By Dr Kathryn Mainstone, NCWQ Health Adviser
With Australia now having one of the highest rates of COVID rates in the world, it will not be long before GPs see increasing numbers of long COVID patients presenting to them.
At present, it appears likely that 1 in 10 patients will go on to experience long COVID, even after booster vaccination. A recently published prospective study of over 2300 patients in the UK who developed COVID in 2020 and were ventilated, found that as many as 70% still had some symptoms of the disease 12 months following infection.
The condition is defined as “signs and symptoms that develop during or following an infection consistent with COVID-19, continue for more than 12 weeks and are not explained by an alternative diagnosis.” Anyone with COVID-19, however mild, and even those lacking a positive laboratory test in the acute phase of the infection, can go on to develop long COVID.
The most common symptoms of long COVID after 12 weeks are:
- Fatigue occurs in 91%
- Respiratory symptoms – shortness of breath in 81% and persistent cough in 62%
- Musculoskeletal symptoms in 72% including pain and muscle fatigue
- Neurological symptoms – headaches in 55%, neurocognitive disorders such as brain fog, confusion, thought disorder in 46% and dizziness in 52%
- Cardiovascular symptoms – palpitations and pulse irregularity in 42% and postural orthostatic tachycardia syndrome ( POTS ) in 25%
- Gastrointestinal upset in 41% including nausea, bowel changes and indigestion
- General symptoms – persistent fever in 38%, pain including non-specific chest pain in 60%, rashes in 19%, ongoing loss of smell/taste in 54%
- Metabolic disruption – in 20%, including poor diabetic control
- Psychiatric and psychological symptoms- occur in 76% including sleep disorders and mood
Depending on what symptoms the patient has, possible initial investigations would include blood tests to exclude anaemia, kidney and liver function or thyroid abnormalities, an ECG, echo, or tilt table test, a CXR, CT scan, lung function tests, sleep studies, H Pylori breath test, food diary, endoscopy and colonoscopy, CT or MRI. Once all the relevant of these tests have been done and a thorough examination undertaken, a diagnosis of long COVID may be entertained.
Long COVID clinics are starting to be open up in Sydney, Melbourne and Canberra, run by respiratory and rehab physicians who then refer them to the appropriate allied health worker such as a physiotherapist or psychologist.
Most treatment is directed towards non-drug care although patients with migraines and POTS will require medication to try and alleviate their symptomatology. Clinics in the UK and Australia are following this direction.
Dr Bruce Patterson, who is a US based viral pathologist who worked at Stanford University doing HIV research before opening his own IncellDx company in California, now has 20 000 COVID long haulers whom he is now treating with the help of many physicians. He uses Maraviroc ( a drug previously used in the treatment of HIV ) and statins ( drugs routinely used for cholesterol lowering ) for 3 months and is now claiming that he has a cure rate of 80 to 85%. He is writing his data into studies which will be published over time.
Long COVID is a disease which is very real and is going to become more frequent in Australia. We will have to watch this space to see what eventually is found out about what causes it and what treatments may work to alleviate the symptoms.
Dr Kathryn Mainstone
NCWQ Health Advisor, MBBS(Qld), DRCOG, FRACGP
background photo credit: https://www.nature.com/articles/d41586-021-00396-2
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