Increase in GP visits following mild COVID

Research into ‘long COVID’ has mainly focused on people who have been hospitalised with the virus, with little known about the long-term risks for those with mild disease. That is until now.
 
In a new study, published in The Lancet Infectious Diseases, researchers examined the health outcomes of 8983 people who tested positive to COVID-19 in Denmark but did not require hospitalisation, compared to 80,894 people who had not caught the virus.
 
They found that although the risk of delayed acute complications for COVID-19 patients is low, persistent symptoms in the six months post-infection saw them visit their GP around 1.2 times (20%) more often than those that tested negative.
 
The same cohort also visited outpatient clinics 1.1 times (10%) more often than those who were never infected. There was no difference in emergency department visits or hospitalisation.
 
‘[This] could indicate persistent symptoms that do not lead to specific drug treatment or hospital admission,’ the authors wrote.
 
Patients diagnosed with mild COVID-19 are also at a slightly increased risk of needing new medications or developing new health problems during the six-month period.
 
The study found 1.2% were at increased risk of a first diagnosis of breathing difficulties, compared to 0.7% for those without COVID-19.
 
The blood clot risk also doubled in the COVID-19 group from one in 1000, to two in 1000.
 
Despite emerging research on a range of symptoms associated with post-infection of hospitalised COVID-19 patients, such as respiratory and cardiac issues, stroke, chronic fatigue, and neuro-cognitive issues, none of these were identified among individuals in the Danish study who did not require hospitalisation.

Study co-author Professor Anton Pottegård from the University of Southern Denmark said the study finds a ‘very low’ risk of severe delayed effects from COVID-19 in people who didn’t require hospitalisation for the infection.
 
‘However, our research provided evidence for some long-term effects that did not require hospitalisation or the use of new medicines, which we found reflected in higher use of primary healthcare services after infection,’ he said.
 
‘This highlights the need to ensure clinicians have the resources and support to manage any potential long-term conditions.’
 
While it is now recognised that longer-term symptoms of COVID-19 can occur after six months, the authors note there are limitations to the study that may underestimate the prevalence.

‘Our analysis only captures specific symptoms leading to contact with hospitals, so it is likely that the study underestimates symptoms which do not require this level of care, like fatigue and breathing difficulties which are not severe enough for hospitalisation or require initiation of new medical treatment,’ co-author Stine Hasling Mogensen from the Danish Medicines Agency said.
 
‘Previous research has found a high level of these symptoms reported by patients, so the differences between patient reports and healthcare encounters could be important to investigate in regards to potential unmet healthcare needs and the need for new medications for treatment.’ 
 
The study authors are calling for larger population-based studies of symptoms and healthcare visits for people following SARS-CoV-2 infection.
 
A separate Chinese study published in The Lancet in January, examined the long-term health consequences of patients with COVID-19 who had been hospitalised.
 
At six months after symptom onset, most participants reported at least one symptom, the most common being fatigue or muscle weakness (63%), sleep difficulties (26%), and anxiety or depression (23%).
 
The authors of the Danish study concluded that the risk is low for delayed acute complications, new onset of chronic disease, and hospital encounters for persisting symptoms two weeks to six months after infection that do not require hospital admission.
 
‘However, among those not admitted to hospital, SARS-CoV-2-positive individuals are at a slightly increased risk of venous thromboembolism, receiving a hospital diagnosis of dyspnoea, initiating bronchodilator therapy, and initiating triptans compared with individuals who tested negative for SARS-CoV-2,’ the authors wrote.
 
Epidemiologist Associate Professor Hassan Vally recently told newsGP that long COVID is evolving as a concerning health issue, and anyone who has had the virus is potentially at risk.
 
‘It certainly seems to be more common than we might have originally thought,’ he said. 
 
‘It does seem to be happening at a reasonable frequency.’
 
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