Inside the nation’s new lengthy COVID clinics, top health professionals are mastering a new kind of bedside manner.
Key points:
- Long COVID is a post-viral illness that appears within three months of onset, with symptoms lasting at least two months
- The more symptoms you have when you are acutely diagnosed with COVID-19, the higher your risk of developing long-term COVID
- Doctors hope to identify specific risk factors so they can advise patients on how to reduce their risk
On the one hand, there are de facto advisors to patients who want to be sure and at the same time show symptoms shared with many other diseases.
On the other hand, experts like Dr. Anthony Byrne – a senior respiratory doctor who co-leads the Long COVID Clinic at Sydney’s St Vincent’s Hospital – is trying to crack the code for treating one of the world’s most mysterious new diseases.
“Some of the common symptoms of prolonged COVID are fatigue and poor concentration. Another is memory loss. We know they exist [more than] 200 symptoms that have been attributed to long COVID, so it’s complicated,” says Dr Byrne.
“It’s not necessarily that the virus spreads everywhere else in the body, but the effect of the immune system trying to get rid of the virus in the respiratory tract and in the lungs results in this collateral damage.
“One of the things that’s really important for doctors is to have confidence in the way you’re managing the disease. But that’s a problem for a new condition that people don’t have experience with.”
What is prolonged COVID and who is at risk?
Long COVID is slowly becoming better understood.
The most widely used definition – used by the World Health Organization – identifies it as a post-COVID illness that usually occurs within three months of the onset of illness, with symptoms lasting at least two months.
“We know there are risk factors for prolonged COVID. Being female doubles the risk of prolonged COVID. Older age is a risk factor,” says Dr Byrne.
“The more symptoms you have when you are acutely diagnosed with COVID, the higher the risk.
“The magic number is five. So if you have more than five symptoms: fever, runny nose, sore throat, chest pain, shortness of breath, aches and pains — you have more symptoms and a higher risk.”
One in 10 people with acute symptoms of COVID-19 are thought to develop prolonged COVID, and there may be many more, says Professor Jason Kovacic, a senior cardiologist at St Vincent’s Hospital and chief executive of Victor Chang Cardiac Research in Sydney. Institute..
“It’s possible that long-term COVID clinics are seeing all the worst patients and outliers. But I think there’s still a significant burden of people with long-term COVID with significant problems,” says Professor Kovačic.
“It’s not something we can ignore.
The latest easing of restrictions this week means Australians have gained freedoms they haven’t had since the start of 2020.
“Of course, from the point of view of deaths and ICU admissions, it seems that the pandemic is heading in a really great direction,” says Professor Kovačic.
“But we’re left with a really significant burden of people with COVID, and we don’t have any specific treatment for them.”
Researchers are beginning to identify biomarkers
The holy grail for researchers is to identify risk factors before the onset of disease.
“What we’re increasingly understanding are biomarkers. If you could actually take a blood test and say, ‘Look, you’re at risk of long-term disease from COVID, and therefore you should do X, Y, Z to reduce your risk’ — that’s dream,” says Dr. Byrne.
However, existing tests are already producing unexpected results.
“It’s possible we’ll find a condition the patient didn’t know they had. They could have diabetes, asthma or sleep apnea,” says Dr Byrne.
“We’ve certainly helped a lot of people – we’re close to 300. But we’ve got another 300 to go.”
Not all predictors of a long COVID can be sealed by fate.
A recent Harvard University study found that stress is also a major risk factor.
“So, in other words, if you’re unfortunate enough to get COVID at a time when you’re stressed and things are happening and you’re nervous, then that’s a risk factor for developing long-term COVID. ” says Dr. Byrne.
“One of the things we see is a lot of successful people: people who are doing 100 things — and then they get COVID and they completely decompensate. They can’t do anything. It’s worse because of the expectation that they should be able to run a marathon and they’re not.”
Doctors don’t have all the answers yet
As long as the drug is out of reach, doctors are aware of patient expectations. However, research continues, including that of Professor Gail Matthews, who is Head of Infectious Diseases at St Vincent’s and one of the principal investigators of the pioneering ADAPT long-term COVID trial.
“Certainly, at two years, there are still some people who have symptoms,” says Professor Matthews.
“I think the first thing we have to do is admit that we don’t have all the answers.
“We can say that most people have some improvement, especially if they are well supported by their GPs. Physiotherapists are very important. Psychologists are very important.”
“So if patients have access to these kinds of supports, they will certainly see an improvement in their well-being.”
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