Long COVID primary care visits marked by breathing, sleeping problems

Visits for symptoms associated with long COVID make up a moderate burden of primary care visits and are marked by recurring symptoms including breathing problems and sleep disturbances. The findings are published in Annals of Family Medicine.

Primary care visits for long COVIDare, however, less frequent than long COVID-associated visits in subspecialty clinics.

The study used data from the American Family Cohort, a national primary care registry to examine data from the years 2018 to 2021. In the United States, the authors estimate one-third of patient health visits occur in the primary care setting.

Researchers compared three groups: people who had COVID-19, people from 2018-2019 with flu-like illnesses (ILI), and people from 2020-2021 who had regular health check-ups but not COVID-19. The researchers used the ILI patients as controls and looked for diagnostic codes for 17 long-lasting health symptoms most commonly associated with long COVID. 

Overall, 28,215 COVID-19 patients were compared to 235,953 historical control patients with influenza-like illness.

COVID-19 patients had higher prevalences of breathing difficulties (4.2% vs 1.9%), type 2 diabetes (12.0% vs 10.2%), fatigue (3.9% vs 2.2%), and sleep disturbances (3.5% vs 2.4%), compared to ILI patients. 

All differences less than 3%

“All differences were less than 3%, with most less than 1%, and all effect size estimates were less than 0.20, suggesting little or no meaningful difference,” the authors said. “The mean number of conditions increased from 0.48 at diagnosis to 0.68 at the 6-month follow-up among patients with COVID-19 and from 0.46 to 0.59 among ILI control patients.”

In general, primary care visits for long COVID represented only 12% of patient visits after COVID-19 infection. 

The authors of the study said the lower prevalence of long COVID visits may be due to more mild initial infections.

A tendency to include mainly patients hospitalized for COVID-19 treatment is a known critique of existing literature on PCC.

“Greater COVID-19 severity is a known risk factor for PCC [post COVID condition], our study patients presented to primary care rather than an acute care setting,” the authors wrote. “A tendency to include mainly patients hospitalized for COVID-19 treatment is a known critique of existing literature on PCC.”