Framework for GPs to manage ‘long COVID’

Press/Media: Expert Comment

Description

A recent GP20 presentation examines how GPs can recognise the signs and manage an emerging clinical concern...

‘Survived COVID – What about after-care?’ discussed evidence from various studies and recommendations for appropriate screening and management of patients who have had the virus.
 
Facilitator Dr Michael Clements, Chair of RACGP Rural, opened the session by acknowledging that many GPs in Australia will care for a patient following a COVID infection at some stage, which makes understanding the effects paramount.
 
‘The long-term sequelae are still now only being defined and described, and can include anything from pulmonary damage post-ventilation to chronic fatigue-like syndromes and cardiac complications,’ he said.
 
Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care, and Co-Chair on the National COVID-19 Clinical Evidence Taskforce, presented the session. He started with the medium- and long-term potential effects of COVID.
 
‘Fatigue and brain fog seem to be a common report from patients,’ Professor Morgan said. ‘These point to the health-related anxiety that new conditions like this generate.
 
‘Post-traumatic stress disorder also seems to be very common in people who’ve survived COVID.’
 
Professor Morgan cited an October 2020 NICE UK guideline scope paper, which released the following definitions:

  • First four weeks – acute COVID
  • 4–12 weeks – ongoing symptomatic COVID that a proportion of people get
  • Beyond 12 weeks – post-COVID syndrome, or ‘long COVID’

Conducting a short, live poll from the audience to track how many GPs have seen at least one patient with prolonged symptoms beyond 12 weeks after acute COVID, Professor Morgan said the number of GPs in this box is increasing.
 
‘We have GPs in the audience who have a practical and lived experience of people living with these conditions.’
 
The UK COVID Symptom Study app recorded daily symptoms logged by COVID patients. The median duration was 11 days from date of the positive swab test.
 
Professor Morgan notes the significance of the findings at four weeks, when 13% still had some symptoms, and at 12 weeks, when 2.3% of people still had symptoms, classified as long COVID.
 
‘The most reported symptoms were fatigue, headache, anosmia, and lower respiratory symptoms,’ he said. ‘The same study was repeated in the US and Sweden, with similar results.
 
‘I think it’s not a bad estimate of how common patient-reported symptoms are.’
 
Professor Morgan pointed out that there were some flaws in these studies, however, including older people being underrepresented and many people opting out, either due to losing interest, or being too unwell to track their symptoms.
 
‘So, really, that 2.3% of people with long COVID is an estimate rather than an exact figure,’ he said.
 
Another study Professor Morgan cited examined patients with symptoms at 20 weeks post-COVID. The average age was 44 and around 18% had ever been admitted to hospital with their acute illness.
 
‘So this was a low-risk cohort who had long COVID symptoms a long time after their illness, with similar symptoms reported as at the 12 week-mark,’ he said.
 
Blood tests and MRIs from the study revealed indicators of organ impairment in close to 70%. About one-third had cardiac impairment, one-third had signs of lung disease, and 12% kidney disease.
 
‘This is a really remarkable finding,’ Professor Morgan said.
 
‘It’s really quite dramatic in people with long COVID. We need to be aware of the potential for significant rates of organ damage. Multi-organ damage was visible in about a quarter of this population, and remember these were low-risk people.’

Subject

COVID-19

Post COVID Syndrome

Long COVID

General Practice

Period26 Nov 2020

Media contributions

1

Media contributions

  • TitleFramework for GPs to manage ‘long COVID’
    Degree of recognitionNational
    Media name/outletNewsGP
    Media typeWeb
    CountryAustralia
    Date26/11/20
    DescriptionA recent GP20 presentation examines how GPs can recognise the signs and manage an emerging clinical concern.
    There is emerging evidence that people experience a range of symptoms for some time after testing positive for COVID-19...

    Reported symptoms include headache, confusion, loss of smell, respiratory issues, shortness of breath, cardiac symptoms, myalgia, bowel symptoms, chronic fatigue, tingling sensation in the limbs, ringing in the ears, and mood swings.

    As part of this year’s GP20 live sessions, experts examined the risks for post-COVID-19 consequences.

    ‘Survived COVID – What about after-care?’ discussed evidence from various studies and recommendations for appropriate screening and management of patients who have had the virus.
    Producer/AuthorMorgan Liotta
    PersonsMark Morgan