Tens of thousands of Australians will have grappled with long Covid by the end of the year and a plan is urgently needed to treat and monitor them, according to an associate professor with Deakin University who has modelled long Covid prevalence.
Prof Martin Hensher, a health economist with expertise in health system organisation, says: “I think we can be very confident that we will see many tens of thousands of people who will have long Covid, and possibly over 10,000 people who will still have long Covid by the end of the year.”
While most people with Covid-19 recover within four weeks, about 5% still experience symptoms three months later, often described as long Covid.
Long Covid is described by the World Health Organization as symptoms that last for at least two months after infection, and which cannot be explained by an alternative diagnosis.
“Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others which generally have an impact on everyday functioning,” the definition states. “Symptoms may be new onset, following initial recovery from an acute Covid-19 episode, or persist from the initial illness. Symptoms may also fluctuate or relapse over time.”
Hensher and his colleagues previously estimated long Covid prevalence by examining the 2021 Delta outbreaks in Victoria and New South Wales in which nearly 140,000 people had been infected by the end of October. They are now updating that modelling to include the much higher number of cases due to the spread of Omicron.
“While we have not finished that yet, we can say fairly confidently with the sheer numbers of cases that we’ve had in this outbreak, and the fact that the true number of cases is clearly going to be significantly more than that, we will have seen well over 2m Covid cases as a very conservative estimate by the end of this outbreak,” he says. “This will correspond to more than 10,000 people with long Covid after one year.”
Hensher says Australia urgently needed to roll out a regular national survey to ask people about their experience with Covid, including their ongoing symptoms. “We are flying blind about the actual scale of long Covid in this country.
“All we have is models like ours, but we need more primary data to help inform our models. I hope we see fewer long Covid cases than I am suggesting, but the way our health system operates means it is very hit and miss as to whether we are properly capturing and measuring those with long Covid.”
Hensher says the federal government should fund a national post-Covid centre of excellence bringing together expertise not just for long Covid, but other longer-term health impacts, such as damage the disease causes to the heart and lungs.
“That centre should revise treatment guidelines according to best practice,” Hensher says. “In addition each state and territory needs to set up a care coordination centre bringing together resources of public and private health systems including physiotherapists, pain experts and others who can give people with ongoing effects the treatments they need, because their GP may not have the expertise and time.”
The director of Baker Heart and Diabetes Institute, Prof Tom Marwick, is a cardiologist leading a study examining the persistent cardiovascular effects of Covid-19, called the PERCEIVE study.
Marwick says at the start of the pandemic there were concerning reports about the impact of Covid on the heart. He and his colleagues examined the frequency of cardiac complications from Covid in Australia, whether certain medications could protect the heart muscle and whether exercise could help people regain fitness after infection.
“Our study has been affected by lockdowns, when it was difficult to get patients to come in for investigations,” Marwick says. “But we did manage to examine the first 100 or so patients, and interestingly, the number of people who had objectively reduced functional heart capacity was very low – less than 5%.”
Marwick suspects Covid did not cause the handful of heart-related abnormalities that were detected in people weeks after an infection, but simply brought them to attention.
“People who have chronic disease from high blood pressure, diabetes and [being] overweight are prone to having cardiac disturbances, but these disturbances can go unrecognised for quite a long time until somebody becomes symptomatic,” Marwick says. “Covid enables the tip of the iceberg to be seen.”
Marwick says it is clear there are many drivers of lasting Covid symptoms and agrees that a range of experts needs to study how the immune system and different organs are involved.
“We also need to reduce the stigma of having Covid in order to conduct these studies,” he says. “We have a facility in western Melbourne, which is an area with a lot of cardiovascular diseases and a lot of Covid. We went to community groups, we went to mosques, and tried to engage people for our study but it was more difficult than I expected, and many people mentioned stigma and privacy as concerns. They didn’t want their neighbours to find out they had Covid and judge them.”
Dr Chansavath Phetsouphanh is a senior research associate at the Kirby Institute and the co-lead author on a recently published study of unvaccinated people with long Covid. The study found even those whose initial Covid infections were mild or moderate had a sustained inflammatory response at least eight months later.
It indicates that even if Omicron proves to be milder, it does not necessarily follow that it will produce fewer cases of long Covid. While it is hoped vaccination will offer some protection against lasting symptoms, vaccinated people with mild disease experience long Covid too, Phetsouphanh says.
“A few studies from the UK suggest vaccinations halve the chance of long Covid but with the prevalence of Covid with the current wave, long Covid is a concern,” he says.
“Our study found a majority of long Covid patients had mild Covid, yet some were still experiencing symptoms 18 months after infection.”
He says he is concerned that with such high cases numbers, those with Covid are not being followed as closely, and GPs may not be aware of many infections, or of symptoms in those who are infected.
“We really need to be clinically recording these cases,” he says.
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