Despite major reductions in acute COVID-19 hospitalisation and mortality,[1] the persistence of symptoms over one year later is notable in the 45% of the 1.5 million individuals who had symptoms four weeks post-COVID in the UK.[2-4] Unlike some long-term conditions (LTCs), individuals with Long COVID (i.e. those with post-COVID symptoms >12 weeks) may still fully recover. However, new care pathways for Long COVID attempt to manage it akin to a LTC, given the increasing recognition of chronic symptoms.[4, 5]

Care pathways for LTCs have tended to be disease- or specialty-specific, an approach which fails to accommodate the heterogeneity of symptoms occurring in Long COVID. ICPs are structured, multi-disciplinary plans of the whole care pathway from primary care to specialist services and rehabilitation services, which may be better suited to Long COVID.[6-8] They offer coordination of investigation, treatment and rehabilitation, as well as opportunities for real-time iterative improvements in service design and delivery, quality and access to care, patient experience and satisfaction, while reducing complications and non-elective admission rates.[9-11] Evolution of integrated care systems (ICSs) in the UK provide opportunities to improve care across LTCs, multi-morbidity or multiple health conditions,[12] and Long COVID.

Long COVID encompasses a broad array of symptoms and symptom clusters. It is unlikely to reflect a single condition or pathology; rather it reflects a multi-faceted condition with numerous contributory factors: some identifiable, and others not yet understood.[13] Trajectory and recovery after SARS-CoV-2 infection are poorly defined and there is overlap with medically not yet explained symptoms (MNYES), referring to symptoms which do not represent a known medical condition, yet contribute significantly to lesser quality of life and treatment need.[14] Multi-organ complications,[13, 15-18] including neuropsychiatric sequelae (up to 20%), are well-documented.[19-24]

Table 1 shows current models that can potentially be applied to Long COVID ICPs. Depending on setting, expectations and provisions regarding treatment may differ. It can be argued that some current models for managing LTCs require improvement[25] as they cannot cover the whole range of patient presentations; episodic care is not appropriate for unpredictable exacerbating conditions, for example heart failure and COPD.[26, 27] An effort should be made to explore how to achieve integrated care from the perspective of individual conditions, but also from the perspective of how health services and settings can inform each other, and work together, to deliver optimal care for LTCs. The current pandemic and effort to set up Long COVID clinics[28] offers a unique opportunity to explore this from the perspective of Long COVID, and then to translate back to ICPs for other LTCs. For example, model 2 could also be based in primary care with better integration of GPs, primary care nurses and therapists. Model 3 could be more of a shared care arrangement between primary and secondary care with two-way data flow between these two sectors. In other words, one of the solutions for Long COVID care could be better working arrangements between community services, primary care and specialty care and ICSs might offer the perfect space for this in England.

Even in well-defined entities such as community acquired pneumonia (CAP), symptoms such as fatigue[31] may take up to six months to resolve, even in young, physically fit people, fuelling fears that their symptoms will not abate, which may be biologically, psychologically, or socially driven, or depend on treatment setting. Learning from other LTCs, optimal Long COVID management may require a biopsychosocial model, rather than consideration of these components separately.[32]