UNDERSTANDING LONG COVID, THE IMPACT UPON QUALITY OF LIFE AND FUNCTIONAL STATUS AND THE NEED TO DEVELOP BESPOKE INTERVENTIONS TO IMPROVE RECOVERY

Long COVID is a patient made term defined as the continuation or development of new symptoms 3 months following COVID-19 infection, with symptoms lasting at least 2 months, amid no alternative diagnosis. Long COVID arises following at least 10% of COVID-19 infections with an estimated 65 million individuals believed to have Long COVID, a number steadily increasing. Biomedical research has made progress in hypothesising the underlying pathophysiological mechanisms and risk factors of Long COVID. However, knowledge surrounding the variable onset of symptoms, the impact on functional status and quality of life and current diagnostic and treatment options incorporating the lived experience remain scarce. The complexity of long COVID and its diverse profile of over 200 symptoms affecting multiple organ systems contributes to unprecedented challenges for patients, clinicians and healthcare services.
The significant long-term impairment caused by Long COVID in the months and years following acute infection has been evidenced, however there is limited empirical data highlighting the frequency and severity of fluctuating and disabling symptom profiles. As public health messaging of Long COVID is overlooked, research centred around the voices and lived experience of those with the debilitating long-lasting effects of COVID-19 is key. Accordingly, the overarching aim of this thesis is to understand Long COVID, considering the impact upon quality of life, and functional status and the need to develop bespoke mechanisms and interventions to support recovery.
Individuals are being severely impacted by their symptoms and are unable to or limited in participating in their daily activities, or live life fully subsequently reducing quality of life (Study 1). Furthermore, patients report varying healthcare experiences, with reports of medical gaslighting, barriers to support and inadequate care. Data from this thesis highlights the episodic and relapsing nature, which can be used to characterise Long COVID disability and inform the development of bespoke guidelines and support services to respond to the reduction in functional status (Study 2). This thesis presents consensus achieved by key stakeholders including patients and medical professionals regarding the appropriate support mechanisms and interventions for long COVID (Study 3). The outcomes of this thesis can be used to guide the design and implementation of efficient and effective services to address the broad challenges of living with Long COVID.