Long COVID guidelines updated ahead of expected ‘influx’



The RACGP has updated its guidelines following concerns that people with post-COVID-19 conditions have “gone under the radar.”

Monitoring symptoms and connecting patients with the appropriate support services is part of the role of general practitioners in the management of patients who have had COVID-19.

Experts warn that the long-term effects of COVID-19 need to be watched more closely, with about one in three people showing at least one symptom 3 to 6 months after their initial diagnosis.

With the The World Health Organization officially recognizes “Post-COVID-19” as a clinical condition in October, general practitioners and other frontline health workers are warned of an “influx” of patients with the disease as a result of infection.

“Unfortunately, the post-COVID-19 conditions have gone unnoticed,” said RACGP President Dr Karen Price.

“Just because you are recovering from the initial illness doesn’t mean you came out of the woods.

“As I have been saying for many months, this may not be the end of your COVID-19 story – it might just be the beginning.”

To better support general practitioners, the RACGP has updated its guidelines on the management of adult patients with post-COVID-19 illnesses.

The updated guide contains the latest evidence-based advice for general practitioners and their teams providing care to patients who have previously tested positive for COVID-19. This includes patients with a “suggestive history” of undiagnosed COVID-19 and who have, or are at risk for, post-COVID-19 conditions at any time after the initial acute infection.

“The guide provides key information on assessing patients for a long COVID after their initial illness, provides education on symptom monitoring and management, and connects patients to appropriate multidisciplinary services, paramedical and support services,” Dr Price said.

“It also addresses considerations when providing care to specific groups recovering from COVID-19, including patients who have had severe COVID-19 illness requiring hospitalization, older patients, people with disabilities, people from culturally and linguistically diverse communities, Aborigines and Torres Strait Islanders. patients, children and babies.

According to the guidelines, the incidence of post-COVID-19 sequelae in people who test positive and are treated on an outpatient basis, such as at home, is estimated between 10% and 35%. For people admitted to hospital, this figure is estimated to be around 85%.

The incidence of prolonged illness increases dramatically with age, comorbidities and the initial severity of acute illness.

But for vaccinated people who contract the virus after their second dose, the risk of post-COVID-19 symptoms is roughly halved.

Dr Price said the focus on potential vaccine side effects and easing vaccine hesitation since rollout began earlier this year has somewhat overshadowed awareness of the risks of COVID along the way.

“Throughout 2021, the media paid a lot of attention to the very rare risks of thrombosis with thrombocytopenia syndrome, or TTS, as well as myocarditis and pericarditis after COVID-19 vaccination,” he said. she declared.

“However, many people don’t know that a long-term COVID can seriously disrupt your quality of life, your job or school, your relationships, and your long-term health and well-being. Some people with long-standing COVID find it difficult to climb stairs months after contracting the virus.

The updated guidelines encourage the development of individualized plans for the ongoing management of patients, including the escalation of care for “red flag” symptoms.

Patients with warning symptoms should be “evaluated immediately” as they suggest serious illness.

Symptoms of the red flag include:

  • shortness of breath or severe hypoxia, new onset or worsening
  • syncope
  • unexplained chest pain, palpitations or arrhythmias
  • new delirium or focal neurologic signs or symptoms.

Aligning with the central place of general practitioners in providing continuous and holistic care, the guidelines recommend that general practitioners follow patients six weeks after infection.

“As is always the role of the general practitioner, caring for patients with long COVID is not just about managing the physical symptoms,” said Dr Price.

“We also support patient mental health and well-being, and the guide includes information on the mental health impacts of acute illness, addressing post-COVID-19 infection stigma, and recognition and validation of patient experiences. “

However, while well within the scope of practice of general practitioners, preparing for an influx of patients with post-COVID-19 conditions will add to their already difficult workload, according to Dr Price, who said that continued support from the state, territory and federal government is required.

“General practices are the backbone of vaccine deployment, and we are also busy helping those affected by COVID-19, including patients with COVID-19,” she said.

“Many GPs and their teams naturally feel exhausted, and we’re about to take on an even heavier load with so many pharmacies pulling out of the vaccine rollout.

“So to play an even bigger role in vaccine rollout, including childhood vaccines and booster shots, caring for those with long COVID as well as providing our usual daily care – we really need more government support.

“We are burning the candle on both ends after two extraordinarily difficult years.”

Management of adult patients with post-COVID-19 conditions is available on the RACGP website.

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