Mar 8, 2021

Digital healthcare tool for Long Covid to roll out in UK

long covid
digital healthcare
Leila Hawkins
3 min
Digital healthcare tool for Long Covid to roll out in UK
The digital Living With Covid Recovery Programme has been used successfully to treat patients after they leave hospital...

A digital healthcare programme treating patients with Long Covid is set to be rolled out across UK hospitals. 

The Living With Covid Recovery Programme has been designed to treat people who are experiencing long term symptoms of the virus, such as tiredness, breathlessness and anxiety, weeks or even months after the peak of their infection. 

Patients can access the programme, which includes exercise, dietary advice and mental health support, via a mobile app after they've been discharged from hospital. 

The programme has been created using evidence-based methods from physiotherapists, psychologists, dieticians and respiratory physicians, to provide bespoke treatment plans for each patient. Several universities, the National Health Service (NHS), patients and the software developer Living With Ltd worked together to create the programme, which combines treatments and exercises already well established in the NHS and used to treat individual symptoms. 

There are two main components to the programme. Patients experiencing long lasting symptoms usually visit their doctor, who can then refer them to a Long-Covid clinic. There a doctor goes through a set of questions with the patient to make sure the programme is right for them. 

A physiotherapist or nurse will help co-create a recovery plan and show the patient how to use the app. They will keep in touch with them regularly to help with exercise and treatments and offer support. 

As well as the app, an assigned nurse or physiotherapist can access a dashboard to track patients’ health and progress, message them, and adapt their care to fit them. 

Lastly, there is a wider NHS team to support patients if needed. This is part of the care pathway that can be adapted to fit local needs and NHS resources. 

Currently in use by several trusts in England, it is being rolled out to more hospitals after successful pilot studies in London have showed it helps NHS staff manage large caseloads of patients safely and well. 

The first version of the rehabilitation tool targeted three common symptoms: fatigue, anxiety and breathing problems, but subsequent versions are targeting neurological problems, depression, and loss of taste and smell among other issues. The programme will continuously evolve over the next 12 months as it learns from the data it acquires and the use of AI.

“The proportion of people needing further help is really high" respiratory physician Dr Paul Pfeffer from Barts Health NHS Trust said. "We’re finding that half of the patients we discharge from hospital are still experiencing significant symptoms after three months. There are simply not enough staff and resources to reach everyone recovering from Covid-19 who are in need of using traditional models of care, such as face-to-face appointments. This tool allows us to provide high-quality treatment to large numbers of patients simultaneously.”

Experts have also commended the tool for including mental health support. “The mental health component of the digital tool is just as important as the physical" said psychologist Dr Stuart Linke, UCL Primary Care and Population Health and Camden and Islington Mental Health NHS Trust. 

"We are finding that the symptoms are often interrelated – for instance, if you’re feeling anxious you may be less likely to eat well, which may lead to further tiredness, which further impacts your mood and so on. A core feature of the recovery tool is Cognitive Behavioural Therapy (CBT) delivered by psychologists to help with anxiety." 

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Jun 14, 2021

Long haul Covid, the brain and digital therapies

4 min
Neuroplasticity expert Ashok Gupta tells us about the symptoms of long Covid, how it affects the brain, and digital therapies

It is estimated that around 10% of people who get Covid-19 develop long haul Covid, a debilitating condition that can last many months and cause breathlessness, exhaustion and pain. 

Research is underway to find out who is more likely to get it and how to treat it. Here neuroplasticity expert and owner of Harley Street Solutions in London Ashok Gupta tells us how the condition affects the brain. 

What is long Covid exactly? 

Long Covid is when patients who have experienced Covid-19 go on to have continuing symptoms for weeks and months afterwards. These symptoms can include breathlessness, exhaustion, brain fog, gastric issues, pain, and post-exertional malaise. It is estimated that around 10% of Covid-19 infections may result in developing long haul symptoms, and in the USA, this may be affecting over 3 million people.

How does it affect the brain?
Here at our clinic, we hypothesise that it is due to a malfunction in the unconscious brain, creating a conditioned response that keeps the body in a hyper-aroused state of defensiveness. At the core of this hypothesis is the idea that we are here because our nervous system and immune system have evolved to survive. We are survival machines!

When we encounter something such as Covid-19, the brain perceives it as life threatening, and rightly so. And in the era of the pandemic, with more stress, anxiety and social isolation, our immunity may be compromised, and therefore it may take longer for the immune system to fight off the virus and recover. 

If the brain makes the decision that this is potentially life threatening and we get to the stage where we’re overcoming the virus, a legacy is left in the brain; it keeps over-responding to anything that reminds us of the virus. Even if we’ve fought off the virus, the brain will react in a precautionary way to stimuli reminiscent of the virus. 

The brain may get stuck in that overprotective response, and keeps stimulating our nervous system and our immune system, just in case the virus may still be present.

What symptoms does this cause? 

These signals cause a cascade of symptoms including breathlessness, extreme fatigue, brain fog, loss of taste or smell, headaches, and many others. And these are caused by our own immunes system.

In the case of long-haul Covid, symptoms in the body get detected by a hypersensitive brain which thinks we’re still in danger. The brain then chronically stimulates the immune and nervous systems, and then we have a continuation of a chronic set of symptoms.

This isn’t unique to long-haul Covid. Many patients develop chronic fatigue syndrome, sometimes known as “ME”, for example, after the flu, a stomach bug, or respiratory illness. Covid-19 may be a severe trigger of a form of chronic fatigue syndrome or ME.

How does long-haul Covid affect mental health? 
Anxiety is a very common symptom in long haulers. It can be frightening to wonder about what may be happening in your body, and what the prognosis is going to be for one’s long term health. Reaching out for support for mental health is crucial for long-haulers.

How does neuroplasticity treatment work for long-haul COVID patients?
We have been working with patients for two decades with a brain retraining programme using neuroplasticity or “limbic retraining.” 

We believe that through neural rewiring, the brain can be “persuaded” that we are no longer in danger and to come back to homeostasis. But to be very clear, we are not saying it is psychological in any way, but we believe there are novel ways of accessing the unconscious brain. 

We recently worked successfully with a 56-year-old male with long-haul Covid, who prior to contracting Covid-19 in March of 2020 was running half-marathons and cycling, but afterwards he struggled to get off the sofa for months. Within 3 months he’s now back to 100% and  running half marathons again.

At our clinic, we train the patient to be able to recognise those subtle unconscious danger signals on the periphery of consciousness. This, coupled with supportive techniques and the natural hallmarks of good health such as sleep and diet help prepare the patient to respond to perceived threats that might trigger the response. 

The natural state of our brain is to default to protection. The brain prioritises survival and passing on our genes to the next generation, over any other impulse. It cares more about that than you feeling healthy and well. Protective responses are evolutionary, and are the right thing for the brain to do – it’s survival. 

What digital therapies or apps are proving effective at treating long-haul Covid? 
It seems that long haul patients are availing themselves of many online therapies and services, including meditation apps and wellness websites. We have an online neuroplasticity “brain retraining” video course called the “Gupta Program” which hosts 15 interactive videos and many audio exercises. This is proving very popular with long haul patients, and we are currently conducting a trial to test the effectiveness of this therapy. 

What is the danger of leaving long-haul Covid untreated?
The longer it goes untreated, we hypothesise that it may become more entrenched in the brain, and  become chronic in the longer term. Therefore we advise all patients to get help and advice as soon as possible.

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