In an unusual appeal from healthcare workers stricken with the malingering symptoms of long COVID, a letter signed by more than 40 physicians calls for more surveillance and research into the poorly understood condition.1

As employee health professionals are aware, people with long COVID — many of whom appeared to recover from initial infection — may experience an intermittent panoply of symptoms that include fatigue, headache, loss of sense of smell, and others. Some come out of it in weeks or months, but others have suffered long COVID for a year and are still followed.

“We write as a group of doctors affected by persisting symptoms of suspected or confirmed COVID-19,” the physicians wrote. “We aim to share our insights from both personal experience of the illness and our perspective as physicians. Tackling this problem will involve collaboration between politicians, healthcare services, public health professionals, scientists, and society.”

The group of doctors in the United Kingdom called for these principles to be implemented to help people with long COVID:

• Research and surveillance. Persisting symptoms of COVID-19 should be addressed using a scientific methodology and without bias, they wrote, making the common-sense point that people experiencing the condition should be counted.

“We still know very little about COVID-19, but we do know that we cannot fight what we do not measure,” the physicians emphasized.

Research and surveillance should capture the full spectrum of disease, including in those not admitted to a hospital and not tested. “We need a clear definition for recovery from COVID-19,” they noted. “We argue that further research into chronic COVID-19 symptoms is essential. Failure to understand the underlying biological mechanisms causing these persisting symptoms risks missing opportunities to identify risk factors, prevent chronicity, and find treatment approaches for people affected now and in the future.”

• Clinical services. “Services need to be timely, tailored to individuals’ presentations, and involve investigating and treating pathology, as well as the functional recovery of individuals,” the physicians emphasized.

Before any active rehabilitation can start, long COVID patients must be assessed for heart and lung health. “Before we get people exercising, it’s important to be sure that it’s going to be safe,” the authors stated. “We need proper evaluation of cardiac and respiratory function, and we need to take things slowly and in a paced measure. … The establishment of one-stop clinics will allow pattern recognition and expertise to develop among clinicians identifying and managing sequelae of COVID-19.”

• Patient involvement. “Patients must be involved in the commissioning of clinical services and the design of research studies,” the authors wrote. “Patients experiencing persisting symptoms of COVID-19 have a great deal to contribute to the search for solutions.”

• Access to services. Clinical services should not unfairly discriminate against those with negative tests. A clinical diagnosis should be adequate for accessing need of care.

“We welcome increasing awareness of the problem of persisting symptoms of COVID-19,” the physicians concluded. “As politicians, scientists, and doctors attempt to tackle this issue, these principles can act as a guide enabling the experiences of those with the condition to inform the efforts of experts and lead to improved research and clinical care, benefiting those affected and society as a whole.”


  1. Alwan NA, Attree E, Blar JM. From doctors as patients: A manifesto for tackling persisting symptoms of COVID-19. BMJ 2020;370:m3565.