An estimated 1.3 million people in the UK are experiencing the enduring symptoms of COVID-19 ranging from 'brain fog' to heart palpitations, and breathlessness.

Two years into the pandemic, what do we know about the virus? We spoke to Royal Free London consultant respiratory physician Dr Swapna Mandal, John Hurst, professor of respiratory medicine, and Shanaz Ahmad, clinical trial practitioner.


The early days

Swapna Mandal leads a portfolio of COVID-19 research here at the Royal Free London. Reflecting on the earlier days of the pandemic, she said: “We were one of the first in the UK to publish data on long Covid.”

Swapna continued: “Four to six weeks after the initial surge of COVID-19, we noticed that symptoms were persisting in some patients. We responded rapidly to this by setting up follow-up clinics for patients.”

The RFL collaborated across north central London to open the clinics, and two of these are located at Barnet Hospital and the Royal Free Hospital. Swapna explained: “During the first wave of COVID-19, around 800 patients visited the follow-up clinics and the data from this has helped us gain a greater understanding of recovery from the virus."

The RFL COVID-19 follow-up service was shortlisted for a BMJ (British Medical Journal) clinical leadership team award in 2021. Swapna said: “It was phenomenal that we could mobilise everything so quickly and this was down to the sheer goodwill of colleagues."

She added: “We’re incredibly grateful to everyone who was redeployed to our team, including medical students, allied health professionals and nursing staff. At our peak, we were making around 40 phone calls to patients a day, and we couldn’t have done this without the additional support.”

Farhan Naim, director of research and development at the trust, said: “I am delighted by the work of our respiratory research colleagues who have risen to the challenge of conducting world-leading research into long Covid.”


Patient recovery

John Hurst and Shanaz Ahmad are part of a UK team seeking to understand recovery from on-going complications and symptoms caused by COVID-19.

PHOSP-COVID is the first UK-wide study to assess the impact of COVID-19 on long term patient health and their recovery. The study is multi-centred and led from Leicester University. 

John said: “Two years ago, I never thought I’d be sitting here having this conversation. We’re a relatively small research team in respiratory medicine, but we’re achieving a lot and this is a really ambitious study.

“I would characterise this as a physical and mental MOT for people recovering from COVID-19. It is an opportunity to understand why longer-term problems occur.”

PHOSP-COVID investigates recovery after patients are discharged from hospital. John said: “Fatigue is very prominent in long Covid, as is a cough, breathlessness, and cognitive problems called ‘brain fog’.”

The research team gather information from questionnaires, physical tests, and sample tests of blood and urine to capture the varied experience of recovery.

Shanaz said: “We take bloods to measure cardiac enzymes, protein levels, and inflammatory markers. The study looks at patient’s physical and cognitive function. This can include measuring people’s strength in their hands using a device.

We also measure psychological effects including post-traumatic stress, and general anxiety disorder. Everyone’s recovery is different and our findings show just how holistic we need to be in caring for COVID-19.”

There are over 201 patients from the RFL taking part in the ground-breaking research. John said: “We’re working together to create new knowledge. Patients taking part don’t just help other people; they gain a deeper understanding of their own recovery too.”


Meet Marilyn

Marilyn Olama of Hampstead participated in the PHOSP-COVID study. Marilyn  was admitted to the Royal Free Hospital in December 2020 after contracting COVID-19. She woke up from a coma in February 2021 unable to walk.

She said: “It has been comforting to know that other people are experiencing this. Contributing to research gives me hope.”

Marilyn, 70, used to be a nurse in Edgware. She said: “I urge everyone to take part in clinical research if they get the opportunity. You never know, just one blood test could result in a breakthrough that could help to save someone’s life. It’s a way of giving back and helping others.”

Reflecting on her care at the RFL, Marilyn said: “The research team have been so thorough and clear at communicating. Most of all, they have been charming. I cannot fault the treatment and I want all the staff to know just how wonderful they have been throughout my recovery.

“From the physios to the ICU domestics, and the research team – they have all been so kind. The nurses in ICU behaved like family to me, and they set up video calls with my loved ones when I missed them so much. They really are the best of the best and they’ve maintained such good humour throughout all the challenges.”


Looking forward

The Royal Free Charity stand shoulder to shoulder with the trust providing vital support for our staff and patients throughout the pandemic. Their Breaking Point appeal sets out to support our pioneering research into long Covid.