Advance care planning for patients with advanced multiple long-term conditions: a qualitative thematic analysis of health and social care professionals' perspectives.

Coronavirus/COVID-19 (SARS-CoV-2), a respiratory disease that was emerged in China during early October to mid- November and the first outbreak was noticed when it got reported from Wuhan, China in December 2019, which later caused a significant damage to the overall human health [–]. SARS-CoV-2 is an enveloped, positive-sense, single stranded RNA virus that contagiously infects humans and variety of animals []. Many patients exposed to SARS-CoV-2 encountered mild symptoms of illness, however up to 5% experienced viral manifestations and multiorgan damage which occurs in severe cases or in the patients with comorbidities like diabetes, obesity, hypertension and others can lead to systemic inflammation, acute respiratory distress syndrome, tissue damage, and cardiac damage and eventually death [–]. According to WHO, as of December 2025, there have been more than 778 million confirmed cases with 7.1 million mortalities throughout the world []. In Pakistan, the burden of drug-resistant infections, including XDR typhoid and drug-resistant tuberculosis, has been well documented. Weak respiratory disease surveillance and delayed outbreak responses have historically worsened infectious disease crises [, ]. Pathophysiology of this virus had a fundamental mechanism of primarily altered lung perfusion []. An early clinical sign of COVID-19 was Pneumonia, alongside symptoms such as fever, dry cough, and difficulty breathing, which affected the lower part of the respiratory system. Research indicates that although severe respiratory symptoms are less common in young populations, cases were observed across all age groups-including young children, adolescents, and senior citizens- contributing to increased respiratory infection burden in the post-COVID period [–]. An overall rise was observed in the respiratory illnesses after COVID-19 epidemic in 2021. In addition, the rates of influenza A and B viruses increased dramatically post COVID-19 e.g. in Spain, influenza A exhibited a significant elevation from 4.5 to 10.8% i.e. more than two folds shoot up in influenza A detection rates []. A study, conducted to discover the trends of seven respiratory diseases post COVID-19, concluded that the respiratory illnesses during the COVID-19 pandemic dopped between 2020 and 2021, however, at the end of 2021 there was a rise in the respiratory disorders as compared to 2020. Notable increase in seasonal influenza was highlighted in 2021 from 7.34 to 65.71% in the People’s Republic of China []. Research conducted after 8 months of COVID-19 proved that 67.5% of the tested population manifested at least one respiratory pathogen, with viral infections being more common than bacterial infections. Co-infections were significant in pediatrics and elderly populations which kept on aggravating symptoms []. Post-COVID studies actually proved positive perception of respiratory pathogens rose up to 56.9% in children, the most dominant pathogens diagnosed were Influenza A virus at 52.1%, with Mycoplasma pneumoniae at 21.2% []. However, while quantitative trends have been described, there is a lack of qualitative evidence exploring how frontline physicians in Pakistan perceive the drivers of post-COVID respiratory surges, the role of irrational antibiotic use, and the practical treatment challenges they face. This study fills that gap by capturing experiential insights from clinicians directly managing respiratory infections in a low-middle-income country setting. This study gathers practical knowledge from the clinicians in Pakistan, who have been directly involved in treating patients who had an exposure to SARS-CoV-2 during and after the pandemic on respiratory illnesses in post-COVID-19. Their valuable insights will open details about disease changing patterns, scrutinizing shift in case numbers, altered disease severity and upgrading respiratory disease surveillance systems. It aims to understand the factors that influence the alleviation of respiratory cases and grow the qualitative evidence to permeate the health policies and to prepare Pakistan for any other pandemics in the future as a united nation.