Long covid patients crying out for local data

Political will and proper resourcing of GP research are needed to give clinicians the best chance of providing quality care.

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The lack of large Australian studies into the long-term sequelae of long covid means GPs need to continue to be cautious about changing clinical practice for patients they suspect have the condition, says an RACGP spokesperson.

Professor Mark Morgan, chair of the college’s expert committee for quality care, and co-chair of the National Clinical Evidence Taskforce primary and chronic care panel, told TMR there was a burning need for “our own data”.

Professor Morgan was commenting on new research out of the US which quantified one-year outcomes for more than 13,000 people with “post-covid-19 condition” or long covid, compared to around 27,000 individuals with no evidence of covid. 

Those with long covid needed more healthcare for a range of issues compared to people without it. They had more than double the risk of cardiac arrhythmias, almost four times the risk of pulmonary embolism, double the risk of ischaemic stroke, as well as almost twice the risk of coronary artery disease, heart failure, chronic obstructive pulmonary disease and asthma. 

The long covid cohort also experienced increased mortality, as 2.8% of individuals with long covid vs 1.2% of controls died, “implying an excess death rate of 16.4 per 1000 individuals”.

“In Australia most people would have been exposed to the Omicron variant in a highly vaccinated population,” Professor Morgan told TMR.

“That means we have quite different statistics about long covid than other countries. We need similar studies here so we can get our own information.”

Professor Morgan said the Australian data to inform clinical management of patients with long covid does exist, but required “political will, public messaging, and resourcing of GP academics” to optimise its use.

“We need to take GP data and link it to hospital and emergency data,” he said. “We can do that, but at the moment the data is being pulled but is not being effectively linked.”

Until that local data is compiled and interpreted, GPs “should not be changing our normal clinical process”, he said.

“GPs need to have a very open mind and perhaps lift our suspicions a notch around symptoms such as breathlessness and fatigue, and do the investigations that make sense.

“We don’t want to subject patients to a battery of unnecessary tests.”

While the US research found a “statistically significant increased risk for a range of cardiovascular conditions as well as mortality”, those risks were amplified for those who experienced a more severe acute episode of covid, requiring hospitalisation.

“It is essential to note that most individuals (72.5%) in the cohort did not experience hospitalisation during the acute phase,” the authors wrote.

JAMA Health Forum 2023, online 3 March