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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE (Open Access)

Post-acute COVID-19 condition (PACC): a perspective on collaborative Australian research imperatives and primary health models of care

Emma Tippett A # , Danielle Hitch https://orcid.org/0000-0003-2798-2246 B C # * , Louis Irving D and David Watters E F
+ Author Affiliations
- Author Affiliations

A Infectious Diseases Unit, Peninsula Health, Frankston, Vic. 3199, Australia.

B Department of Allied Health, Sunshine Hospital, Western Health, St Albans, Vic. 3021, Australia.

C Occupational Therapy and Science, School of Health and Social Development, Deakin University, Geelong, Vic. 3220, Australia.

D Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne Health, Parkville, Vic. 3050, Australia.

E Department of Surgery, University Hospital Geelong, Barwon Health, Geelong, Vic. 3220, Australia.

F School of Medicine, Deakin University, Geelong, Vic. 3220, Australia.

* Correspondence to: Danielle.Hitch@wh.org.au
# These authors contributed equally to this paper

Australian Journal of Primary Health 29(4) 293-295 https://doi.org/10.1071/PY22009
Submitted: 1 June 2022  Accepted: 31 October 2022   Published: 12 December 2022

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY)

Abstract

Post-acute COVID-19 condition (PACC) – also known as long COVID – is a serious and growing problem in primary health. This letter describes the work of the Victorian Post-Acute COVID-19 Study (VPACS) group, which comprises clinician researchers, basic scientists and consumers. Two key priorities for PACC research in Australia are identified and discussed: (1) the establishment of COVID-19 patient registries and data linkage; and (2) the consolidation of clinical guidelines. Collaboration between consumers, researchers, clinicians and institutions must be the foundation of PACC management in Australia. Ongoing research should focus on large, multicentre controlled studies, the protective effect of vaccination, differential impacts from variants, pathobiological underpinnings, disease mechanisms to avoid severe and enduring impacts on the Australian economy. The lived experience of people with PACC is also essential to enable the design and implementation of effective models of care. VPACS brings a diverse group of people together to work on a shared vision of holistic and high-quality care, and collectively maximise their impact on outcomes for patients and the broader community.

Keywords: clinical guidelines, collaboration, COVID-19, data linkage, long COVID, models of care, patient registries, post-acute COVID-19 condition, research.

As of 18 November 2022, there have been 637 million cases of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) globally, leading to 6.62 million (1%) confirmed deaths (Johns Hopkins University (JHU) 2022). Emerging research shows many people describe persistent fatigue, cognitive impairment, shortness of breath, and chest and musculoskeletal pain following acute COVID-19. This syndrome (known colloquially as ‘long COVID’) is named ‘post-acute COVID-19 condition (PACC) by the World Health Organization (2021). The individual impact is variable and often multi-systemic; local research is urgently needed to determine whether Australian experiences differ from those reported internationally.

Victoria’s Clinical Leadership Expert Group (convened by Safer Care Victoria to respond to the pandemic) identified the provision of clinician (Department of Health 2021) and consumer facing guidance (Wark 2020) and collaboration between research groups as priorities in early 2021. The Victorian Post-Acute COVID-19 Study (VPACS) group formed in February 2021 to share latest developments in this rapidly evolving field. The aims of VPACS include improved data linkage, promotion of evidence-based practice, sharing clinical experience and enabling ongoing research. During 20 meetings in 2021, VPACS identified two key imperatives for Australian PACC research and models of care (MoC).


Establishment of COVID-19 patient registries and data linkage

The key activity of VPACS is surveying the Victorian population of COVID-19 cases, to identify patients with PACC, define prevalence in an Australia setting, and establish a Victorian COVID-19 registry. A comprehensive, multidisciplinary questionnaire (incorporating validated tools) will be delivered via RedCap (Table 1), and will also be available to other Australian jurisdictions to foster linkages with national, state and health service datasets. With Department of Health support, all Victorian COVID-19 patients will be invited to participate, and provide consent for medical records access and data linkage. VPACS is also collaborating with the Centre for Victorian Data Linkage on a series of studies using existing public health data. The majority of Australian cases have not required hospital admission, but this cohort are under-represented in present research (McClymont 2021). Collaborative studies of registry data can inform effective MoC in primary care that optimise recovery and reduce longer term disability.


Table 1.  Victorian COVID-19 registry outcome measures.
T1


Consolidation of clinical guidelines

The Australian clinical guidelines for PACC are regularly updated with close to real-time evidence reviews by the National COVID-19 Clinical Evidence Taskforce (National COVID-19 Clinical Evidence Taskforce 2021; Tendal et al. 2021). The guidelines summarise published evidence about PACC symptoms and management principles, but is currently limited by the small number of available Australian studies. This will ease as new evidence emerges; however, the guidelines reflect established MoC in which assessments and interventions have been tested. As previously noted in this journal, Australia’s primary care funding arrangements can inhibit innovative MoC (Duckett 2020). The pandemic has amply demonstrated the capacity of the health sector to rapidly respond to evolving demands; however, we are yet to see proactive action on the establishment of multidisciplinary PACC clinics

The foundation of building an Australian evidence base for the management of PACC is collaboration between consumers, researchers, clinicians and institutions. We need large, multicentre controlled studies (Amin-Chowdhury and Ladhani 2021) to define the rates, duration and prognosis for PACC. There is limited evidence on the potentially protective effect of vaccination (Antonelli et al. 2022) and differential impacts from variants of concern. We need ongoing exploration of pathobiological underpinnings and disease mechanisms, which will be crucial to mitigating future pandemics that might further cripple our economy. The lived experience of people with PACC (particularly those managed in the community) is another essential area of investigation, to complement and enhance healthcare-led research. Groups like VPACS can maximise research impact on a state, national and international level by bringing clinician researchers (in both primary and tertiary care), basic scientists and consumers together to work on a shared vision of holistic MoC and best outcomes for patients and the broader community.


Data availability

Data sharing is not applicable as no new data were generated or analysed during this study.


Conflicts of interest

The authors declare no conflicts of interest.


Declaration of funding

This research did not receive any specific funding.



Acknowledgements

We acknowledge the traditional custodians of the lands on which we work and live, and pay our respects to their elders past, present and emerging. We also acknowledge the contribution of the following members of the Victorian Post-Acute COVID-19 Study (VPACS) Group to discussions that formed the basis of this letter: Professor David Kaye (Alfred Health), Dr Tom Marwick (Alfred Health, Baker Institute), Professor Karin Leder (Alfred Health, Monash University), Dr Christine McDonald (Austin Health), Dr Hari Wimaleswaran (Austin Health), Professor Louise Burrell (Austin Health, University of Melbourne), Professor Jonathan Shaw (Baker Institute), Dr Erin Howden (Baker Institute), Professor Dianna Magliano (Baker Institute, Monash University), Professor Stephen Kent (Doherty Institute, University of Melbourne), Dr Alex Holmes (Melbourne Health, University of Melbourne), Dr Kirsty Buising (Melbourne Health, University of Melbourne), Dr Samantha Chakraborty (Monash University), Dr Donald Campbell (Northern Health), Dr Manuja Premaratne (Peninsula Health), Dr Trish Walker (Peninsula Health), Dr Kasha Singh (Peninsula Health), Dr Kirsty Mackwell (Peninsula Health), Dr Bernard Shiu (Royal Australian College of General Practitioners, Deakin University), Dr Andrew Wilson (Safer Care Victoria), Dr Amy Osborne (St Vincent’s Health), Dr Nick Hewitt (St Vincent’s Health), Professor Siddhartha Mahanty (University of Melbourne), David Bevan (Victorian Department of Health), Dr Marion Kainer (Western Health) and Dr Tissa Wijeratne (Western Health, University of Melbourne)


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