

What can be done

As always, there is such as thing as too much and too little. As Long-COVID isn't easily defined, what's required by care staff is an open mind, and a pragmatic approach. Professor Sharpe explained that, first and foremost, patients need to feel listened to and believed. Physicians must then identify and treat what is treatable – and with positive messaging help patients toward rehabilitation.

As we're still in the midst of the pandemic, there are not yet a great many answers to the long-term outcome for patients affected by the Post-COVID Syndrome. For now, research suggests that most improve over time, and that psychologically informed rehabilitation is the best treatment. There is, based on what is known at this time, an expectation that one percent of affected people will have long-term disability.

In a next part of the afternoon, three experts talked about the state of research into the effects and long-term consequences of COVID-19 on the heart and lung; in addition a hospitalist shared his learnings on patient recovery and readmission; and findings from a Boston U collaboration about COVID-19 mortality across sociodemographic and health characteristics was shared. While some research does not yet benefit from large-scale studies, what scientists agree on even now is that lack of capacity by hospitals around the world, due to COVID spikes, had multiple negative side-effects as many tests were delayed and surgeries postponed.

Ashwani Bhatia, Chief Medical Officer at BayCare Clinic, talked about his experiences as a hospitalist. While acknowledging that hospitals are still busy dealing with the immediate effects of the pandemic, he urged that now is the time to look at long-term effects. As we all know, this wasn't the first pandemic, and it won't be the last. Now's the time to learn and prepare for that next time. Bhatia highlighted some of the COVID-19 long-term effects he has observed and said that one in ten discharged patients was readmitted within two months – something he attributed to sending people home too early because of hospital space shortages.

The long-term strain on mental health

The psychological impact on patients and healthcare workers is often talked about – and is intensively studied by the experts. Bhatia showed that the overall working population (people aged 18-64) is experiencing a considerable decline in emotional health and wellbeing. In healthcare workers, he pointed out a rise in feelings of burnout by physicians by almost 20% (compared with 2018), and that almost 40% of physicians would like to retire in the next year – a clear reminder that every system has it's breaking point, and COVID-19 brought the healthcare system all-too-close to that point.

The effects of the Post-COVID syndrome will continue to put a stress on the system long after the immediate crisis is over. To help society navigate the next months and years, vaccination, to prevent transmission and achieve herd immunity, is essential. Long-COVID also requires the launch of post-COVID clinics with multi-disciplinary approaches. To monitor and learn, a registry for high-risk COVID-19 survivors is envisioned. In a sense, COVID-19 survivors become a frontline in the fight against the next pandemic – through them, with them, we can learn and better prepare.

If you're interested in the topic from a mental health perspective, I particularly recommend the three sessions on day two, with Heather Haq, Chief Medical Officer at Baylor College of Medicine; Tom Heffernan, Senior Lecturer at Northumbria University; and Neil Greenberg, Professor of Defence Mental Health at King's College London. They offer great insights into the impact of lockdowns, quarantine and self-isolation; PTSD in medical workers; and the impact on children. This last topic was especially revealing as, because COVID-related deaths and/or severe outcomes in children are rare, the focus on children is often neglected.

Haq called it a "dual pandemic" – COVID on one hand, pediatric mental health on the other. She showed that emergency visits for mental health crises for 12-17-year-olds were up by 31%. There's an increase in suicide ideation and attempts – and underlying mental health issues are exacerbated by the pandemic. Haq alerted to another dramatic side-effect that's likely not the radar of many, namely that many of the COVID-19 deaths leave behind children who find themselves suddenly single or even double orphans.

It has become clear that, during this pandemic, psychiatric institutions also reached their limits. With no beds available, mental health patients, in need of a secure environment, had to be sent to medical hospitals instead. And those were, of course, equally strained.

Science is the way out and forward

I invite you to immerse yourself in these recordings. While some may be too technical for laypeople, most help us better understand what's behind us, where we are now, and what we can and must expect in the coming months and years. One presentation slide offered a quote, by Dr. Jeremy Farrar, that perfectly illustrates the importance of this expert forum, and that of every other collaborative effort by scientists around the world:

 "There is only one way the world can exit this pandemic – and that is through science. We need diagnostics to detect and limit the spread of this virus, vaccines to provide long-term protection, treatments to save lives in the short-term and social sciences to understand the behavioral and societal implications."

dr. Jeremy Farrar