Review finds long Covid patients need to be treated by doctors from various specialties
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A review of how long Covid patients are cared for internationally has found patients do best when doctors from different specialties work together, health watchdog Hiqa has found.
At least three countries explicitly advise long Covid patients should be sent urgently for psychiatric help if they are at high risk of self-harm or suicide.
In the review, published Friday, the Health Information and Quality Authority (Hiqa) said advice around different kinds of care operating together reflects the HSE model of care.
However they also found, unlike international models, the Irish plan does not emphasise standardised assessment tools or structured patient follow-up.
Patients with long Covid in Ireland have frequently spoken out about delays in setting up the one-stop-shop clinics. The HSE have openly said hospital groups are struggling to find staff with clinics running without everyone they want to hire.
Hiqa used the World Health Organisation (WHO) definition of long Covid, to mean continuing or new symptoms three months after the initial Covid-19 infection, lasting for at least two months with no other explanation. Over 200 symptoms are identified globally, and these can come and go.
Symptoms including brain fog, fatigue, and heart issues are now widely accepted, and international guidelines also list less well-known signs including eyesight problems, tinnitus, vomiting, hair loss, and symptoms of post-traumatic stress disorder. Hiqa reviewed 24 guidelines and two models of care.
Director of Health Technology Assessment Dr Máirín Ryan said: “We found that most guidelines are recommending a holistic, person-centred approach to diagnosis, management, and treatment, with an emphasis on shared decision-making, which is consistent with the HSE’s interim model of care.”
She added: “Long Covid can affect a person’s ability to carry on with their normal daily activities.”
Hiqa looked at guidelines and models of care from Australia, Canada, Germany, Italy, New Zealand, Singapore, Spain, Switzerland, the UK and America.
“As more evidence is published, the approaches to treatment and management may change,” the review found. “The dynamic nature of this area can be seen from the many updates to guidelines that are occurring.”
Overall the guidelines focus on the need to bring specialist care from different areas together under one roof, so to speak, including staff from allied health, clinical psychology, nursing and rehabilitation medicine.
Mental health of patients with long Covid appears to be a growing concern, with guidelines including those in the UK (the NICE guidelines) and Korea recommending a focus on this.
The Australian guidelines were recently updated with a conditional recommendation for psychological and psychiatric support for patients with symptoms of a new or exacerbated pre-existing mental health condition.
In the UK, patients who were hospitalised with Covid-19 should receive a follow-up consultation after six weeks to check for new symptoms developing. The British and Australian guidelines offer doctors advice on how to treat ‘postural symptoms’ including dizziness and heart palpitations when standing.
While the guidelines focus on adults, the American Academy of Paediatrics recommends children be sent for additional testing and/or referral to a multidisciplinary paediatric post-Covid-19 clinic.
The New Zealand guidelines specifically advise doctors to look out for signs of PIMS (paediatric inflammatory multisystem syndrome temporally associated with Covid-19) in children.