Regional inequalities in Long Covid rates revealed

A fifth of patients in some areas of the North of England have Long Covid, according to a study which includes  university of Manchester researchers.

Navigating the Long Haul: Understanding Long Covid in Northern England, published by Health Equity North, reveals the striking inequalities in Long Covid rates and a clear North-South divide.

Analysis of General Practice Patient Survey data from 2022 found the North West had the highest number of people reporting Long Covid symptoms (5.5%) followed by the North East and Yorkshire (5.1%).

In some northern GP practices as many as one in five patients (20%) reported having Long Covid.

The regions with the lowest rates were the South West (3.4%) and the South East (3.6%), and the average for England as a whole was 4.4%.

The research suggests that people in the North of England are among the worst affected by Long Covid, which follows patterns evidenced in previous reports highlighting the devastating impact of Covid-19 across northern regions.

The link between deprivation and higher rates of Long Covid is also explored in the report. Nationally, the prevalence rate in the most deprived areas (6.3%) is almost double that in the least deprived (3.3%).

Within region inequalities are also evident in the North East and Yorkshire, where rates in the most deprived areas (8.3%) were 5.2% percentage points higher than in the least deprived areas (3.1%).

The report, a collaboration between Health Equity North, Newcastle University, University of Manchester, Insights North East, Public Health South Tees and Healthworks, explores the impact of Long Covid on the health, wellbeing and employment prospects of adults living in northern England.

The findings have prompted calls for more research into Long Covid and for Government to undertake a consultation with Long Covid patients to better understand the condition and to implement care plans to facilitate rehabilitation and management of the condition.

Further findings from the report include:

• In England, 1.9 million people were experiencing a myriad of self-reported Long Covid symptoms as of March 2023, with 79% saying it has had a negative impact on their day-to-day activities.
• Fatigue was named as the most experienced symptom, and over half reported reduced functionality in their everyday activities, which resulted in their inability to return to work.
• The 10 GP practices with the highest prevalence of Long Covid were all in the North.
• While many employers in the North provide support for Covid-19, this is specified on an acute basis, rather than in response to later Long Covid/post Covid illnesses.
• Only three out of 10 northern employers contacted offered a specific rehabilitation package to employees living with Long Covid despite the high prevalence in the region.
• There is considerable evidence of socioeconomic inequalities in Long Covid in the North East and Yorkshire, where rates in the most deprived groups (8.3%) were 5.2 percentage points higher than in the least deprived areas (3.1%).
• The most deprived areas in the North had higher Covid-19 mortality rates than equally deprived areas in the rest of England, indicative of ‘deprivation amplification’ where the negative health effects of local deprivation is worsened for those living in deprived regions.

Long Covid encompasses physical, cognitive and mental impairments, with brain fog, fatigue, breathlessness, low mood, and depression among the most common symptoms.

As part of the research, academics conducted interviews with people who have experienced or continue to experience Long Covid.

The findings lay bare the significant impact it has on the personal and professional lives of those with the condition. Many of the people involved in the research had been demoted, fired, forced to resign or switch to part-time work because of Long Covid.

During the research, one participant said: “At one point, more than once, I was surprised to wake up the next morning. I felt like I was having stroke-like symptoms, the pressure in my head. I couldn’t move enough to either call for my children or to reach for my phone to get help. I think I lost consciousness. The next morning, I was like, I can’t believe I’m waking up. I wrote my end of life wishes and told my kids what to do if I didn’t make it.”

The report recommendations centre on the need for more research into Long Covid – covering both biomedical and social research – and also the importance of drawing on learnings from other post-viral conditions to ensure better diagnosis and treatment for patients in future.

Dr Stephanie Scott, lead author of the report and Senior Lecturer in Public Health at Newcastle University, said: “Long Covid is a complex condition that goes beyond physical and mental symptoms, affecting other parts of people’s lives including their sense of self and professional identity. This can then lead to experiences of social isolation.

“Currently, there is little evidence-based treatment for Long Covid and the health system focuses on symptom management. This needs to change. Our research has offered a glimpse into the reality of what it is like to live with this often-debilitating condition and the knock-on effects it has on people’s personal and professional lives.

“I hope that the evidence presented in this report cuts through to policymakers and gets the attention it deserves so more research into Long Covid is funded, and so measures can be put into place which enables employers to better support their workforce with Long Covid.”

Hannah Davies, Executive Director at Health Equity North and Deputy Chief Executive at the Northern Health Science Alliance, said: “Covid-19 hit the country unevenly with a disproportionate effect on northern regions – more people died, we spent more time in lockdown, had higher unemployment, and experienced a larger drop in mental wellbeing. Yet again, we are seeing the lasting impact of the pandemic being felt the hardest in the North of England.

“This pattern is reflected in our latest report which shows the North as having the highest rates of people experiencing Long Covid. And it’s likely that these figures could be much higher as many people may not report their symptoms.

“The report provides a timely analysis of the health and economic repercussions of Long Covid, which we hope will prompt action from Government. The regional differences in rates of the illness and the relationship between deprivation is clear. It is also clear that more research needs to be done to understand this devastating condition so people can be diagnosed, treated and supported.”

The report recommendations are:

• Research funders should prioritise biomedical research into Long Covid to establish accurate diagnostic tests, understand the illnesses’ pathophysiological mechanisms and develop treatments.
• Research into the impact of known social determinants of health and their relationship with Long Covid should be undertaken.
• Learning from overlap with other post-viral conditions such as myalgic encephalomyelitis / chronic fatigue syndrome (MF/CFS) should harnessed during Long Covid research and further funding into these conditions should be allocated to assist with treatment and future pandemic preparedness.
• The relationship between disability figures, sex and Long Covid should be the basis of further research.
• Priorities for government: Government should develop programmes for employers to support members of their workforce with Long Covid;  A government consultation with Long Covid patients should be undertaken to better understand their condition and to implement care plans to facilitate rehabilitation and management of the condition.

View the full report here: https://www.healthequitynorth.co.uk/app/uploads/LONG-COVID-REPORT-2024-FINAL.pdf

Health Equity North is a virtual institute focused on place-based solutions to public health problems and health inequalities across the North of England. It brings together world-leading academic expertise from the Northern Health Science Alliance’s members of leading universities and hospitals.