Lily Pratt, PHAA
On Monday 20 February, the House Standing Committee on Health, Aged Care and Sport held one of several public hearings for their Inquiry into Long COVID and Repeated COVID Infections. PHAA was invited to speak and Professor Catherine Bennett, head of Deakin Epidemiology, and Professor Caroline Miller, PHAA Vice-President (Policy), provided their expertise on our behalf.
This session of the public hearing discussed challenges facing the definition, equity, prevention, and treatment of Long COVID and repeat infections.
Professor Bennett outlined actions PHAA called for in our submission to the Inquiry, including:
- The need for further research into diagnostics and social impacts
- Promoting vaccine uptake
- Ensuring a uniform definition of Long COVID (this may include various subsets of infection)
- Creating a Long COVID register
- Seeing the National Preventive Health Strategy firmly committed to within the new Australian Centre for Disease Control (ACDC) framework.
An ongoing challenge is the definition of Long COVID itself. The WHO defines it as symptoms persisting at least three months from the onset of COVID-19, which is in accordance with international research. However, some consider a definition of four weeks, to ensure faster access to treatment, is required instead.
Professor Bennett highlighted concerns with current definitions, noting a lack of specificity, and “that you will include many other conditions where you do have that overlap with a variety of other pre-existing conditions, including other post-viral conditions.”
Prof Bennett did however note that she thinks the definition “will evolve.”
“I do think that we will have different levels of case definition, some more inclusive, some more specific, as we start to look at this as a constellation of conditions and refine that.”
So, what’s in a name?
Long COVID’s vague definition and diagnosis has likely impacted public understanding of the condition. Many submission respondents made clear that employers did not take their symptoms seriously and were penalised for missing work, or GPs did not diagnose them until much later (in some cases, people felt they were not believed). Delayed diagnosis then meant delayed access to treatment, and their ability to function in society and complete daily tasks was diminished.
This of course has the greatest effect on people with low or insecure income, people with disabilities, people with some co-morbidities, and elderly Australians, with these groups contracting severe COVID at much higher rates than the general population.
Our representatives made two clear policy recommendations that not only addresses the definition, but would also assist in research, diagnosis, prevention, and treatment:
- Set up a register to monitor confirmed and/or suspected Long COVID infections and
- Invest in the ACDC to ensure such registers are swiftly mobilised, and any information gleaned from the monitoring centrally shared.
Recommendation: a registry to gather live data about Long COVID
A register is a larger commitment than usual public health surveillance, “but it has an important difference from surveillance; that is, it allows you to focus on the distribution, prevalence and risk factors associated with conditions like long COVID. Importantly, it also allows you to have that longitudinal follow-up, looking at treatment protocols and outcomes,” Professor Bennett said.
Professor Bennett stressed that there probably will not be one single test to diagnose Long COVID. However, a registry with longitudinal follow up could provide guidance on common continuing symptoms, co-morbidities most associated, and who is affected. This informs policy to better prevent Long COVID and support those afflicted. Such an idea is already in practice to good effect in the United Kingdom.
Recommendation: a fully funded Australian Centre for Disease Control
A registry is a prime example of a public health program that a fully funded and functioning ACDC could administer. Monitoring and collecting data about new conditions should undoubtedly be part of the ACDC’s role. As should providing central guidance of best practice on preventing, diagnosing, and treating conditions like Long COVID. This is currently lacking in Australia.
Additionally, enacting the National Preventive Health Strategy (NPHS) would also play a key role with Long COVID as part of the ACDC.
Professor Bennett urged lawmakers that the NPHS see “a firm commitment within the new Australian CDC program as that develops to make sure we’re recognising [Long COVID] as one of [those] really important conditions that crosses over from an acute to a chronic disease.”
Preventing chronic diseases and promoting good health and wellbeing is a key strategy for managing emerging health threats, and the NPHS aims to create a sustainable prevention mechanism. A mechanism that could help prevent chronic Long COVID and prevent severe illness caused by emerging diseases.
PHAA would like to thank Professors Miller and Bennett for sacrificing their time to lend their insights to this Inquiry, upholding PHAA’s evidence-based standards and providing considered policy expertise.
If you would like to read the full account, including the our representative’s remarks about biomarkers and Long COVID numbers, you can access the Hansard transcript of the public hearing here.
Image: Aditya Joshi/Unsplash