GPs to face ongoing COVID sequelae for ‘years’

In just two years, the pandemic has completely changed primary care.
 
With hospitals buckling under pressure, GPs continue to manage the majority of acute mild-to-moderate COVID-19 cases in addition to their usual, and often complex, general practice workload, despite being under-resourced.
 
Post infection, there is also emerging evidence of the lingering effects of COVID, with older adults appearing to be at greater risk of long COVID, signifying that the pandemic’s true burden will not be felt for years to come.
 
Now new research, published in the British Medical Journal appears to confirm that respite, for both GPs and older patients with COVID, is still a long way off.
 
The US-based observational research found that during the study period, almost a third of older adults with COVID-19 developed at least one new condition after their initial infection that required further medical attention.
 
This number was 11% higher compared to those who did not have COVID-19.
 
This risk of developing a range of conditions increased with age, with adults aged 65 and over at greater risk of respiratory failure, hypertension, cardiac rhythm disorders, memory difficulties, kidney injury, hypercoagulability and mental health diagnoses.
 
When compared to a separate cohort with non-COVID viral lower respiratory tract infection, only respiratory failure, memory difficulties, and fatigue showed increased risk differences.
 
The findings add to a growing body of evidence that COVID-19 can lead to multi-organ and multi-system sequelae requiring longer-term community care.
 
Academic GP Professor Paul Glasziou told newsGP that while the findings are concerning, they need to be considered in context.
 
‘One important thing to note is that there was a much higher rate [of sequelae] in hospitalised and ICU cases, though [there was] some increased risk in community cases,’ he said.
 
‘Given Australia’s much lower rate of hospitalisation than the US, and also [the] UK, we are likely to see fewer ongoing sequelae. And since most of our case load has come after vaccination, we have also had milder disease.
 
‘But it will still be an important problem here for several years and, assuming endemic COVID-19, will never fully go away.’
 
A key take home message from the study authors is that understanding the risks could enhance the diagnosis and management of individuals with sequelae after acute COVID-19 infection.
 
‘Our results can help providers and other key stakeholders anticipate the scale of future health complications and improve planning for the use of healthcare resources,’ they write.
 
With Australia’s health system already stretched, aged care GP Dr Sachin Patel told newsGP the rise in chronic disease burden will inevitably see the demand for services increase.
 
‘Resources are going to need to increase, so the questions [are] when, how and where are those resources going to be provided?’ he said.
 
In November 2020, Federal Health Minister Greg Hunt announced a plan for an additional $132.2 million to be invested into the COVID response for aged care.
 
However, more than a year later the aged care sector is still struggling to cope with ongoing outbreaks, forcing the military to be deployed in some areas to help with staff shortages.
 
Dr Patel believes that while financial resources are a big part of the ongoing response, dealing with the fallout from COVID is multifactorial.
 
‘In terms of recruitment and humans to deliver care [to older and elderly Australians], there’s actually been a lack of trainees coming through and this is well documented,’ he said.
 
‘So that’s something that’s going to need to be addressed from the care side, in addition to streamlined expert health services that are tailored to aged care.’
 
Log in below to join the conversation.

aged care chronic disease COVID-19 elderly long COVID pandemic