A 'special issue on COVID-19'. Fourteen primary care publications with implications for practice, teaching, and research

Background

On 17 November 2019, the first case of a coronavirus infection that broke the interspecies barrier by transferring from animal to human was recorded in Wuhan in central China. The responsible pathogen was labelled SARS-Cov-2, and the disease it caused was named COVID-19. On 11 March 2020, the World Health Organisation announced a pandemic, which after three years took a toll in the form of 760 million confirmed cases, of which almost 7 million ended in death [1].

Earlier warnings were not taken seriously, so societies and healthcare systems were unprepared to cope with the spreading plague. The lack of procedures, personal protective equipment and essential awareness of the threat meant that, especially in the first period of the pandemic, the fight against it cost the lives of many medical workers, including family physicians, especially in Italy. Quarantine, isolation, restrictions on social life and bans on travel and contact are just some of the restrictions that unprecedentedly hit the lives of societies, families and individuals.

The new reality also came to family doctors’ practices [2]. Limitations in physical contact with the patient, including replacing a traditional visit with a phone call, barriers and new sanitary procedures, and finally, the rapid development of telemedicine are just some of the challenges faced by family doctors in the first period of the pandemic. Those who combined clinical work with teaching or research also experienced limitations in these areas of their activity. In place of the abruptly stopped traditional face-to-face educational formats, such as seminars, lectures, courses, conferences or practical training, new solutions appeared, based mainly on information and communications technologies (ICT), enabling work and communication at a distance.

New hope came with the appearance of vaccines that could prevent the development of the disease or at least mitigate the possible course of infection. In many countries, family doctors again stood on the front line by organising vaccination stations and vaccinating with other primary healthcare staff. Next to vaccination enthusiasts, sceptics soon appeared, often organising themselves into aggressive anti-vaccination movements, ready to even resort to physical violence. This anti-vaccination movement and the following general vaccination hesitancy was a real challenge. Family physicians naturally had to become a competent source of information for their patients on the benefits and risks of vaccination.

There is no doubt that the challenges caused by the COVID-19 pandemic for most family physicians are an unprecedented event in their entire professional lives. Strenuous work, physical and mental effort, stress, and fear for their health and life of themselves and members of their families are just some of the costs that family doctors had to bear.

The EJGP special issue on COVID-19

Aware of these extraordinary circumstances [3], the WONCA Europe Executive Board proposed preparing a special EJGP issue devoted to various aspects of the fight against the pandemic. The proposal was accepted, and in response to the call for papers, the editors received 32 manuscripts presenting the results of varied research conducted in connection with COVID-19 in primary health care. Fourteen manuscripts were accepted for publication in this special COVID-19 issue. You will find reports from original studies, both quantitative and qualitative, conducted in many European countries. In the following paragraphs, we highlight some of their messages.

Effects of the pandemic on healthcare professionals and patients

An international collaborative study and studies from Catalonia, Germany, Turkey, and Slovenia report on the pandemic’s effects on primary care and its healthcare workers: how they managed the professional challenges they faced and how they coped with the personal stress the pandemic brought [4–8]. The authors of the German study point to the significant role of teamwork and mutual support in overcoming the difficulties of this period [5]. A collaborative international qualitative study in eight European countries performed during the first wave of the COVID-19 pandemic points out the distress experienced by patients with COVID symptoms and the role the availability of testing played in this [9]. Important lessons can be learned from these descriptions for future large-scale threats to the healthcare system.

Primary healthcare

The authors of a historical cohort study conducted in northern Italy (2020–2021) show how active monitoring and home visits by GPs were associated with reduced hospitalisation in COVID-19 patients [10]. A French qualitative study explored the experiences of GPs and their patients regarding the influence of wearing masks during consultations on their communication and relationship. Both parties identify patient categories requiring special attention from health professionals when wearing masks [11].

Vaccination

Another French study shows how essential participants in a medical congress (June 2021) found it to meet each other face-to-face. A safe meeting was possible thanks to the high effectiveness of vaccinations among physicians (mean age 35 years) at a relatively early stage of the vaccination campaign [12]. Various other reports are devoted to vaccination issues. During the primary vaccination campaign, Belgian authors found a significantly worse serological response in vaccinated nursing home residents (aged 81–91 years) than in their staff (aged 33–52 years) [13]. Polish authors showed that short-term vaccine adverse events among family practice patients, however frequent, were usually mild. Five per cent of the patients required immediate medical assistance for pre-syncope or loss of consciousness [14].

Prognosis

A population-based cross-sectional study (data collection in 2020) from Israel shows that physical activity might protect against the SARS-CoV infection [15–17]. In an Estonian study (data collection in 2021), symptoms of fear patients experienced after an episode of COVID-19 were studied [18]. The results of an international study conducted in 11 countries on long-COVID and post-COVID among outpatients (data collection in 2021 and 2022) indicate that half of all patients had symptoms after eight weeks, and one-third still had symptoms after three months. Obesity appeared to be a risk factor for lingering symptoms [19].

Future research

This special EJGP issue dedicated to COVID-19 does not exhaust our knowledge about this disease. The research is in progress, and its results will continue to be published in this journal’s regular issues and other journals. Much is still unclear about the prevalence and the symptomatology of post- and long-COVID [20]. More evidence is needed on the long-term effects of vaccination and the need for future vaccinations. Our profession would have to evaluate the way the pandemic changed our practice. Video and telephone consultations and digital correspondence with patients altered the ecology of family medicine. There is an urgent need to evaluate and deepen research into the teaching of our trainees, the treatment of our patients and the safeguarding of quality, patient safety and equity in the post-COVID-19 era.

The COVID-19 pandemic has ended. However, this painful episode must not be wasted. It is crucial to draw the broadest and most accurate conclusions from its course and the experiences of the public and healthcare professionals. We may face similar threats in the not-too-distant future. A thorough analysis of recent experiences will help us prepare for future challenges. We believe that the content of this special EJGP issue and articles on COVID-19 already published in the EJGP in recent years [21] will make this task easier.

Shlomo Vinker
Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Medical Branch, Leumit Health Services, Tel Aviv, Israel
The WONCA Europe Executive Board

Adam Windak
Department of Family Medicine, Jagiellonian University Medical College, Krakow, Poland
WONCA Europe Executive Board member at large (EURACT)

Jelle Stoffers
Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht
University Medical Centre, Maastricht, the Netherlands, and Editor-in-Chief of the European Journal of General Practice
[email protected]

Acknowledgements

WONCA Europe Executive Board members formed the guest editorial team for this Special Issue on COVID-19: Josep Vilaseca, Zalika Klemenc-Ketiš, Mehmet Ungan (guest editors); Shlomo Vinker and Adam Windak (guest editors-in-chief).

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.