As the acute response to the COVID-19 pandemic shifts to long-term management, the lasting effects of infection are becoming increasingly evident. Long COV
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Shiqi Luo, Zhen Zheng, Leila Karimi, Magdalena Plebanski, Chintha Lankatillake, Jacob Sheahan, Kate Anderson, Natalie Jovanovski, Emma-Louise Seal, Wendell Cockshaw, Dennis Wollersheim, Sonja Cleary, Doa El-Ansary, Katie L. Flanagan, Rebecca Jessup, Sarah Abrahamson, Naomi Whyler, David Fineberg, Michelle Jo’anne Lila Scoullar, Marie-Claire Seeley, Emma Tippett, Sophia Xenos & Catherine Itsiopoulos
Background
As the acute response to the COVID-19 pandemic shifts to long-term management, the lasting effects of infection are becoming increasingly evident. Long COVID continues to challenge healthcare systems, with many healthcare professionals reporting uncertainty about assessment and referral pathways. This updated review examines recent international guidelines alongside Australian services to identify gaps between guidelines and practice.
Methods
Between April and October 2025, we searched for guidelines on Long COVID published in English and assessed their quality by applying the AGREE II appraisal tool. We also conducted a grey literature search to profile active Australian services providing Long COVID care.
Results
Three new or updated guidelines were published in the United States, Canada, and New South Wales, Australia. Together with the World Health Organisation, United Kingdom and New Zealand guidelines identified in the previous review, all emphasise integrated, primary care-led approaches. Notably, Australian service delivery remains fragmented, with a growing number of primary health practitioner-led private services operating largely under a fee-for-service model, leading to variations in access and affordability. Many hospital-based outpatient clinics have been absorbed into existing chronic-disease services. The most fundamental challenge is statistical invisibility: without an activated diagnostic code, services cannot reliably identify or follow people living with Long COVID. This invisibility limits both surveillance and service planning.
Discussion and conclusions
Australia is currently developing national clinical best-practice guidelines for ME/CFS, which may also benefit Long COVID; however, Australia remains behind comparable nations such as Canada, the United Kingdom, and the United States in developing and implementing the integrated, multidisciplinary care models recommended internationally. This has significant implications, namely that the rapid transition from hospital-based Long COVID clinics to primary care-led services has resulted in fragmented and uncoordinated care. Strengthening Australia’s response will require national leadership and investment in workforce training, sustainable funding for care coordination, improved public and professional awareness, the establishment of primary care-led multidisciplinary pathways, and the activation of a dedicated diagnostic code. Also importantly, shifting to a patient-centred approach and patient-practitioner collaborative model of care is essential to prepare the health system for managing Long COVID and future complex, multi-system conditions.
It's hard to see the value of reviewing and comparing guidelines when they are all completely inadequate, which doesn't seem to have been considered here. It all ends up like a bunch of students cheating on each other when no one has a single right answer. After six years, everything is still left to be done, there is nothing currently in operation, or even written anywhere, that wouldn't be better thrown off entirely and restarting entirely from scratch.
I have no idea where the idea that Canada has any such thing as "developing and implementing the integrated, multidisciplinary care models recommended internationally". We possibly have the most fragmented approach to this because of the nature of our country's confederation foundation, where provinces have jurisdiction on all health matters. So there isn't even a concept of a national approach to this, only in research, and on the LC research front, Canada is not doing anything worth writing about outside of asking "what the hell are you people doing?"
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