Background

Post COVID-19 condition or long-COVID refers collectively to all mid- and long-term symptoms that some people experience after they have had COVID-19 including fatigue, post-exertional malaise, breathlessness, and cognitive dysfunction (i.e., problems with memory, concentration, information processing) and insomnia. Prevalence is estimated at 10%.

Evidence is constantly evolving and to date, much of what is known about long-COVID comes from research initiated or led by patients themselves.

Patients have been actively involved at different stages in research: identifying their needs, setting research priorities and agendas, developing patient information and consent procedures, designing interventions, data collection and analysis, identification of outcomes, contributing to diagnostic and treatment guidelines, and informing policy and practice.

Regarding long COVID, patients are taking the lead, identifying relevant needs and pointing out promising research opportunities before researchers and even physicians have suggested potential experimental treatments to be beneficial. The slow and cautious response of the healthcare system to provide safe and effective treatment and adequate support has boosted this shift towards a true patient-centeredness and a strengthened patient-researchers relationship.

Target Group: Professionals interested in research

Didactic Method: Through different case-scenarios, patients’ involvement will be discussed. At the end of the workshop guidance will be offered on how to effectively establish and maintain such partnerships and assure mutual benefits .

Objectives: Explore the different ways in which patients can be involved effectively in research.

Take Home Message for Practice: The impact of early patient involvement in research is crucial and it should be consider best practice

Objectives: Explore the different ways in which patients can be involved effectively in research.

Background:

It is estimated that between 10-20% of people who experienced COVID-19 develop a 'post COVID-19 condition' or 'Long COVID' (LC), which includes all mid- and long-term physical, psychological and neuropsychological symptoms.


Question: What are the psychological and neuropsychological symptoms associated with Long COVID?


Methods: Descriptive, online cross-sectional questionnaire and neuropsychological tests. Participants were recruited through public relations, information and social media campaigns, targeting long COVID patients, general public and healthcare professionals.

Outcomes: Out of the 1.895 participants who completed the survey, 78.4% reported to have had COVID-19, and 64.3% experienced LC symptoms with fatigue as the most frequently reported symptom (65.4%). The estimated most common Corona variant was omicron (40%), followed by delta (11.5%). There were positive and statistically significant correlations between reported physical symptoms and results from the neuropsychological tests, perceived stress, anxiety and depression scores. The average time that elapsed between LC symptom onset and completion of the online survey was 8.3 months.



Conclusion:

Online real-time neuropsychological testing should be considered as part of the routine evaluation of Long COVID patients to specifically treat these symptoms within multidisciplinary teams.


Discussion

Validated self-report assessment scales and neuropsychological tests should be included in standard diagnostic procedures to adequately address neuropsychological and mental health consequences of long COVID.


Take Home Message for Practice

eHealth solutions offer a valuable alternative to provide effective assessment for Long COVID patients experiencing cognitive impairment.

Online real-time neuropsychological testing should be considered as part of the routine evaluation of Long COVID patients to specifically treat these symptoms within multidisciplinary teams.

Research presentation

Background
Coronavirus Disease 2019 (COVID - 19) is a condition caused by Severe Acute Respiratory Syndrome Corona Virus (SARS-CoV 2). Gandaki province government established Nepal’s first provincial infectious and communicable disease hospital (ICDH) on 16th July 2020 to provide treatment for people with infectious diseases including COVID – 19. This research aimed to find the mortality and discharge rates among the admitted COVID-19 cases during the pandemic in ICDH in Gandaki province of Nepal.

Methodology
A retrospective cross-sectional study was done among 1366 cases admitted with COVID-19 infection in ICDH in Gandaki province using convenience sampling method. Semi-structured questionnaire was used to collect secondary data from the hospital database system. Both the paper-based registry system and digital database system were used to collect information about demographic features of the admitted patients (age, sex, address) suffering from COVID - 19 along with duration of hospital stay and severity of disease.

Result
The hospital managed 1366 cases, 791 (57.9%) were males and 575 (42.1%) were females, in 24 months. The hospital admitted maximum number of cases between March of 2021 to December of 2021. The average age of the patients was 46.17 (±18.25) years and common age group affected was 31 to 40 years (23%). Majority of the admitted cases (79.9%) were from Kaski district of Gandaki. The average duration of stay was 8.48 ±5.29 days. Majority, 884 (64.7%) were moderate cases, followed by 391 (28.6%) mild cases and 91 (6.7%) severe cases. The discharge and mortality rates were 1203 (88.1%) & 59 (4.3%).

Conclusion
The database of hospital is helpful to document discharge and mortality rates of admitted COVID – 19 cases. The common age group, geographic locations, severity and average hospital stay provide valuable evidence and can be useful to make necessary plans.

1. The discharge rate from the hospital is 88.1 %.
2. The mortality rate of admitted COVID - 19 cases is 4.3 %.
3. Males are affected more than females.

Research presentation

The emergence of the SARS-CoV-2 Omicron variants has been associated with the milder acute disease compared to earlier variants. However, post-COVID-19 syndrome (PCS) 's incidence and clinical features after Omicron variant infection remain poorly understood. This study aimed to estimate the incidence of PCS, identify common clinical complaints, and investigate potential risk factors and biomarkers of PCS among Thai patients who survived COVID-19.

A bidirectional prospective cohort study was conducted involving 209 Thai patients who had recovered from COVID-19 and received both hospitalised and non-hospitalised care during their acute infection. Patients were randomly selected and evaluated for PCS between three and four months after the acute onset. The diagnostic process involved a questionnaire of PCS symptoms and a physical examination to rule out other potential causes. Additionally, routine blood tests, CRP, D-dimer, Anti-spike IgG, and Anti-NCP IgG were performed during the same visit.

Among the 209 patients, 44% (91/209) developed PCS within three months of acute onset. The top five clinical complaints were fatigue (21%), abnormal hair loss (19%), cognitive dysfunction (8%), continuous cough (8%), and dyspnoea (6%). Patients who experienced severe acute disease, were female, or had comorbidity had a higher risk of PCS. Treatment with antiviral drugs did not reduce the risk of PCS. While alkaline phosphatase was significantly higher in patients with PCS, AUROC value was low. No other blood tests showed significant associations with PCS in multivariable analysis adjusted for age, sex, and disease severity.

This cohort study provides new information on the incidence and clinical complaints of PCS following Omicron variant infection among Thai patients. The study identifies key risk factors and highlights the lack of an effective biomarker for PCS. These findings have significant implications for the clinical management of PCS and underscore the need for continued research on the long-term effects of COVID-19.

1. Definition of PCS diagnosis could be accounted for disturbed daily life function or more than one symptom avoiding medicalization
2. PCS care needs multidisciplinary teams; family doctor should be involved
3. No effective biomarkers of PCS thus using clinical diagnosis with ruling out other conditions is key

Rapid impact presentation

Brazil declared Public Health Emergency of National Importance on February 2020. Being the fifth country in the world concerning social media usage, a fake news epidemic took place in Brazilian cyberspace in that scenario, specially about COVID-19 vaccines. Fake news works in vaccine hesitancy favors, being quality public communication a strong opposition force. The information produced by fake news and by Health Ministry are assimilated by people according to theirs Health Literacy abilities, being Health literacy fundamental in combating fake news and vaccine hesitancy. 794 fake news checks on vaccination against COVID-19 from 4 fake news checking sites and 1287 Facebook posts from the Health Ministry, both between 03/01/2020 and 09/10/2022, were selected and analyzed based on content analysis and the load analysis by Zarcadoolas, being created a matrix of vaccination demands against COVID-19 for analysis. As results, each group had: list of people and institutions that produced or were mentioned in the communicative pieces, categories of ideas present, formats identified, presence of anti-vaccine and pro-vaccine themes, mention of vaccines in circulation in Brazil, 5 pieces selected by the author to represent the team and analysis of the results by load analysis. It was concluded that the Ministry of Health's digital public communication had a strong strategic component aimed at improving its image, a low presence of pro-vaccine themes, low popular participation, poor combat against the main fake news of vaccination against COVID-19 that circulated in the country and an emptying of strategies that meet the main Health Literacy demands of the moment; bringing a greater load of understanding to the population. Disinformation, on the other hand, had a strong presence of anti-vaccine themes, strategic articulation of ideas´ categories, diverse responses to almost all Health Literacy demands listed and specific themes for each vaccine brand.

1. The importance of a health literacy in public communication
2. The impact of fake news in vaccine hesitancy
3. Strategies to tackle down fake news concerning COVID-19 vaccination

According to Nature Reviews Microbiology published in Jan 2023, at least 65 million people worldwide already have long COVID, or post-COVID conditions, which is when symptoms persist for more than 12 weeks after the initial infection. These figures represent more than 10% of all infected individuals. General Practice is well placed to manage and support these patients provided a team of highly motivated specialists and allied health practitioners work together closely. Geelong Long Covid Clinic was established in June 2022 and here we present our work and our approach hoping others could consider employing our approaches and start helping those patients who maybe suffering in silo in other communities especially in rural and remote areas.

- Long Covid management in the community
- Working with Allied Health Practitioners
- Reduce Hospital admission burden