Introduction by Croakey: As Australia’s Chief Medical Officer Professor Paul Kelly stands accused of downplaying the significance of Long COVID, the head of the World Health Organization (WHO) has urged countries to do far more to tackle this problem.
Writing for a new series on Long COVID launched by The Guardian, Dr Tedros Adhanom Ghebreyesus warned that the condition is “devastating” the lives and livelihoods of tens of millions of people globally, and wreaking havoc on health systems and economies.
While the pandemic has changed dramatically due to the introduction of many lifesaving tools, and there is light at the end of the tunnel, the impact of Long COVID for all countries is very serious and needs immediate and sustained action equivalent to its scale, Tedros wrote.
Countries must now “seriously ramp up” both research into the condition and access to care for those affected if they are to “minimise the suffering” of their populations and protect their health systems and workforces.
Five key elements were needed to drive efforts in tackling Long COVID, he said. Countries need to listen to patients, use their “first-hand knowledge” to shape Long COVID policies, and collect better data to understand the condition better. Sharing of information between countries must be improved to “quickly close knowledge gaps” worldwide.
He also called for “equitable access” to COVID tests, treatments and vaccines to avoid infections in the first place and thereby cut the risk of Long COVID, “sustained investment” in Long COVID scientific research, and prompt multidisciplinary care.
In Australia, the House Standing Committee on Health, Aged Care and Sport has been “tasked with doing an inquiry into Long COVID, post COVID and recurrent COVID, its risks and costs to the health system”, according to committee Chair Dr Mike Freelander.
Below, Croakey managing editor Alison Barrett reports on her recent interview with Freelander, who calls himself a paediatrician first and politician second. The inquiry’s terms of reference are here, with submissions closing on 18 November.
The Consumers Health Forum of Australia is holding a consultation on 19 October seeking feedback from community members to help inform their submission.
Alison Barrett writes:
Hearing the voices of young people is one of Dr Mike Freelander’s key intentions in the parliamentary inquiry into Long COVID and repeated COVID infections.
The inquiry needs to reach out to young people and see how post COVID symptoms have affected them as their voice hasn’t been heard as much during the pandemic, the MP told Croakey.
“We’ve tended to pat them on the head and say ‘do as we say’…and I’m really keen to talk to young people” during the inquiry, Freelander said.
Also a paediatrician, Freelander told Croakey that he and his colleagues have noticed that children appear to be presenting with ongoing respiratory symptoms rather than lethargy – one of the more typical symptoms of Long COVID. The inquiry will explore post COVID symptoms in children and any related effects on education.
In addition to hearing from young people, Freelander said the inquiry was interested in finding out the impacts of Long COVID on those who have felt the worst effects of the pandemic to determine “how we can protect them” moving forward.
This includes people with immune disorders such as lupus and rheumatoid arthritis, culturally and linguistically diverse communities and Aboriginal and Torres Strait Islander people, acknowledging that Aboriginal groups in western NSW are still feeling the effects of COVID.
While most people recover from a COVID infection with no complications, a “significant number of people” do have long-term complications that are not simply Long COVID symptoms, but post-viral diabetes, stroke and cardiovascular disease, Freelander said.
Freelander said that the inquiry “is not a partisan exercise. It’s not a matter of looking back and blaming the past for what they did or didn’t do. It’s a matter of looking forward and trying to see how we can best plan government policy”.
He told Croakey that a “lack of data” is one of the current challenges in Long COVID management and we “need some definitive information” and more accurate data for the Government to act on.
Freelander said the United States had been investing a lot of resources into getting more accurate information about post-COVID problems (as reported by Nature).
A strong evidence-base is required to inform government decisions on how best to support patients with Long COVID in the future, he said, cautioning against relying solely on anecdotal reports “because it can lead us down tracks that are going to cost a lot of money”.
Inquiry members want to hear from as many people as they can – “it is important that people have their voices heard,” Freelander said.
Public submissions may be lodged on the Australian Parliament’s website before 18 November. As well, the Committee will hold public hearings in capital cities and also reach out to research, medical and public health organisations.
Freelander told Croakey the Committee has reached out to the National Aboriginal Community Controlled Health Organisation and plan to meet with them.
New findings
Meanwhile, ANU researchers this week released new findings on the experience of COVID-19 in Australia. They report that 29 percent of adults with confirmed or suspected COVID-19 experienced Long COVID symptoms more than four weeks post acute infection, which equates to an estimated 14.2 percent of Australian adults.
“We estimate that 4.7 percent of adult Australians have had or currently have post-COVID-19 syndrome (symptoms that lasted three months or more),” they wrote.
Along with the long-term medical and physical outcomes of COVID, the inquiry will explore mental health impacts, Freelander told Croakey, acknowledging the pandemic’s effects on mental health are complex.
He said it is important not to over-medicalise the mental health impacts, but look at practical solutions, such as keeping people connected to community.
“In the last few years, we’ve spent a lot of money on mental health without much in the way of demonstrable outcomes,” he said. “A lot of issues in mental health can be fixed by giving people access to housing and access to community engagement.”
The inquiry will explore the best way to manage Long COVID moving forward by evaluating options in primary care, community nurses, GPs or specialist Long COVID clinics.
Freelander said his “gut feeling is that we probably need to move away a bit from special treatment centres because they can get very quickly overwhelmed so you end up with a Long COVID centre that has a waiting list of 12 months or so”.
This is an issue being experienced in the United Kingdom where clinics to treat people with Long COVID “are accepting no more than 5,000 new referrals each month”, reports the BMJ. With an estimated two million British people with Long COVID, at this rate, it would take more than five years for those most severely affected at present to be seen.
While there may be a need for Long COVID centres, Freelander suggests that GPs and community nurses might be better placed to support patients with Long COVID. However, “we know there are problems getting access to primary care”.
In addition to primary care, Freelander recommended that structural supports be explored to help people cope in various different ways in schools and workplaces, such as supporting people to work from home, or adolescents with Long COVID to do a mix of study from home and school.
Continuing discussion on social and structural determinants of health, Freelander said that while he was not as “strident as some people about it”, National Cabinet’s decision to remove mandatory isolation and Pandemic Disaster Leave Payments could “have been thought through a whole lot better”.
Freelander told Croakey that people should have to isolate when infected, but “we have to continue paying them. Many people in his electorate are in casual or part-time work – “if they don’t work, they don’t get paid”.
“I think it was a bad public health decision to stop the pandemic payments,” he said.
Freelander has been a paediatrician in Campbelltown for 37 years and was elected to represent Macarthur in 2016.
More from Twitter on recent COVID developments
Read the “Key lessons” article.
See this Twitter thread about the article on pandemic origins. 
See Croakey’s archive of articles on chronic conditions
