Doctor forced to give up her job after months of terrifying Covid-19 symptoms calls for one-stop clinics

A doctor who was forced to quit job after getting covid-19 warns patients left to recover at home need specialist help, and not pushed into ‘exercise’ programmes that can make them feel worse in the long run.
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Dr Amy Small, from Prestonpans was forced to give up working at her practice in September and take on reduced hours as a locum GP, because she struggled for months with fever, racing heart rate, headaches and brutal fatigue.

After first falling ill with the virus in April Dr Small was offered physiotherapy, psychological services and says she had to fight to get other tests that showed she had a condition causing an abnormal rate, caused by covid-19.

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The mum-of-two says patients recovering at home with long term symptoms, or Post-Covid syndrome, are being offered rehabilitation services like exercise programmes that could be damaging their recovery in the long run.

Covid treatment call: Dr Amy SmallCovid treatment call: Dr Amy Small
Covid treatment call: Dr Amy Small

She is campaigning with other doctors who have fallen ill with covid-19 for specialist one-stop clinics in Scotland.

It comes as a special investigation by the Evening News reveals that a number of health boards are prescribing people recovering from covid-19 at home with physiotherapy before any other services.

A growing number of campaigners, including Long-Covid patient groups and medical experts, have warned that exercise therapy, which gets patients to slowly increase activity, can pose serious risk to people with post-viral illness like long covid-19.

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Experts in Scotland have said a ‘significant minority” of coronavirus victims will continue to have symptoms for 12 weeks or more afterwards. The illness has been compared to ME or chronic fatigue syndrome.

Dr Small said: "I’m devastated. I love my job. I am not the first doctor to have to give up my job because of Covid and I won’t be the last. Now we have an uncertain time ahead, we have to figure out how to pay our mortgage.

“I was always a very active person prior to long Covid, running several times a week and doing other exercise, I have found it very difficult to come to terms with the post-exertional malaise I suffer now. I have learnt that graded exercise therapy is potentially very damaging.”

Dr Small says the constant ups and downs make it hard to work or help to look after her children so she tried to push her recovery – but this led to a setback. “I still have days where I can’t help to look after my kids, frustrating and distressing.

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“At first I kept pushing myself. My husband was ill too and trying to work. We had no childcare during lockdown. I’d take our kids out for a walk, despite having a fever and feeling exhausted. Then I would get up the next day feeling awful but I had to just keep doing it. I realised what I was doing could make me unwell for a long time.

“I got to a point where I could be outside with the kids for a few hours so I thought I’d try a gradual return to work. But after one morning of seeing patients I was floored for ten days and basically bed bound. I couldn’t speak properly and was struggling to eat cereal. It was frightening.”

The 40-year-old, whose husband has also been off work and is still struggling with symptoms, has called for specialist one-stop clinics to be set up to stop community rehabilitation services like physiotherapy leading on patient treatment.

“I had one follow up call from the NHS to see how I was doing. But after that I had to contact them. It’s helpful to a point - but it falls short if you are experiencing medical issues, like fever. Physiotherapists can’t help me with that. Rehab teams that people are referred to just now are not equipped to deal with this illness.”

What treatment do people get now?

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Freedom of Information requests seen by the Edinburgh Evening News revealed that no health boards are offering dedicated covid-19 clinics. Ten health boards refer patients to community rehab services, GP help and web advice or leaflets in the post.

Out of the eleven boards who sent information eight said patients are automatically put in touch with rehab teams. Four boards confirmed that a patient was first allocated a physiotherapist, before any other treatment.

One health board is trialling a new Occupational Therapy model, one said it had set up a specialist website following a pilot and two have a rehab phone service.

This week the National Institute of Clinical Excellence (NICE) is expected to recommend a programme of structure exercise south of the border, after it accepted that it might not be acceptable for patients with Long-Covid. Those guidelines are expected soon, with growing fears the Scottish Government will follow.

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Dr Small is one of 39 doctors from across the UK who published a letter in the British Medical Journal in September arguing the case for one-stop clinics to support Covid recovery and more research into long-lasting symptoms.

The calls have been backed by charities including Chest, Heart and Stroke Scotland.

Dr Small said: “If we focus on rehab before we have even looked into what’s causing people’s symptoms, we lose sight of what could be medical causes of persistent problems. I have an abnormal increase in heart rate, cause by covid-19. Now I’m on a beta blocker drug and that helps.

“There are lots of reasons for breathlessness. A fair number of Covid patients have myocarditis, inflammation of the heart muscle. Exercise can cause damage in those cases. People need proper investigations before treatment like physio is prescribed. My concern is if health services focus only on rehab and psychology services, they are missing the chance to medically treat people and help them get better.”

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“I’ve seen so many patients on forums going to the doctor with breathlessness and heart racing, but the GP puts it down to anxiety.”

“What we need is multi-disciplinary teams, special clinics set up with access to cardio, neurology, infectious diseases, ear nose and throat, as well as the physio, OT and psychological services.”

ME charities in Scotland have launched a campaign calling for specialist Long-Covid clinics in Scotland to help those struck by the condition in the long-term, warning the number of specialists here is “scandalously” minimal. They have written to the Scottish Government asking to put a stop to exercise therapy and warn a significant number of people with Covid-19 will go on to develop ME.

A spokesperson said: “There is evidence of a risk of Covid-19 leading to a large increase in post- viral illness and potentially ME. The letter requested urgent action to stop graded exercise therapy.”

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In Scotland, doctors and other health professionals are working to draw up new treatment guidelines for Long-Covid by the end of the year.

Dr Tracey Gillies, Medical Director NHS Lothian said: “Patients recovering from COVID-19 can access a range of support services. Every patient’s GP can provide advice on these services and refer them to a specialist if needed.

“NHS Lothian, alongside our four Health and Social Care Partnerships, offers support specifically for patients following prolonged intensive care treatment. Patients can also access community rehabilitation services such as Physiotherapy, Occupational Therapy, Speech and Language Therapy, Dietetics and Psychology, depending on their individual needs.

“In addition, Edinburgh Health and Social Care Partnership provides a self-referral Recovery Advice Line which is particularly beneficial for people in the community who have not required a hospital admission, but who may have ongoing COVID symptoms.”

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A Scottish government spokesperson said: “We are actively supporting the Scottish Intercollegiate Guidelines Network (SIGN), which is working with the National Institute for Health and Care Excellence and the Royal College of GPs to develop a rapid clinical guideline on the persistent effects of COVID-19.

“This guideline, expected to be published before the end of the year, will address a formal definition of the disease, how to identify ongoing symptoms and a definition of best practice investigation and treatment options to support the management of the condition.”

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