Long Covid

Advancing the frontiers of knowledge

Our Newman Fellows enhance the richness and diversity of UCD’s research landscape across both the sciences and humanities, in subjects ranging from history and creativity to plant sciences and human health. Current Fellow and infectious diseases specialist Dr Brendan O’Kelly, UCD School of Medicine, is leading critical research into COVID-19 and making significant breakthroughs in our understanding of the long-term health impacts of this complex disease.

Hope for patients with Long Covid

Long Covid is a multifaceted condition that can have a severe impact on patients’ well-being and quality of life. Although there is no pharmacotherapy yet approved for its treatment, the findings from Brendan’s Newman Fellowship research offer hope of improved outcomes for patients with symptoms of the condition.

Working with colleagues at UCD School of Medicine and Dublin’s Mater Misericordiae University Hospital, Brendan conducted an observational study into the safety and efficacy of low dose naltrexone (LDN) as a treatment for patients experiencing symptoms for at least 12 months post infection with the virus.

Pre- and post-treatment questionnaires using symmetrical Likert scales showed a significant improvement in six of the seven parameters explored: respondents reported feeling recovered from COVID-19, as well as improvements in performing activities of daily living, energy levels, pain and discomfort, concentration, and sleep. The largest effects were seen in pain/discomfort and feeling recovered from COVID-19. Mood was the only parameter that was not significantly improved.

LDN was also demonstrated to be a relatively safe medication in this context. Two patients (5.3%) stopped LDN due to gastrointestinal upset, but no major adverse events were seen. As this work was observational, the research group are now hoping to conduct a randomised controlled trial to gain a better understanding of the potential of this drug for use in patients with Long Covid.

Groundbreaking work

This research builds on Brendan’s previously published work done through the Anticipate research collaborative, showing that one quarter of patients attending a COVID-19 follow-up clinic met the definition of ‘Post COVID-19 Syndrome’ one year after initial diagnosis. These patients had a significant reduction in their physical well-being, demonstrated using well-validated health-related Quality of Life Questionnaires including the SF-12 score, which measures general health status in eight domains.

This is one of the first studies to follow COVID-19 patients for one year after their initial illness – and longer in some cases – and it gives an insight into the trajectory of the disease for many patients and the constellation of symptoms that patients experience. It is also one of the first studies to explore the impact of Long Covid on how people are functioning in their day to day lives.

“What we are finding is that it’s not just that people are living with chronic symptoms like fatigue, headache and other symptoms but that some people have not been physically able to get back to their usual level of function prior to COVID-19, get back to work and usual family life, and this is worrying,” Brendan said.

The study is also groundbreaking in identifying predictors of those who will go on to have Long Covid at one year: a high resting heart rate and low SF-12 score in the weeks after diagnosis. These parameters can be measured in any clinic setting, to allow earlier multidisciplinary intervention to mitigate the long-term impact of the disease.

The results of the study were published in The International Journal of Infectious Diseases in March. Congratulating Brendan on these publications, Professor Jack Lambert, who supervises the Newman Fellowship research project, reiterated that “this is groundbreaking work” and should be highlighted more widely.

Not just a lung disease

A multitude of symptoms have been reported for COVID-19 – including shortness of breath, palpitations and chest pain – and in the early stages of the pandemic, clinicians anticipated that any lasting complications of infection would be primarily related to the heart and lungs. However, the research conducted at the Long Covid Clinic in the Mater Hospital tells a different story.

The Anticipate research collaborative, which also includes Walter Cullen, Professor of Urban General Practice at UCD School of Medicine, and UCD PhD student John Broughan, has spearheaded work on exploring mood-related issues in this cohort. Data from the group show high levels of anxiety, depression, and post-traumatic stress disorder. Alarmingly, alcohol overuse at one year was seen in almost three quarters of the cohort. These results have been published on the HRB Open Research platform.

The positive indications of Brendan’s research into treatment with low dose naltrexone, published earlier this year in the journal Brain, Behavior, & Immunity – Health, now pave the way for further exploration in a larger study cohort, and offer hope to patients suffering from Long Covid.

Unparalleled support for early-career researchers

Reflecting on his Newman Fellowship experience, Brendan appreciates the unusual level of freedom and opportunity the programme offers to someone in the early stages of a research career:

“The Newman Fellowship Programme is special. It supports researchers at a really pivotal time in their careers, and at its core it is a force for the betterment and enrichment of society as a whole. I have been supported in a completely unbiased way, which shows the role of pharma in forwarding medical science outside of the more typical routes of drug and device development.

“Being awarded the Fellowship was a huge honour and looking at the profiles of my impressive peers in the Programme I knew I had much to live up to. The resources available to me are second to none, and I’ve really been struck by the UCD ethos of enabling people to reach their full potential.

“The Newman Fellowship has given me the freedom to dedicate myself to my research at the Mater Hospital. This was so important in my case, given the time-sensitive nature of COVID-19 research. Many colleagues and friends involved in research elsewhere have teaching or clinical commitments that take valuable time away from their research. They cannot believe the freedom that this Programme provides, and I cannot see how I could do this work successfully without the unique support of the Newman Fellowship.”

 Dr Brendan O’Kelly graduated with a medical degree from the Royal College of Surgeons in 2013 and became a member of the Royal College of Physicians in 2016. He has worked in Beaumont Hospital, The Mater Hospital and St James’s Hospital as an Infectious Diseases Specialist Registrar and completed clinical training in Infectious Diseases in July 2021. His Newman Fellowship is supported by Gilead, Pfizer and GSK.