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Australian GP's: COVID-19 survivors long-term impacts & funding

RACGP Acting President Associate Professor Ayman Shenouda said that GPs would be managing the long-term impacts of the virus on some patients for years to come.

The Royal Australian College of General Practitioners (RACGP) is warning government that GPs will need adequate resources to manage the long-term care of COVID-19 positive patients. The RACGP has released a guide for GPs providing care to adult patients who have previously tested positive to COVID-19 or have a history suggestive of undiagnosed COVID-19 and have - or are at risk of - post-COVID-19 conditions. The guide was developed in collaboration with HealthPathways. RACGP Acting President Associate Professor Ayman Shenouda said that GPs would be managing the long-term impacts of the virus on some patients for years to come.

“Some COVID-19 positive patients quickly make a full recovery but that is certainly not the case for all people,” he said.

“Evidence is emerging that some patients are being left with serious physical, cognitive and psychological impairments that will require long-term care. For these patients, it is not a case of contracting the virus, getting better and never thinking about it again.

“Post-COVID-19 conditions include lung scarring, post-viral fatigue as well as ‘brain fog’. Emerging data suggests that up to 80% of people with severe cases of COVID-19 resulting in hospitalisation will experience post-COVOD-19 conditions.

“There is also evidence that people who have contracted COVID-19 exhibit neurological symptoms, from loss of smell, to cognitive impairment, to an increased risk of stroke. There are also potential long-lasting consequences such as post-traumatic stress disorder (PTSD) following severe illness, liver dysfunction, and heart failure.

“These long-term effects are likely to be particularly severe for older people, those with chronic disease and those who experienced severe acute COVID-19. GPs will be crucial in managing the health and wellbeing of these patients in the years ahead.”

The Acting RACGP President said that GPs need government support in caring for the potentially significant needs of patients with post-COVD-19 conditions.

“When we look at the patients most likely to suffer severe post-COVID-19 health concerns it is older people and those with multiple chronic conditions, including patients who have delayed or avoided care during the pandemic,” he said.

“A voluntary patient enrolment model, where clinics receive additional payments for ‘enrolling’ a patient with a regular GP, would be particularly beneficial for these patients. This model enhances comprehensive care for patients and reduces hospitalisations for those who frequently visit GPs.

“Post-COVID-19 health impacts will take a significant toll on many patients including on their mental health. The guide is mindful of this and includes information on accessing mental health services or online supports.

“The Federal Budget included a $100.8 million investment in extending the doubling of Medicare-subsidised psychological therapy sessions for people who have used their initial 10 sessions.

“That is a welcome announcement that will make a real difference. However, in the longer term, many patients including those suffering the after effects of COVID-19 would benefit enormously from new Medicare subsidies for longer consultations.

“Longer consultations allow GPs to take the time to talk through what our patients are experiencing and how we can help them.

“Similarly, new Medicare subsidies for longer consultations for people with chronic conditions would be very helpful. These are the patients who require a bit more time and attention, particularly if they have had COVID-19.”

The guide includes information on:

· infection control precautions and advising patients that having COVID-19 may not confer complete immunity

· collaborating with the patient to develop an individualised plan to support their recovery. This also presents a unique opportunity to optimise the management of existing chronic conditions

· providing care for specific groups recovering from the virus including those with severe COVID-19 requiring hospitalisation, older patients and people with disability

· options for enhancing support for patients including home delivery of medicines, assistance with food and meals and support lines including the Older Persons COVID-19 support line.

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Consider this - even through the lock down thousands of people have been travelling in and out of Melbourne - yet it has only spread in a few cases - they are the cases where the people were actually infected. Thus the lock downs do not help, contact tracing and quarantine of the sick does.

Also everyone at Chadstone was wearing masks - yet they still got it - so what use are masks then? Also if you get sick, take ivermectin triple course early, you will only get mild flu - developing countries know this as many use ivermectin as a matter of course for malaria. A Melbourne couple used it - one with serious health complications - were completely better in a day or two - they and their doctor are interviewed by Sky news - look at the youtube video:

Any spread, with such an infectious virus, creates a danger of exponential spread. We do not know how many people have been infected overall in Victoria; we only know the ones detected by tests, but, like the tip of an iceberg, there is more we don't know about.

You write that we should only contact trace and quarantine the sick, yet this is how this problem began. We failed to contact trace and quarantine the sick. That got us into a situation that required strong movement controls. We have now probably brought the virus down to more or less manageable levels - so that it won't overwhelm our hospitals, and so that we will soon be able to move. However it is not yet time to throw everything open because we still have 127 active cases, including 15 mystery cases, and two new detected cases just today (18 October 2020). How do you quarantine only the sick when they have to be attended by staff who are not themselves quarantined? How do you quarantine the sick when you don't know who or where they are? The only way you can deal with unknown infections is by localising their movement, which then helps pinpoint sources when other infections occur nearby.

Europe and America thought they could control the spread of the virus in the manner you suggest and, at the moment Europe and America are facing shocking odds with this disease. Sweden, a country whose self-monitoring method you previously recommended, is now looking at lock-downs.

With regard to the wearing of masks: they are a mechanical barrier, but this is a very infectious disease. Protection also requires social distancing, disinfection of surfaces, and hand-washing. Any of those things can break down. Masks are not vacuum-sealed onto our faces, they need to be changed frequently, etc. Masks are also particularly important to be worn by an infected person, to reduce the amount of virus they put out into the environment. We don't know how well the person who infected people in Chadstone was observing infection protocol. Hospital staff wearing masks and using strict protocol still get infected, due to exposure to massive amounts of virus.

With regard to your assertion that ivermectin is a sure thing, your evidence is anecdotal. It is easy to assert that something is effective against a disease if you cannot be held to account if people suffer through your advice, since you are not a medical doctor, who can be sued for endangering lives. You cannot expect editors on this site to allow this kind of assertion to pass as if it were an unassailable truth. It is fair enough to say that you hope that this drug is effective, but it is irresponsible to insist that it is.

Ivermectin quad-therapy - works as a preventative and a cure - taken on day 1, mean recovery time - 3.6 days.

Multiple studies - including two by Australian researchers. India is using it, and has 80 deaths per million cases (0.00008 chance of dying), much lower than the USA (667):

As for the spread - the only reason we cannot open is due to poor contract tracing and management. That is very clear now.

Having lived in virtual isolation for many weeks, feeling fairly confident of not having Covid 19 but not allowed to travel outside 5km radius of my home I am furious that 17 New Zealanders appear to have been let into Melbourne. The acting Minister for Immigration appears to brush this off as unimportant because NZ doesn't have any cases of Covid 19. At this point the likelihood of a Melbournian and the likelihood of someone from NZ having Covid 19 are probably not much different but the fact remains, people in Melbourne are living severely restricted lives in a large scale effort to suppress (or dare i say eliminate?) the virus. People in Melbourne are not allowed to visit family outside Melbourne. What rules will apply to the New Zealanders? I think the Acting Minister for Immigration mocks the people of Melbourne in being so dismissive.

I suspect the Minister for Immigration misses the point, which is that Victorians have been restricted to five kilometre radiuses in order to restrict transmission of the virus. If the New Zealanders (now assessed at about 53, not 17) traveled from Tullamarine Airport, north of Melbourne, to any other point in Victoria, they would run far greater risk of encountering and then transmitting, the virus, than any Victorian who only travelled within 5km, or for essential purposes. Furthermore, there is more COVID-19 in the north than the south, so the danger is that they would pick it up in the north and take it into less infected areas. The two latest known cases [18 October 2020] are in Hume, which is about 16 km from Tullamarine (Melbourne Airport). There are still 137 known active cases in Victoria, and who knows how many undetected cases? There are still 15 'mystery' cases of COVID 19 in Victoria, which means that we don't know where they came from. Our best bet is to be able to control people's and thus virus movement. The minister for immigration's attitude is not only disrespectful to Victorians, but dangerous through his ignorance.