And appointments are typically longer than a standard consult.

Here comes the aftermath of the rising COVID numbers, with almost 60% of Australian GPs now saying they are treating at least one patient with long COVID.

A survey of almost 400 GPs conducted by Healthed on 2 August revealed that 58% had seen at least one patient with long COVID in the past two weeks.

In the survey, long COVID was defined as: ‘A person whose symptoms have persisted for longer than 12 weeks after their initial COVID infection where these symptoms cannot be ascribed to any other cause.’

As far as Healthed is aware, these are some of the only data currently providing insights into the Australian long COVID situation in primary care.

The tricky aspect to interpreting this data is the question of ‘What is long COVID?’, says Professor Andrew Lloyd, an infectious disease physician at the Kirby Institute who has decades of experience working with patients with post-viral fatigue.

It’s difficult to “sort the wheat from the chaff” because the symptoms associated with long COVID are so varied and overlap with other conditions, he says. People with long COVID can have breathlessness, fatigue, and psychological, neurological and/or cardiovascular symptoms.

However, the definition of long COVID used in the survey is “reasonable” and the GPs surveyed are representative of the broader population of Australian GPs, with maybe a few deviations, says Professor Lloyd.

Overall, the survey suggests that the prevalence of long COVID is high, which is unsurprising, he says.

Previous studies suggest that long COVID affects around 20-30% of people infected with COVID, he says. A review by Professor Lloyd found that in most COVID-19 cohort studies, persistent fatigue was reported by 13% to 33% at 16-20 weeks post-symptom onset, and 10%-35% at six months.

Long COVID is a time sink

Managing chronic illnesses typically requires lengthier consultations, and long COVID appears to be no exception.

Around half (55%) of GPs surveyed typically spent around 20 minutes or longer with their long COVID patients.

This wasn’t a one-off occurrence; around half (51%) of GPs had between one and 10 patients with long COVID who were regularly seeking treatment.

“The typical symptoms patients report are diverse. They are often multiple, and they don’t fall neatly into one domain,” says Professor Lloyd.

“One piece of advice I have already been giving GPs – they probably don’t need me to tell them this – but if they don’t have time available for an extended consult, then they can always break the task into repeated consultations and accumulate the information that’s required to do a good evaluation.”

People with long COVID often turn to alternative and complementary medicine because the practitioners who work in this space often have more time to offer support, says Professor Lloyd.

“I would say that every GP is seeing patients suffering from long COVID, whether they diagnose it or not,” says Dr Mark Donohoe, the current president of the Australasian College of Nutritional and Environmental Medicine, which ran a long COVID symposium earlier this year.

“I have seen in excess of 100 patients fulfilling the various criteria for long COVID, and this number is increasing beyond my capacity,” says Dr Donohoe, who is a GP based in Sydney who has treated patients with ME/CFS and long COVID. “The waiting time for new appointments has now blown out to eight months or more for long COVID sufferers.”

“Long COVID is not a simple disease with known pathology that can be assumed for all sufferers,” says Dr Donohoe.

“It varies greatly from one person to the next, the underlying processes are poorly characterised, the symptoms are wide ranging and variable, and the understanding of the illness and the person suffering long COVID takes time. Lots of time.

“In my practice, usually two hours for a first consultation, and follow up consultations of 30 to 60 minutes. Why? Because the life health and illness history of each person is criticalto understanding the illness.

“The history (and family history) of allergy, infections, nutrition, antibiotic use, diet, environment, physical and psychological stress, sleep quality, travel illness, movement and exercise to name just a few areas are important.

“In COVID-19, as in ME/CFS, time spent listening in the early stages is more than repaid by identifying predisposing, causative and contributing factors, and this in turn opens opportunities for treatment and recovery.”

In Dr Donohoe’s opinion, some people with long COVID will need GP support for more than a year and possibly many years.

“There are an estimated 180,000 ME/CFS sufferers in Australia, and GP practices already struggle to meet their needs and support them with their disabilities… I fear that GPs simply will be unable to meet the needs of long COVID sufferers over the coming years.”