Far more intense efforts are needed to identify the characteristics of the long COVID before nourishing the ambition of being able to address the problem effectively. Syndromes are, by definition, heterogeneous and difficult to manage in the absence of a clear understanding of the causal mechanisms. The plethora of symptoms affecting multiple systems exhibited by "long COVID sufferers" suggests several underlying mechanisms1,2,3. In this sense, long COVID is a syndrome par excellence. Being a heterogeneous condition from a pathophysiological point of view requires efforts to improve its understanding, diagnostic accuracy and, above all, establish an effective therapeutic program. The latter cannot be achieved ahead of the antecedent two steps. The National Institute for Health and Care Excellence (NICE), the Scottish Intercollegiate Guidelines Network and the Royal College of General Practitioners have developed a quick guideline for managing the long-term effects of Covid-19. The current guideline lacks essential details, including a comprehensive list of organ complications seen in patients with long COVID, the required investigations, and specific interventions for these complications4,5. It is not clear which speciality could be more suitable for aggregating patients suffering from long COVID. Preliminary to initial referral mandatory exams include FBC, U&E, LFTs, CRP, CK, haematinics, TSH, HbA1c, Calcium, BNP, ECG, CXR, SpO2, RR, HR and temperature. The lack of a specific target underlines the generality of the approach. It leaves us with doubts about what the clinics responsible for managing long COVID are expected to do, at least in the hospital setting. Furthermore, we are moving from the premises of a diagnosis of exclusion. It is even not clear what the overall cost of the initial referral is. Costing should include the charges for the multitude of mandatory tests - often already recently performed, but not within the six weeks antecedent to the referral as per requirement - plus the first hospital consultation charge to the NHS. It also remains to be established what the referring doctor and the patient should expect from the referral, especially in the treatment plan. A cost-benefit analysis – that is, the process used to measure the benefits minus the costs associated - of the long COVID clinics in their current form appears to be lacking. Such analysis should also factor in the opportunity cost in the decision-making process. Opportunity costs are alternative benefits deriving from choosing one alternative over another. In other words, the opportunity cost is the forgone or missed opportunity because of a choice or decision.  The above situation, once again, emphasizes the need for at least more solid diagnostic and pathophysiological premises before proceeding further with clinics and therapeutic programs, other than in a field of scientific research aimed at obtaining more information. In the absence of measures so designed, the long COVID can produce a second crisis of the health system and the job sector in the wake of the pandemic itself. Until we have a better idea of dealing effectively with long COVID, there is a strong case for redirecting any money destined to the Long COVID Clinics to clinical research on long COVID and Primary Care. A golden rule in healthcare is that spending more on prevention, early detection, and better-diagnosing spares patients suffering and leads to less complex and less expensive care later.

After the pandemic extent of SARS-CoV-2 infection was recognized in mid-February 2020, indicators of influenza activity began to decline worldwide.The significant reduction in influenza activity may have implications in terms of forecasting the most appropriate strains towards which to direct the 2021/2022 vaccination campaign, its possible benefits against the inevitable costs, not only economic, but also organizational. The latter deserve special attention by virtue of the realistic need for a new mass vaccination for Covid19 in autumn 2021.In order to have a better perception of the fluctuation of influenza activity at the level of General Practice, we verified the cases of influenza diagnosed after hospitalisation for pneumonia and flu-like illness for a period of 5 years in a population belonging to a large GP Surgery in Merseyside, UK.

The human body is, by definition, a "corpus". This Latin term emphasises the synergy and interdependence of each of its parts. There is no scientific basis for estimating the number of specialists of various types needed to meet the population's needs of the type of interventions that confer benefit. However, it is virtually certain that the proper functioning of the filter could free up more time for properly deployed specialists to provide services that would significantly improve health and, above all, equity in health.  Recognition of the importance of first contact function in Primary Care as a filter and co-ordinator, should lead us to better clinical outcomes for the most part. The government should recognise, protect, and prioritise, the role of the Primary Care interface. 

The presence of pigmented and partially pigmented skin lesions of non-univocal interpretation should always trigger a cautious approach. Albeit the diagnosis of malignant melanoma should remain our main concern, other more common skin conditions, namely basal cells carcinoma, should be taken into consideration in the diagnostic process and management plan. The following case highlights how, sometimes, the diagnosis of partially pigmented basal cells carcinoma may not appear to be immediately evident and the opportunity to deal with non-surgical approach missed. Case report 50-year-old man of Caucasian origin, phototype III in Fitzpatrick scale, initially presenting with a 6-month history of pigmented, inflamed, flat skin lesion at the base of the neck. The lesion had been noticed in the summer months due to the itching and occasional burning it caused (figure 1). Physical examination revealed a 7 mm x 8 mm superficial skin lesion, partially pigmented, not well defined, slightly hyperkeratotic, against a background with several lentigo and nevi. No particular concerns were raised by dermoscopy, or dermatoscopy, and the patient was reassured, even though a small white clod was noted.