Sick and tired of COVID

Doctors and public health experts have welcomed new research funding into long COVID, which is thought to persist in up to one in 20 people infected with the coronavirus.

The Commonwealth Government’s pledge of $50 million for research follows the handing down this week of the final report from the House of Representative’s Standing Committee on Health, Aged Care and Sport’s inquiry into long COVID and repeated COVID infections.

A national long COVID and COVID-19 database is among the key recommendations, as well as calls for more support for GPs.

Committee chair Dr Mike Freelander said it was clear that the emergence of long COVID had created challenges for patients and health care professionals alike.

The committee was particularly concerned to hear that long COVID is associated with poor mental health. It heard that many people with long COVID felt isolated, disbelieved, anxious or depressed.

“People with long COVID suffer from a lack of information and treatment options,” Dr Freelander said.

“Health care professionals, who worked tirelessly over the acute phase of the pandemic, are now in a difficult situation trying to support patients with this new and poorly understood condition.”

The committee made nine unanimous recommendations aimed at strengthening the Australian Government’s management of long COVID, including:

  • A definition of long COVID for use in Australia
  • Evidence-based living guidelines for long COVID, co-designed with patients with lived experience
  • A nationally-coordinated research program for long COVID and COVID-19
  • A COVID-19 vaccination communication strategy
  • Access to antiviral treatment
  • Support for primary health care providers.

Over the course of the inquiry, the committee held four public hearings and received almost 600 submissions from individuals, organisations and government bodies.

Role of GPs

The Royal Australian College of General Practitioners welcomed the recognition of the role of GPs in managing long COVID but president Dr Nicole Higgins said patients needed urgent support.

“GPs across Australia are caring for people with long COVID – this is a debilitating illness, and much more needs to be done to understand it and support those experiencing it,” she said.

“I’m pleased the report recognises the essential role of GPs in diagnosing and caring for people with long COVID. GPs are expert in managing chronic disease and are best placed to provide ongoing care for those experiencing long COVID and coordinating the patient’s care with other specialists and health professionals.

“The report also recognises the challenges GPs face because this is a new disease and we don’t even have an agreed definition of long COVID for use in Australia, let alone clinical guidelines to help GPs diagnose and care for people with long COVID. The development of these key clinical tools will make a big different for people with long COVID.”

Dr Higgins said it was disappointing the report failed to recommend immediate measures for people suffering distress and disability from long COVID.

“Patients’ Medicare rebates don’t adequately support people with long COVID. It’s a complex chronic condition and it requires more of a GP’s time, but the current patient rebates penalise GPs for spending longer with patients,” she said.

“The RACGP is continuing to call on the Federal Government to increase patient rebates for longer consultations to ensure people with complex conditions, including long COVID, can get the care they need.”

Professor Jaya Dantas from Curtin University’s the Curtin School of Population Health also welcomed the funding for research, in light of several studies across Australia highlighting that 4-5% of the population impacted by COVID suffered long-term effects.

“We need to keep up the surveillance, support people who have adverse reactions through long COVID clinics and undertake research to collect data and evidence to help the departments of health have a long-term plan to mitigate the impacts of long COVID,” she said.

Need to drill down on COVID

Professor Jeremy Nicholson, director of the Murdoch University-led Australian National Phenome Centre, said the main medical focus was on major persistent symptoms, definitions and sub-classifications of COVID.

“The report states that there are 200 diverse and non-specific symptoms for long COVID – this clearly creates a challenge for the classification, diagnosis and stratification of the disease as well as its treatment,” he said.

“If there is a weakness in the report, it is in relation to the emphasis on symptomatic manifestations of long COVID, rather than creating a pathway to the objective molecular classification of the disease using validated digital metrics which are now available.”

Professor Nicholson said many long COVID complications were due to the triggering of multiple inflammatory conditions or the acceleration of pre-existing conditions, including heart disease, diabetes and neurological disorders, for each of which there are numerous existing treatments.

“There needs to be more emphasis on advancing chemical diagnostics for long COVID (blood and urine tests) for assessing individual patient problems and then applying those at population scale.

“There is also a real issue about the increased disease risks for multiple conditions that have been accelerated by COVID-19 but are not necessarily symptomatic. These include new onset atherosclerosis, diabetes and neurological problems that are now well-established as long-term effects of SARS CoV-2 infections and are affecting millions of people around the world.”

Prof Nicholson said the pledge of $50 million to support long COVID research was welcome but fell short of the research needs across such a broad swathe of medicine. It was also a small sum in relation to the health care burden imposed by COVID and long COVID.