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‘Major potential burden’: Long COVID warning for GPs

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The number of patients with persistent symptoms will almost certainly increase, with one expert calling it a “very big” public health challenge.

Woman with long COVID

A number of studies now suggest that women are significantly more likely to have a long COVID.


GPs have been warned of the significant challenges primary care is likely to face as a result of the growing number of long-lasting COVID cases.


The latest COVID-19 Primary Care Update webinar explored in depth the current understanding of the condition, including evolving details on its definition, risk factors and 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 disease is difficult to gauge, the impact is likely to be very significant.


“As we are still in the relatively early days of people getting and recovering from COVID, the exact prevalence and incidence in Australia is still somewhat unclear,” she said.


She said current estimates show that about one in five people diagnosed with COVID still have symptoms after a month, while about 5% have symptoms lasting longer than three months.


“Model estimates vary, but whichever estimate you use, the potential long-COVID burden in Australia will be very large indeed,” she said.


“We have to be very well prepared for this and for the growing number of people who will be presenting in the coming months.


“It’s a very significant challenge for public health and health services themselves.”


Professor Venn said understanding of how to define long COVID is still evolving, but pointed to summaries from the UK’s National Institute of Health and Care Excellence (NICE) as benchmarks.


“Pretty much everyone who has had COVID is exposed to long COVID,” she said.



Specific Risks
While anyone can develop longer-lasting symptoms, Professor Venn highlighted emerging evidence identifying factors more commonly associated with the condition.


As NewsGP Reported earlier this week, a number of studies are now clearly suggesting that women are significantly more likely to have long COVID, which was one of the trends Professor Venn pointed to.


“In general, we see from evidence around the world that female gender is a risk factor, [as well as] some pre-existing health conditions, obesity, high viral load in this initial infection,” Professor Venn said.


She also said other factors appear to be important, including poor rehabilitation and nutrition during recovery from COVID-19, and either no vaccination or only partial vaccination.


“Vaccination itself, while reducing the risk of long COVID, does not protect against long COVID,” she said. “It’s by no means total protection.”


Asked whether protection could be afforded to those taking oral antiviral treatments, Professor Venn said the evidence is still emerging.


“It’s taking quite a long time to get the literature 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 poor socioeconomic backgrounds.



diagnosis
During the primary care webinar, Dr. Samantha Chakraborty, Senior Evidence Officer of the National COVID-19 Clinical Evidence Taskforce, the process of diagnosing long-lived COVID.


In addition to determining the likelihood that the patient had COVID-19, Dr. Chakraborty, an “important part” of an assessment is finding out how the symptoms affect overall functioning.


She also emphasized that a differential diagnosis should be considered.


“Are the symptoms a patient has related to a long COVID?” she said. “Or are they possibly aggravated by or related to another condition?”


dr Chakraborty added that understanding the condition, which is still in its relatively early stages, means treatments need to be tailored to individual patients and their symptoms.


“We have no evidence-based recommendations specifically for long COVID, [but] We know and have learned what works in other similar conditions,” she said.


“They really recommend tapping into this expertise that is relevant to your patient with long COVID.”


She highlighted evidence emerging regarding physical activity, with resistance and strength training being shown to reduce symptoms — although such an approach “may not be right for everyone.”


“Some patients will be able to manage the symptoms on their own, but some of them will need additional care,” she said.



No need to wait
One thing that both Dr. Both Chakraborty and Professor Venn stressed is that GPs do not have to wait until 12 weeks have passed to start treating potential long COVID cases.


“Although the definitions speak of this 12-week component, what we really emphasize is that you don’t have to wait up to 12 weeks to start caring for patients if they arrive earlier,” said Dr. Chakraborty.


“It’s really important to start this treatment as early as possible and even refer a patient if you think they would benefit.”


Deputy Chief Medical Officer, Professor Michael Kidd, said vigilance in general practice will likely be crucial as understanding of long COVID develops, especially as it “will be predominantly a primary care disease”.


“I think it will be very important as GPs that we keep our clinical antennae very sharp with people who have had COVID just in case they develop some of these very serious complications that we can see post COVID-19 “, he said .



General practitioners can access the RACGP guidelines, Care of Adult Patients with Post-COVID-19 Disorders college website.



Patients can also seek advice Coping with post-COVID-19 symptoms at home.



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