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Long COVID guidelines updated ahead of expected ‘influx’


Morgan Liotta


17/12/2021 3:45:39 PM

The RACGP has updated its guidelines following concerns that people with post-COVID-19 conditions have ‘flown under the radar’.

Doctor in video consult
Follow up of symptoms and linking patients to appropriate support services are part of GPs’ role in managing patients who have had COVID-19.

Experts are warning that the long-term effects of having COVID-19 need to be more closely monitored, with an estimated one in three people experiencing at least one symptom 3–6 months after their initial diagnosis.
 
With the World Health Organization officially recognising ‘post-COVID-19’ as a clinical condition in October, GPs and other frontline healthcare workers are being warned of an ‘influx’ of patients with the condition following infection.
 
‘Unfortunately, post-COVID-19 conditions have flown under the radar,’ RACGP President Dr Karen Price said.
 
‘Just because you recover from the initial illness, that does not mean you are out of the woods.
 
‘As I have been saying for many months, it might not be the end of your COVID-19 story – it could just be the beginning.’
 
To better support GPs, the RACGP has updated its guidelines on caring for adult patients with post-COVID-19 conditions.
 
The updated guide contains the latest evidence-based advice for GPs and their teams who are providing care for patients who have previously tested positive to COVID-19. This includes patients with ‘a history suggestive’ of undiagnosed COVID-19 and who have, or are at risk of, post-COVID-19 conditions at any point after the initial acute infection.
 
‘The guide provides key information on assessing patients for long COVID after their initial illness, providing education on symptom monitoring and management and linking patients to appropriate multidisciplinary services, allied health and support services,’ Dr Price said.
 
‘It also addresses considerations when providing care for specific groups recovering from COVID-19, including patients who have had severe COVID-19 illness requiring hospitalisation, older patients, people with disability, people from culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander patients, children and babies.’ 
 
According to the guidelines, the incidence of post-COVID-19 sequelae in those who have tested positive and been managed in an outpatient setting, such as the home, is estimated to be between 10% and 35%. For those admitted to hospital, this is estimated to be around 85%.
 
The incidence of prolonged illness significantly increases with age, comorbidities and initial severity of the acute illness.
 
But for vaccinated people who contract the virus after their second dose, the risk of post-COVID-19 symptoms is approximately halved.
 
Dr Price said the focus on potential vaccine side effects and easing vaccine hesitancy since the rollout began earlier this year has somewhat trumped awareness of the risks of long COVID.
 
‘Throughout 2021, there was so much media attention paid to the very rare risks of thrombosis with thrombocytopenia syndrome, or TTS, as well as myocarditis and pericarditis following COVID-19 vaccination,’ she said.
 
‘However, many people are not aware that long COVID can severely disrupt your quality of life, your job or study, your relationships and your long-term health and wellbeing. Some people with long COVID are struggling to walk up a flight of stairs months after having the virus.’
 
The updated guidelines encourage the development of individualised plans for patients’ ongoing management, including escalating care for ‘red flag’ symptoms.
 
Patients with red flag symptoms should be ‘immediately assessed’ as they are suggestive of severe disease.
 
Red flag symptoms include:
 

  • severe, new onset, or worsening breathlessness or hypoxia
  • syncope
  • unexplained chest pain, palpitations or arrhythmias
  • new delirium, or focal neurological signs or symptoms.
 
Aligning with GPs’ central place in providing ongoing, holistic care, the guidelines recommend GPs follow up with patients at the six-week mark following infection.
 
‘As is always the role of the GP, caring for patients with long COVID is not just about managing the physical symptoms,’ Dr Price said.
 
‘We also support the mental health and wellbeing of patients, and the guide includes information on the mental health impacts of the acute illness, addressing stigmatisation post-COVID-19 infection, and acknowledging and validating the patient’s experiences.’
 
However, while well within GPs’ scope of practice, preparing for an influx of patients with post-COVID-19 conditions will add to their already challenging workload, according to Dr Price, who said ongoing state, territory and Federal Government support is needed.
 
‘General practices are the backbone of the vaccine rollout, and we are also busy helping those affected by COVID-19, including patients with long COVID,’ she said.
 
‘Many GPs and their teams are feeling understandably exhausted, and we are set to shoulder an even heavier load with so many pharmacies pulling out of the vaccine rollout. 
 
‘So, to take on an even more significant role in the vaccine rollout, including vaccines for children and booster jabs, care for those with long COVID as well as provide our usual day-to-day care – we really need more support from government.
 
‘We are burning the candle at both ends after an extraordinarily difficult two years.’
 
Caring for adult patients with post−COVID-19 conditions is available on the RACGP website.
 
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