‘Large potential burden’: Long COVID warning for GPs

GPs have been warned about the substantial challenges likely to face primary care due to growing numbers of long COVID cases.
 
In the most recent primary care COVID-19 update webinar, current understanding of the condition was explored in depth, including evolving details on its definition, risk factors and the best treatments.
 
Professor Alison Venn, Director of the Menzies Institute for Medical Research at the University of Tasmania, said that while the potential spread of the condition is hard to gauge, the impact is set to be very significant.
 
‘Because we’re still in the relatively early days of people getting COVID and recovering from COVID, exactly what that prevalence and incidence is in Australia is still a little unclear,’ she said.
 
She said current estimates indicate around one in every five people diagnosed with COVID is still experiencing symptoms after a month, while around 5% have symptoms that linger beyond three months.
 
‘The modelling estimates vary, but whichever estimate you use, the potential burden of long COVID in Australia is going to be very large indeed,’ she said.
 
‘We need to be very ready for this and the growing numbers of people who will present in the coming months.
 
‘It is a very significant public health and health services challenge in its own right.’
 
Professor Venn said that understanding how to define long COVID is still evolving, but pinpointed the UK’s National Institute of Health and Care Excellence (NICE) the World Health Organization’s summaries as benchmarks.
 
‘Pretty much anybody who has had COVID is at risk of long COVID,’ she said.
 
Specific risks
While anyone may develop longer lasting symptoms, Professor Venn did highlight emerging evidence that identifies factors more often associated with the condition.
 
As newsGP reported earlier this week, a range of studies now clearly suggest women are significantly more likely to suffer from long COVID, which was among the trends referenced by Professor Venn.
 
‘Generally, we’re seeing from evidence around the world that female gender is a risk factor, [as well as] some pre-existing health conditions, obesity, high viral load at that initial infection,’ Professor Venn said.
 
She also said that other factors appear important, including poor rehabilitation and nutrition during recovery from COVID-19, as well as either not being vaccinated, or only being partially vaccinated.
 
‘Vaccination itself, whilst it will reduce the risk of long COVID, it is not protection from long COVID,’ she said. ‘It’s not complete protection by any means.’
 
When asked if any protection may be conferred among those who take oral antiviral treatments, Professor Venn said the evidence is still emerging.
 
‘There’s quite a lag before the literature is there in sufficient quantity and quality for us to be confident,’ she said.
 
As with COVID-19 itself, the burden of long COVID is also likely to be greatest among people in low socio-economic circumstances.
 
Diagnosis
During the primary care webinar, Dr Samantha Chakraborty, Senior Evidence Officer from the National COVID-19 Clinical Evidence Taskforce, elaborated on the process of diagnosing long COVID.
 
As well as establishing the likelihood of the patient having had COVID-19, Dr Chakraborty said an ‘important component’ of an assessment is working out how far the symptoms impact on general functioning.
 
She also stressed that differential diagnosis should be considered.
 
‘Are the symptoms that a patient is experiencing related to long COVID?’ she said. ‘Or are they potentially exacerbated by another condition or related to another condition?’
 
Dr Chakraborty added that given the understanding of the condition still in its relatively early stages, treatments will need to be tailored to individual patients and their symptoms.
 
‘We don’t have evidence-based recommendations specifically for long COVID, [but] we do know and have experienced what works for other similar conditions,’ she said.
 
‘They are really recommending drawing on that expertise relevant for your patient with long COVID.’
 
She highlighted evidence that is emerging about physical exercise, with resistance and strength training having been shown to relieve symptoms – although advised such an approach ‘might not be appropriate for everybody’.
 
‘Some patients will be able to manage symptoms themselves, but some of them will require additional care,’ she said.
 
No need to wait
One thing that both Dr Chakraborty and Professor Venn stressed is that GPs need not wait until 12 weeks have passed to start treating possible long COVID cases.
 
‘Even though the definitions talk about that 12-week component, we really emphasise that you do not need to wait until 12 weeks to start providing care for patients when they arrive earlier,’ Dr Chakraborty said.
 
‘It’s really important to begin that treatment as much as you can early on and even refer a patient if you think that they would benefit from that.’
 
The Deputy Chief Medical Officer Professor Michael Kidd said that vigilance in general practice is likely to be key as understanding of long COVID evolves, especially as it will be ‘predominantly a condition which is managed in primary care’.
 
‘I think it’s going to be really important as GPs that we keep our clinical antennae very sharpened with people who’ve had COVID just in case they are developing some of these very serious complications which we can see after COVID-19,’ he said.
 
GPs can access the RACGP’s ‘Caring for adult patients with post−COVID-19 conditions’ guidelines on the college website.
 
Patients can also access advice on managing post-COVID-19 symptoms at home.
 
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