Experts urge careful investigation to confirm post-COVID syndrome

Careful investigation is key to differentiate potential cases of post-COVID syndrome from other illnesses that can cause overlapping symptoms, experts told the 2021 RCGP conference - urging GPs also to consider the wider impact of the pandemic on patients.

Dr Steve Holmes
Dr Steve Holmes

Speaking at the RCGP annual conference 2021, Somerset GP and education lead for the Primary Care Respiratory Society Dr Steve Holmes said healthcare professionals were learning more all the time about the medium- and long-term impact of COVID-19.

He urged GPs to look after their colleagues, warning that historically pandemics have pushed significant numbers of doctors to retire early - as polling has suggested could happen in the current crisis.

Dr Holmes also highlighted the impact of COVID-19 on people who have not had the disease itself - for those who have lost their jobs, their income and family or friends.

Post-COVID syndrome

'In the UK at the moment there are more people than ever before going to food banks,' he told the conference. 'That sort of impact on the social lives of many of the population results in increased healthcare attendance.

'In Somerset last month we saw virtually half the population face-to-face - there is an incredible amount of work going on, and I know that is going on round the country.'

The social impact of COVID-19 - from the rise in domestic abuse, increased waiting times and delays in care as well as the 'predictable legacy of shielding' in terms of a rise in isolation and loneliness, would be 'with us for a while', Dr Holmes warned. 'It isn's only about having the disease,' he added.

For patients who had shielded for a long time, he said doctors must be alert to risks linked to 'deconditioning' after prolonged periods of isolation - with can increase the risk of falls, poor mental health, osteoporosis, infection, and worse cardiovascular and respiratory outcomes.

Protracted recovery

He said all GPs would likely have come across patients experiencing protracted recovery from COVID-19. But he said it was often patients who had not experienced the most severe disease initially and had developed longer-term symptoms that 'probably give us a lot of stress in primary care, where you are being challenged to think: is there anything else underlying this.'

Dr Holmes said post-COVID syndrome could be considered in patients who had 'signs and symptoms after 12 weeks and don't have an alternative diagnosis'.

But he warned: 'It's not always straightforward. We still need to keep our brains open to anaemia, cancer, COPD, myocarditis, polymyalgia, thyroid dysfunction, diabetes.' He warned these could all present symptoms that 'overlap with post COVID syndrome'.

He cited the case of a patient who had experienced fatigue for a number of months after a COVID-19 infection, which the patient and several clinicians had attributed to post-COVID syndrome. However, Dr Holmes said after investigation it turned out to be polymyalgia, which was treated relatively quickly.

Prevalence

Early estimates that as many as one in 10 people infected with COVID-19 may experience long-term symptoms are 'coming down', Dr Holmes said - and he urged doctors to follow advice to 'investigate selectively after careful history and appropriate examination'

He told the conference there was no 'one-size-fits-all' answer on whether patients should exercise or rest during recovery from post-COVID syndrome. Dr Holmes added: 'I would suggest encouraging people to be active, but not silly active.'

Citing advice from an occupational health professional, he said the best advice was to 'be gentle on yourself' - and that this was advice that should be applied both to patients and GPs themselves.

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