Post COVID circulation screen

The Post-Covid Circulation Screen programme is designed to assess and address circulatory system complications that may arise and persist as Vascular Long Covid following a COVID-19 infection. The screen includes:

Vascular Health Evaluation with PASC (Post Acute Sequelae of Covid) severity assessment
Clotting Risk Analysis
Personalised Long Covid cardiovascular rehabilitation programme

Most of us have now been exposed to the SARS-COV-2 virus. Unfortunately, some continue to experience odd symptoms of fatigue, brain fog, exercise intolerance, aches and pains in the legs, palpitations and breathlessness, gut symptoms and so on that have persisted for months after they had the infection. This is now being recognised as Long COVID or PASC (post-acute sequelae of COVID).

Research into the mechanisms of Long Covid, possible diagnostic markers in blood tests and definitive immune-modifying treatments continues worldwide, though none are approved or available in Singapore yet. However, some aspects have become clear. Long COVID patients have a prolonged inflammation of the inner lining of their blood vessels (a condition called endothelialitis) and form small clots in their blood vessels that affect how well their circulation functions. In addition, any minor disease they may have in their circulation like cholesterol plaques, small aneurysms, poor blood flow in the veins, etc., can suddenly take a turn for the worse – potentially increasing their risks of forming clots in veins, blockages in their arteries, heart attacks or strokes. This is Vascular Long COVID.

Our Post COVID Circulation screen aims to identify these circulation issues in those who have been exposed to COVID and suffer from persistent weakness and symptoms even after 3 months of having been exposed. They can then be recommended early preventative treatments for their circulation issues and targeted Long COVID-specific cardiopulmonary rehabilitation to help return to a better circulation health.

Who is this screen for?

If you have had or been exposed to COVID at least 3 months ago, and now have unexplained weakness, fatigue, brain fog with an inability to concentrate, inability to exercise as well as you could compared to before you had COVID exposure, odd aches and pains in the legs, palpitations and breathlessness, gut symptoms of diarrhoea or constipation – then this screening programme is for you.

What does this screen contain?

Nurse assessment

For ART test, body composition measurements, BP, post-COVID functional grading, vaccination, risk factor and medication record.

Urine test

For blood cells, sugar and protein.

Blood tests

Full blood count – low haemoglobin levels affect the ability of the circulation to carry oxygen; high white cell counts can signify infection, which is common in diabetics.
Glycated haemoglobin or HbA1C – a measure of average blood sugar control over 3 months
Kidney function – high blood pressure and diabetes can cause kidney failure from a variety of circulation-related mechanisms.
Liver function – silent diabetes and poor dietary habits can cause a fatty liver.
Lipid (cholesterol) profile – high cholesterol, or co-existing poor thyroid function and pre-diabetes, can cause blockages in the arteries to the heart, brain, legs and the penis.
CRP – The high-sensitivity C-reactive protein (CRP) test is a protein that measures general levels of inflammation in your body. It is market for persistent endothelial inflammation in vascular Long COVID.
Hs-cTnT (cardiac Troponin-T, High-sensitivity) – Blood level of high-sensitivity cardiac troponin T (hs-cTnT) is a useful biomarker for the evaluation of heart muscle damage and high levels can predict cardiovascular events. Acute COVID-19 can lead to inflammation of the heart muscle (myocarditis), which may persist in vascular Long COVID.
COVID-19 serological tests for antibodies to S (spike) and N (nucleocapsid) protein. The Anti-SARS-CoV-2 S antibody test detects quantitative antibodies against SARS-CoV-2 spike (S) receptor binding domain. Its main use is to detect and quantify vaccination-induced immune responses by providing you with a numerical value of the level of antibodies present in your bloodstream.The Anti-SARS-CoV-2 N antibody test detects qualitative antibodies to the nucleocapsid (N) protein of SARS-CoV-2 virus. It detects the presence of antibodies in the bloodstream, rather than the level of antibodies present. Its main use is to detect the body’s immune response following a natural infection.Please note that the presence of either or both antibodies DOES NOT mean that you are immune from further SARS-cov-2 infection.
D-Dimer – this detects whether small clots are being formed (and broken down) inside the circulation.

Cardiopulmonary exercise testing (CPET)

CPET measures the ability of your lungs, heart and muscles to function as a composite unit that oxygenates blood, pumps oxygenated blood to the muscles and the ability of the muscles to utilise that oxygen. This allows us to assess if your symptoms are from lung damage, heart damage or muscle deconditioning post-COVID, and customise rehabilitation recommendations accordingly.

Echocardiogram

To assess heart function and any heart muscle damage.

Peripheral Arterial Hemodynamic study

A non-invasive assessment of the blood pressure and doppler wave forms of the arteries at various levels in both the legs, to determine the presence and location of any narrowing or blockages in the legs from cholesterol and/or calcium deposits which may need monitoring, further investigation or treatment.

Carotid Duplex scan

To assess the presence and structure (morphology) of any cholesterol plaques in the carotid and vertebral arteries, which may turn unstable in Vascular Long COVID, with a potential increase in stroke risk.

Aorto-iliac aneurysm Duplex ultrasound scan

This is to look for the presence of an abdominal aortic or iliac artery aneurysm, which are the largest arteries in the body. Sudden increases in size of aneurysms are now known in Vascular Long-COVID, with risk of potentially fatal rupture if not monitored.

Extended consultation with a senior specialist vascular surgeon

To discuss results, identify the severity of functional decline post-COVID, the need for any medication to prevent progression of any underlying circulation disease, assess the state of heart and circulation health and make recommendations for targeted Vascular Long COVID cardiopulmonary rehabilitation.

Please note that there is currently no approved or accepted immune-specific treatment for Long COVID. Our Post-COVID Circulation screen is to help screen for underlying diseases in the circulation, like cholesterol plaques, aneurysms and clotting risk, and monitor closely and manage them to prevent disease progression.

How do I prepare for this screen and how long does it take?

If you have booked this screen, you should have received instructions on what to expect via email or phone. If not, please call the clinic at least 1 day before the screen at +65 64720503 during working hours to confirm the instructions.
Please reschedule the appointment if you have tested positive for COVID in the two weeks prior to the screen. You will be asked to sign a declaration that you have not tested positive for COVID in the preceding 2 weeks. You will also still be tested by ART on the morning of the test, and if positive, it will be rescheduled. This is to avoid contaminating the CPET machine, even if it is thoroughly disinfected after each test.
The screen is conducted over 3 days, scheduled as per your convenience. Plan about 5 hours in the clinic on the first day, and about 1 hour in the clinic on the second day and about 1.5 hours on the third day.
You will need to come in the morning on Day 1 having fasted (without having had anything to eat) for at least 6 hours. You may have clear non-sugary drinks, black coffee or black tea.
Please DO NOT take your diabetic medication, if prescribed for you, on the morning of Day 1, but you should bring the medication with you. You must, however, take any other medication you take for blood pressure or blood thinners etc with water as normal.
Come prepared for a brisk walk on the CPET treadmill. Bring along a water bottle, t-shirt and shorts or gym attire, and running shoes on Day 1.

What can I expect on the screening days?

On Day 1 of the screen, you will first be registered for the screening.
You will then be ART tested and be asked to provide a mid-stream urine sample whilst still fasting.
Following the urine sample and the ART test, the screening will proceed if ART is negative. You will have your blood tests as well as the Aorto-iliac Duplex scan.
You may now go and have breakfast and return to the clinic, where you will have the nurse assessment and can have your diabetic medication, if any, as well.
You may now change into gym attire if needed for all remaining tests including the CPET test to be done on Day 1. Day 1 may need 4-5 hours to complete.
On Day 2 (which can be scheduled to your convenience but would be at least 5 days after Day 1 to allow for all test results, especially CPET that is reported on by a specific cardiologist, to come back in), you will see the specialist vascular surgeon for a consultation and discussion.
Day 2 may take up to 1 hour to complete. Please eat and take medications as normal on Day 2.

What if my screening detects a problem?

We will give you a detailed report and recommendations in writing to take away.
If screening results suggest you need further investigations or treatment, you will also be given a note for you to show your family doctor to make a formal referral to us or to a cardiologist, chest physician or infectious diseases physician, if needed. Further treatments or tests may not be covered by insurance if there is not a formal referral.
Your screening results and reports are NOT shared by us with your doctor or any third party including your insurers or employers. Sharing your report results with other doctors, insurers or employers is for you to do as you deem fit but is recommended.

Please note that there are yet no approved treatments specifically directed at the immune responses to vascular Long COVID. Our screening is directed at identifying potentially increased risks of forming clots in veins, blockages in the arteries, heart attacks or strokes, and the need for Long COVID specific cardiopulmonary rehabilitation, and our recommendations will be directed towards that.

How often is a Post Covid Circulation Screen needed?

This comprehensive screen is needed as a one-off screen only, to ensure that any underlying disease that may progress rapidly because of vascular Long COVID is detected early. Any further follow-up and treatment, if required, will depend on what the screening tests show.

you are covered

We are on the panel with most insurers in Singapore and with many international insurers; We also offer convenient options for self-paying patients.