Queries over long COVID prevalence in Australia

A major review into long COVID has given a ‘conservative’ estimate that at least 10% of people with COVID-19 will develop post-infection sequelae, although queries remain about the figure and its application to Australia.
 
The article, published on Friday in Nature Reviews Microbiology, looks at existing studies, with its authors estimating long COVID prevalence at 10–30% of non-hospitalised COVID-19 cases, 50–70% of hospitalised cases, and 10–12% of vaccinated cases. They conclude that up to half of patients with long COVID could be described as meeting criteria for Chronic Fatigue Syndrome (CFS). 
 
They also warn that ‘a significant proportion of individuals with long COVID may have lifelong disabilities if no action is taken’.
 
Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC-QC), says the situation may differ in Australia.
 
‘Luckily, in Australia, the proportion of people who have lasting symptoms or develop symptoms following acute COVID infection appears to be lower,’ Professor Morgan told newsGP.
 
‘This might be because Australia kept a lid on the spread of COVID during the Alpha and Delta waves.
 
‘Many people were vaccinated prior to Australia letting COVID rip through the community.’
 
The Australian Institute of Health and Welfare (AIHW) published its own review of existing literature last month, suggesting that 5–10% of infections could lead to long COVID. The AIHW authors note that data is limited in Australia, due to the late widespread onset of the virus through the community when compared to elsewhere.
 
‘However, these figures may be an overestimate as all these studies are based on self-reported long COVID and do not include a control group to adjust for the occurrence of symptoms in people who have not had COVID-19,’ the AIHW review states.
 
Associate Professor James Wood, an applied mathematician from the UNSW’s School of Population Health, queried the reliability of the Nature report on the condition’s prevalence.
 
‘The study cannot be relied on as an estimate of long COVID incidence,’ he told newsGP.
 
‘It simply bases its reported values on a couple of relevant studies, without performing any kind of comprehensive review, which would be expected to be a systematic review and meta-analysis by an epidemiologist reviewer.
 
‘The authors have not appropriately reviewed and presented uncertainty around their incidence estimates, or for instance acknowledge that these primarily reflect pre-vaccine, pre-Omicron infections.’
 
The Nature article, which includes three authors who previously had long COVID, also called for more comprehensive long COVID research involving a representative mix of those most at risk.
 
The researchers said medical schools should ensure long COVID and CFS are studied as a matter of course and recommended more public communications campaigns to warn the public of the risks of long COVID.
 
Professor Morgan is the co-Chair of Primary and Chronic Care Expert panel of Australia’s Clinical Evidence Taskforce, and said the Taskforce is keeping ‘a close eye on emerging evidence’ to help prevent and treat post-COVID conditions.
 
‘As patterns of post-COVID conditions emerge, it is likely different treatments will be needed,’ he said.
 
He also warned of a significant risk that patients could be exposed to ‘limited evidence-based treatments’ with little benefit due to long COVID being an emerging area of medicine.
 
‘Some of these therapies might be harmful and most will be expensive,’ he said.
 
It is a concern also raised by the Nature authors, who give the example of therapies used for CFS patients ‘despite the injury that these interventions cause’.
 
Professor Morgan said GPs will have a significant role supporting people through the long COVID recovery.
 
‘GPs will need to identify people who might benefit from specialist services … and will also be vital for assessing new and worsening symptoms being careful not to miss alternative diagnoses,’ he said.
 
According to Professor Morgan, more work is needed to establish the best way to care for patients.
 
‘The relative benefits of long COVID clinics [versus] more distributive ways to deliver care [remain unclear],’ he said.
 
‘Research is needed to answer this question. Investment in services will be needed in both models of care.’
 
Professor Morgan is, however, optimistic that the intense worldwide interest in long COVID can have a positive impact on treatment for conditions with which it is often associated.
 
‘I am very hopeful that some of the challenges of identifying and managing post-viral syndromes and CFS will be helped by the worldwide effort at researching long COVID,’ he said.
 
A long COVID inquiry is currently underway through the Federal Parliament’s Committee on Health, Aged Care and Sport.
 
An issues paper was released last month, and the Committee has stated it will hold more public hearings early this year.
 
The dates of those hearings and of the final report are yet to be confirmed.
 
The RACGP has published clinical resources to help GPs care for patients with post-COVID-19 conditions on its website.

The college’s Victorian Faculty has also established a post-COVID community of practice, open to GPs and nurse practitioners nationwide, in an effort to improve evidence-based care for patients with long COVID.

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