Long-haul illness after last century’s flu pandemic

As some people affected with COVID-19 face lingering long-term effects, post-infectious symptoms were also seen in various countries after the 1918 flu pandemic, as described in a humanities article published in CMAJ (Canadian Medical Association Journal).

Dr. Arthur J. Hall, a British physician, carefully documented his patients’ diverse and complex postencephalitic symptoms, in part because of Britain’s excellent public health system that officially recorded cases of “epidemic encephalitis.” Symptoms included chronic fatigue, insomnia, tremors, movement and eye disturbances, and behavioural changes. The value Hall placed on his patients’ descriptions of their illness increased over time, even as their numbers receded.

“Hall’s local and national reputation empowered him to create a system that collected and amplified patient voices,” writes Dr. Kenton Kroker, York University, Toronto, Ontario. “He saw little distinction between making Britain’s new systems empathetic and making them efficient.”


The work of Dr. Hall in helping sufferers of encephalitis lethargica may inspire clinicians during the COVID-19 pandemic.

“It may be advisable to devise similar ways to encourage the impassioned curiosity of those practitioners watching and caring for COVID-19 “long haulers,” as health systems are reshaped to respond to long-term challenges with greater sensitivity, responsivity and efficacy,” writes Dr. Kroker.

“Encephalitis lethargica: Last century’s long haulers? is published September 20, 2021.