Long Covid

Lord Kakkar Excerpts

Thursday 17th November 2022 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join other noble Lords in thanking the noble Baroness, Lady Thornton, for having secured this important debate and for the very thoughtful way in which she introduced it. I declare my own interests as chair of King’s Health Partners, chairman of UK Biobank and an active researcher in the field of thrombosis, a particular pathophysiology that has both impacted acutely on Covid and may have some role in long Covid symptoms.

We have heard that some 2.1 million people—some 3.3% of our population—have self-reported, as part of the ONS data collection programme, symptoms attributable to long Covid. It is striking that some 500,000 of those individuals reported having had Covid some two years previously. This represents a substantial, ongoing, chronic burden of disease. We should all be conscious of its potential impact on the way in which we are able to deliver healthcare through the National Health Service.

As we have heard, little is known about the etiology of long Covid. There is a suggestion that part of it may be attributable in some individuals to a failure to properly clear the virus from their bodies. It is also possible that there are genetic determinants that drive individual immune response and that this dysfunction is part of the explanation for long Covid symptoms. There is a now well-established phenomenon of dysfunction in the microvascular and endothelial cells that line blood vessels, which may be responsible for some of the long Covid symptoms. Indeed, a profound hypercoagulable state—a tendency to a risk of thrombosis and blood clots—manifests itself in an important number of long Covid patients.

We have heard of the importance of research in trying to understand more about the etiology of long Covid and to better understand its history. This is critically important if we are to be able not only to research and develop new therapies but to address the question of long Covid through the mechanisms underlying its development and sustained impact. This research is also critically important in understanding how we should properly develop services to manage patients. At the moment, His Majesty’s Government have committed some £194 million to the provision of clinics and services to manage Covid patients—some £90 million of which is to be spent in the financial year 2022-23. However, when one looks at the burden, this resource is only able to provide services for some 5,000 patients a month. The substantial demographic of long Covid is running into many hundreds of thousands, if not millions, of people. We clearly need to understand from prospective research not only what volume of services is needed but how those services should be constructed, based on our knowledge of the natural history of the disease, in order to adequately and properly manage the requirements of those patients beyond symptom control.

Is the Minister content that the approach to research is sufficient? As we have heard, some £50 million has been committed by the Chief Medical Officer to a variety of research programmes. Is he able to address the question, raised by the noble Baroness, Lady Thornton, of why a national cohort has not been established to allow us to marshal the current clinical burden of long Covid in our country and then to apply an appropriate methodology and protocols to the evaluation of these individuals? Research undertaken in this systematic fashion is not only highly efficient but provides the best opportunity for us rapidly to understand and start addressing the questions that need to be addressed if we are to be able to develop these new therapies and organise and deliver services in the most appropriate way for these patients.

Beyond the financial commitment to the development of a long Covid research cohort, there is also the need to ensure that the data collected through routine exposure of these patients to NHS services can be marshalled to inform the research effort. Those data should be able to link with other datasets whose huge value in addressing acute Covid and in the post-infection period has been established. I reiterate my interest as chairman of UK Biobank, which has been used in this regard. It is a unique resource, available to the country, where half a million of our fellow citizens have provided their biological material. The genome in those individuals has now been mapped and the opportunity exists to interrogate the dataset, using that biological material, to assess novel biomarkers and the prevalence of disease. The deep phenotyping and repeat imaging give the capacity to understand structural end organ dysfunction in Covid. All this requires an approach from His Majesty’s Government with regard to data sharing, within and across datasets, between researchers in different institutions and, as we have heard, with those outside the public sector wishing to support this research. Is the Minister able to provide some reassurance on this?