‘A constellation of symptoms’: Long COVID in focus

Jolyon Attwooll

12/10/2022 4:51:25 PM

The first public hearing into long COVID has taken place as clinicians attempt to work out the scale of the problem, and one GP reports a rising demand for treatment.

Tired woman with long COVID
More work needs to be done to establish the true burden of long COVID in Australia.

Establishing a large population study specifically for Australia is ‘critical’ to appreciating the burden of long COVID and develop the right treatments, a Parliamentary committee has been told.
That was the view expressed by Dr Irani Thevarajan, an infectious diseases physician at the Peter Doherty Institute for Infection and Immunity, who appeared at the first public hearing of the Inquiry into Long COVID and Repeated COVID Infections on Wednesday.
Dr Thevarajan said there is an increasing body of international evidence for the risk factors involved in long COVID, including its greater prevalence among women, those with certain comorbidities, as well as patients from poorer socio-economic backgrounds.
However, its evolution in Australia remains poorly understood, she told members of the Health, Aged Care and Sport committee.
‘What we don’t have a lot of understanding of is the incidence of long COVID on a population level in the Australian context,’ she said.
‘We experienced a larger burden of infection in a vaccinated population, which does make us a distinct population to other cohorts and other studies.’
The committee heard of the significantly different conclusions reached on the prevalence of symptoms that continue beyond 12 weeks, with one NSW cohort reporting a figure of 5%, a UK cohort with symptoms in 14% of patients, and other studies indicating it affects up to 30% of people.
On the same day as the public hearing, the results of an Australian National University study were released, reporting 29% of Australian adults with confirmed or suspected COVID-19 had symptoms more than four weeks after first infection.
Authors of the study, which was based on 3510 survey responses collected from 8–22 August, estimated that 4.7% of adult Australians have had or currently have post-COVID-19 syndrome, involving symptoms that lasted three months or more.
Dr Thevarajan and several other witnesses referenced the complexity and diagnostic challenges of long COVID, with Deakin University Chair of Epidemiology Professor Catherine Bennett describing it as having ‘a constellation of symptoms’.
Dr Shidan Tosif, consultant paediatrician at the Royal Children’s Hospital in Melbourne, who also appeared before the committee, said much remains to be known.
‘A lot of work needs to be done to understand this condition and its impacts,’ he told the committee.
He said one of the challenges in assessing long COVID in children is working out the lingering impact of pandemic restrictions.
‘Sometimes it is quite difficult to delineate what the contribution is – how much is long COVID? How much is the pandemic?’ he said.
Associate Professor Louis Irving, a Royal Melbourne Hospital respiratory physician who has been running a long COVID clinic, told the committee the SARS-CoV-2 virus interacts with the whole person, meaning its impact can be wide-ranging.
‘How much of this is new disease and how much of it is activation of a background tendency I think is unclear,’ he said.
‘There is certainly not a single disease called long COVID, nor is there a test nor a unifying pathophysiology.’
Associate Professor Irving also said he has noticed a susceptibility to the condition among healthcare workers and emphasised the importance of general practice in tackling the issue due to the varying nature of people’s symptoms.
‘[GPs] know the patients,’ he said. ‘We based our model of care on exactly what GPs do in terms of validating symptoms, supporting the patient, keeping in touch with them, then using targeted referrals.
‘Whether a general practitioner has got the time to do it is a question for your committee.’
Geelong GP Dr Bernard Shiu has been running a long COVID clinic in Geelong for the past four months – with another one in Torquay imminent – and agrees with the emphasis on the role of general practice.
‘Things have been more busy than ever,’ he told newsGP. ‘We are seeing a crazy amount of patients now.
‘Managing these patients who have mild-to-moderate but long-term symptoms requires a GP specialist to coordinate care in the community, and, ideally, a GP who is familiar with the patients’ background, medical history, as well as their psychological and social situation.’
Dr Shiu believes the situation is set to get worse and that targeted extra funding is necessary to cope.
For him, this should include a new MBS item number and an extra 5–10 long COVID-specific Enhanced Primary Care sessions to help prevent further deterioration, along with more subsidies for allied health treatments.
He also stresses the need for interventions to happen as early as possible.
‘Timing is very important,’ Dr Shiu said. ‘If they were infected in January, by the time they come and see us, it’s already been nine months.
‘It’s very hard to treat them because there are a lot of psychological impacts.’
While Associate Professor Irving told the committee that most people tend to recover, Dr Thevarajan said the data is yet not conclusive enough to say whether this is a universal trend.
‘It’s early days to be able to give that answer,’ she said.
The inquiry was ordered by Federal  Health and Aged Care Minister Mark Butler last month.
It is being chaired by Dr Mike Freelander, a paediatrician and the current MP for the NSW electorate of Macarthur.
Submissions for the inquiry are open until 18 November. For more details see the inquiry’s website.
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Dr Graham Carl Exelby   13/10/2022 8:29:53 AM

DNA underpinning Long Covid and POTS has been worked out with a molecular biologist I work with managing these areas, but lack of funding is a problem. I'm going live in a webinar next week then all information including proposed management protocols will be available on my website hopefully from next week. Current patient numbers- 400 POTS, around 100 Long Covid . Marked improvement to recovery in 4 to 5 weeks depending on levels of damage but there are no Cochrane Guidelines and there is a steep learning curve in the complex ones, and are very time consuming to work out.

Dr Stewart James Jackson   13/10/2022 10:27:46 AM

I must be missing cases in my busy rural practice. I haven’t diagnosed anyone! Also what evidence based treatments are there anyway?

Dr Peter James Strickland   13/10/2022 11:32:41 AM

What to ascertain are the actual clinical markers to diagnose long Covid, i.e. to differentiate between subjective vs objective markers. The systemic effects seem to be a vasculitis mainly, and thus affecting lung and brain vessels in particular, and probably multiple other organs incl. muscles, kidneys, liver, skin etc etc. One has to go back to other post-viral infection syndromes, eg Guillain Barre, and transverse myelitis (years after measles with the latter) --they were serious and potentially fatal. Any non-fatal syndrome should be managed NOT by medications necessarily, but by having the patients with suspected long Covid placed on an exercise program. I have had long Covid for months with respect. wheezing plus sputum (age 78 years), but have eventually begun to recover after daily 'puffing' aerobic exercise to maintain total body function by beach running of up to 2 km --worth a try for others?