COVID: a never-ending story

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An unknown quantity

According to the inquiry, “the cause or causes of long-COVID are unknown” and the condition has remained as equally difficult to diagnose as define.

“There is apparent and significant overlap between long COVID and some other chronic health conditions, such as chronic fatigue syndrome. However, the nature of any relationship between long COVID and other chronic health conditions remains unclear,” the committee reported.

This was highlighted in March, when Australian researchers from UNSW, Western Sydney University, and the University of Sydney published research in JAMA Network Open

The team clinically examined a cohort aged 12-25, six months after they took a COVID test – 382 who tested positive and 85 who tested negative – and while 48.5% of the group who had been infected had long COVID symptoms, 47.1% of the COVID negative group presented with symptoms too.

The researchers noted that other factors, including psychosocial ones, could be behind the persistent symptoms and disability some young people were experiencing, and suggested that the WHO’s definition of long COVID, which has been adopted by most State healthcare systems, may not be accurate.

The latest round of consultation saw the Inquiry meet with federal bodies and Australians living with long-COVID at a public hearing on 17 February 2023 at Parliament House, followed by another in Melbourne on 20 February 2023.

At Malvern’s Cabrini Hospital, the Burnet Institute’s Director and Chief Executive, Professor Brendan Crabb, unpacked the latest information on long COVID and repeat COVID infections, and the hearing listened to peak bodies, medical researchers, and ventilation experts about the impact on patients, health workers and schools.

Dr Freelander noted at the time that it was also important to see how long COVID and repeat COVID infections were impacting Australia’s primary care capability. While the committee acknowledged that primary care would “play an important and central role in supporting people with long COVID”, in the Issues paper, it also noted that serious challenges still existed in terms of implementation and integration.

Role of GPs

“The committee has heard about different approaches to managing long COVID, including through GPs, specialist long COVID clinics, and via multidisciplinary approaches involving allied health services,” it said.

“There is currently a lack of consistency in relation to the long COVID clinics between how they operate, including the referral processes, how they are funded, the services they provide, and their existence and accessibility across Australia.

“There also appears to be ambiguity as to whether and/or how these should be integrated into the healthcare system. Some submitters have also reported challenges seeking help from GPs, partly due to limited GP knowledge and/or acceptance of long-COVID as a condition, or lack of access to a GP in a timely manner.”

RACGP president Dr Jacqueline Small said that the consequences of repeated infection were still unknown, so doctors’ ability to provide effective treatment was hampered.

“There could be as many as 500,000 Australians living with long-COVID and yet we still do not have all the answers that we need to properly diagnose and treat it,” she said.

“And once diagnosed, the pathway to recovery is still unclear and there is an urgent need for research into long-COVID and its impacts – for some doctors, managing patients with long-COVID can feel like putting together the puzzle pieces without always having the full picture.”

The National COVID-19 Health Management Plan for 2023, released in December, acknowledged that “an important aspect of Australia’s COVID recovery will be management of long-COVID,” with the Government committing an additional $2.9 billion dollars in special measures and research in 2023.

“We need to investigate the Australia-specific, longer-term effects of the COVID pandemic. Research is required into the causes and impacts of long-COVID on individuals and the health system, particularly in the context of high vaccination rates and lower severity variants,” the National Plan stated, in agreement with WA’s Dr Effler.

“Understanding the effect on mental health, chronic disease management and cancer screening as well as delayed elective surgery will also be important.”

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