How can we better understand and manage the effects of long COVID?

People walking on red floor, backs to the camera. One has arm around the other and is wearing medical gown

BF, current PHAA Intern

As COVID-19 isolation requirements come to an end across Australia, experts warn the risk of developing potentially debilitating long COVID remains.

Recognising the need to learn more about the effects of long COVID, the Standing Committee on Health, Aged Care and Sport has launched an Inquiry into Long COVID and Repeat COVID Infections.

Long COVID is a condition where symptoms of COVID-19 remain or develop long after the initial infection. Symptoms can last for weeks, or months, and include extreme fatigue, shortness of breath, heart palpitations, chest pain, problems with memory and concentration, changes to taste and smell, and joint and muscle pain.

At a press conference to announce the scrapping of mandatory isolation requirements and support payments, national Chief Medical Officer Paul Kelly downplayed the risk of long COVID in Australia, stating that “we’re not seeing a major picture of [it]”.

But the head of a long COVID clinic at Sydney’s St Vincent’s Hospital, Professor Steven Faux, says that’s not true.

While vaccination reduces the risk of long COVID, there is research that suggests the effect isn’t as significant as once thought. There is a risk of long term illness, impairment, or disability, even among vaccinated people who experienced mild COVID-19 infection.

 

No data

There is no official record of how many Australians experience long COVID.

Estimates of the prevalence of long COVID among COVID-19 survivors vary, but the rate is generally understood to be about five per cent. One study published by researchers from the University of New South Wales found that five per cent of people diagnosed during the ‘first wave’ in NSW still had persisting symptoms three months after their COVID-19 diagnosis. However, there are other studies that contend rates of long COVID could be even higher. Researchers from the University of Oxford found there could be as many as one in three people who experience at least one long COVID symptom in the three to six months post infection.

Even based on the most modest estimates of prevalence at around five per cent, there is the potential for hundreds of new long COVID cases in Australia each week.

Evidence suggests even low rates of COVID-related illness could lead to a significant future burden of disease.

But with this degree of uncertainty, it is all the more important to standardise and harmonise data on long COVID in Australia.

 

Managing long COVID

Without knowing the scale of the problem, it’s impossible to prepare for the future management of long COVID.

While there are long COVID clinics at some major hospitals around Australia, the advice from state and territory health departments is that anyone experiencing long COVID symptoms should see their general practitioner (GP).

The Royal Australian College of General Practitioners (RACGP) has warned this is not a sustainable solution. RACGP president Dr Karen Price has said GPs are preparing for an influx of post-COVID-19 symptoms that will add to an already challenging workload and she has called on federal, state and territory governments to provide support.

The Australian Healthcare and Hospitals Association (AHHA) has also highlighted the lack of planning for long-term management of post-COVID conditions. AHHA Chief Executive Adj Prof Alison Verhoeven said there is a need to establish a national post-COVID Centre for Excellence and ensure genuine modelling to plan for managing future long COVID burden.

The World Health Organization has recommended countries adopt a systemic approach to collecting data on long COVID and make a commitment to post-COVID rehabilitation.

What is needed now is a commitment by state, territory and federal governments to the ongoing treatment and management of long COVID.

 

Long COVID and health equity

The COVID-19 pandemic has highlighted and exacerbated social, economic and health inequalities.

Those on lower incomes and casual workers are at increased risk of exposure to the virus at work and research shows they are more likely to be hospitalised or die from COVID-19.

But the impact of the pandemic has far broader implications in terms of worsening existing structural disadvantage such as access to housing, healthcare and employment.

While state, territory and federal governments have attempted to reduce the impact of those inequalities by ensuring things like widespread access to testing, JobKeeper payments, increased JobSeeker payments and COVID-19 sick leave payments, those supports are now being wound back.

And while the risk of acute illness from COVID-19 has been reduced by widespread vaccination, the risk of inequality associated with long COVID, remains.

The end of the pandemic leave disaster payment means those who need to take time off for long COVID related illness have no safety net, other than leave entitlements provided by their place of work.

This is despite Treasury data that shows long COVID has “absolutely smashed” the labour market and was responsible for tens of thousands of absentee days in the first half of this year.

Given the over representation of people from disadvantaged, marginalised and vulnerable groups in experiencing acute COVID-19 illness and related social and economic impacts, those experiencing long COVID are at greater risk of these systemic inequalities.

 


The PHAA is developing a submission to the Long COVID and Repeat Infection Inquiry.

If you would like to provide input to our submission, email the PHAA Policy and Advocacy team.

 

Image: Mat Napo/Unsplash

 

 

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