Australia’s Omicron wave earlier this year was much larger than we thought, a recent investigation has confirmed.
We have also heard that Health Minister Mark Butler acknowledged that Australia can expect a “very big wave” of people with long COVID over the next few years.
Doctors and researchers have been warning about the long-term COVID threat, as restrictions are reduced and the number of cases increases.
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Therefore, we need to take an urgent look at how we manage and treat it.
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More than 7 million Australians have had COVID; most have recovered from acute illness. But some have persistent symptoms for months or more.
The World Health Organization long defines COVID as symptoms that occur three months after infection, lasting at least two months, that cannot be attributed to other diagnoses.
The most common symptoms include: fatigue, especially after activity, difficulty breathing, fog or difficulty concentrating, sleep problems, chronic cough, muscle aches and pains, loss of smell or taste, depression and anxiety.
But there is no test that diagnoses long-term COVID. Therefore, this multitude of complex symptoms makes it a difficult condition to locate, study, and treat.
Common symptoms of long COVID include fatigue, difficulty breathing, brain fog or difficulty concentrating, sleep problems, chronic cough, muscle aches and pains, loss of smell or taste, depression, and anxiety. Credit: Halfpoint Images / Getty Images
Who is more likely to have long COVID?
The risk of long-term COVID increases in people who have had more severe COVID, women, and people with a chronic illness, such as diabetes, or chronic lung or heart disease.
An American study analyzed 4.5 million people cared for in the community or hospital and followed them to see if they developed long-term COVID. At six months, 7% had symptoms.
Of concern, this study also suggests that vaccination only reduced the risk of long-term COVID-19 by 15 percent.
There were symptoms like brain fog and fatigue and vaccination seemed only partially protective against them.
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How do we treat long COVID?
The recommendations of Australia’s national COVID-19 clinical evidence working group to treat long-term COVID were updated in May.
But these take the UK recommendations very seriously and the evidence supporting these recommendations is, at best, weak.
In the UK, “long COVID clinics” have adopted a holistic model of medicine-led care.
It involves general practitioners, specialists and related health workers, such as physiotherapists, occupational therapists and exercise physiologists. Similar clinics have been established in Australia.
However, the advice for these clinics is based on consensus and the experience of similar conditions, such as chronic fatigue, and what we know about how people recover after leaving intensive care, rather than results of solid studies focused on long COVID.
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The UK’s advice for treating COVID in the long term is to look for and manage COVID complications that can affect the lungs, cause heart disease and manage other existing conditions such as obesity and diabetes.
It also recommends assessing and managing anxiety and depression, which is not surprisingly common in people with long-term COVID.
UK guidelines advise supporting people to manage their own symptoms, including the assistance of their GP, and then refer them to specialist services when needed.
If people had COVID pneumonia, especially those who went to intensive care, still have respiratory problems and are weak, there is some limited evidence that lung rehabilitation helps.
It is an outpatient care with physiotherapists and specialist nurses, which includes breathing exercises, education and support.
Two small trials have shown lung rehabilitation, improved breathing, exercise capacity, fatigue, and quality of life. So now it is recommended.
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However, respiratory problems are only one component of long-term COVID.
For people with long COVID and severe fatigue or pain after exertion, a standard exercise program can make things worse.
Here, the recommendation is an initial rest period and then an incremental increase in activity, often for many months. However, the optimal approach is not defined.
Neurological symptoms of poor concentration or brain fog, sleep disturbances, and taste disturbances are common, but there are no consensus or proven therapies yet.
Some people with more severe neurological symptoms and fatigue develop an incapacitating condition known as postural orthostatic tachycardia syndrome or POTS.
When people get up, their heart beats and their blood pressure drops. This causes severe fatigue, headaches and difficulty concentrating.
This condition can be treated by modifying someone’s diet and taking medication.
We know this because we see POTS after other infectious diseases or other serious and prolonged illnesses that lead to hospitalization. However, we need long-term clinical trials for these COVID therapies to see which treatments work and for whom.
Cases of COVID-19 are on the rise across Australia, especially for the latest Omicron subvariant. Credit: AAP
What is in the future
There are many aspects of the long COVID that health authorities, doctors, and researchers still need to pinpoint.
We still don’t know what causes the long COVID-19, we don’t have a universally accepted definition, solid data on how many Australians are or will be affected, or a concrete plan on how to handle the thousands of cases we have. can wait. Therefore, evidence-based treatments for long-term COVID are only part of the picture.
But the problem we have now is here. We can’t wait for the standard tests to arrive before we start treating people.
Meanwhile, people need reliable information about the symptoms of long COVID, what to expect and where to look for help. And health professionals need to take their symptoms seriously.
Healthcare professionals also need training on how to manage people with long-term COVID, focusing on appropriate research and treatment that benefits people to the fullest.
This does not mean only long specialized COVID clinics in the capitals, although we probably need them to help people with the most debilitating problems.
Our response will also need to leverage the help of a number of existing healthcare providers and a coordinated response to address symptoms ranging from mild to severely debilitating. People need support for rehabilitation, mental health, and a return to work or study.
If we don’t start planning and preparing now, the problem will only get worse.
Peter Wark is a Joint Professor in the Faculty of Medicine and Public Health at the University of Newcastle.