Long COVID is a multi-system syndrome following SARS-CoV-2 infection with persistent symptoms of at least 4 weeks, and frequently for several months. It has been suggested that there may be an autoimmune component. There has been an understandable caution amongst some people experiencing long COVID that, by boosting their immune response, a COVID vaccine may exacerbate their symptoms. We aimed to survey people living with long COVID, evaluating the impact of their first COVID vaccination on their symptoms. Methods: Patients with long COVID were invited to complete a web-based questionnaire through postings on social media and direct mailing from support groups. Basic demographics, range and severity of long COVID symptoms, before and after their vaccine, were surveyed. Results: 900 people participated in the questionnaire, of whom 45 had pre-existing myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) but no evidence of COVID infection, and a further 43 did not complete the survey in full. The demographics and symptomology of the remaining 812 people were similar to those recorded by the UK Office of National Statistics. Following vaccination, 57.9% of participants reported improvements in symptoms, 17.9% reported deterioration and the remainder no change. There was considerable individual variation in responses. Larger improvements in symptom severity scores were seen in those receiving the mRNA vaccines compared to adenoviral vector vaccines. Conclusions: Our survey suggests COVID-19 vaccination may improve long COVID patients, on average. The observational nature of the survey limits drawing direct causal inference, but requires validation with a randomised controlled trial.

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Referrals to the high-risk anaesthetic antenatal clinic Discussion: Demand for clinic slots more than doubled in 5 years. The number of medical problems has also risen dramatically, with 44% of patients now having 2 or more problems compared to 9% 5 years ago. An increase in the number of women with a BMI>40 kg/m 2 puts additional pressure on delivery suites and elective caesarean lists as IV access, neuraxial blocks and operative delivery are more complex and time-consuming. Our unit has needed to rapidly adjust to the increasing demand and complexity of patients by adding additional clinics, training in ultrasound for neuraxial procedures, and more double time slots on elective lists for patients with high BMI or medically complex pregnancies. We anticipate that this trend will continue, with a similar picture seen in smaller centres within 5 years. References

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