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Federal Health Minister acknowledges we need to do much better on COVID

The two related articles below explore some of the issues likely to be considered by any national inquiry into the strengths and weaknesses of Australia’s pandemic response.


Melissa Sweet writes:

Health Minister Mark Butler has this week stressed the importance of a rigorous inquiry – once the challenges of this fraught winter are behind us – into the lessons to be learnt, good and bad, from Australia’s pandemic response.

In a series of interviews and media statements, the Minister acknowledged and engaged with the alarming challenges of Australia’s high transmission rates, pressures on hospitals and other services, and the scale of the Long COVID toll.

“There are still almost 3,000 people in hospital today with COVID. And we’re seeing dozens and dozens of deaths every week. So this is still a very serious health challenge we can’t take lightly,” he told the Sunrise program.

He highlighted the need to increase third dose vaccination rates – more than six million Australians who are eligible for a third dose have not had it. “And we need to get the message out that you’re not fully protected, particularly against Omicron, until you have three doses.”

He said aged care facilities needed to do a better job of boosting fourth dose rates among residents, and also that we need to do better on ensuring those in most need get the treatments now available to prevent severe disease and death.

From today (23 June), the Government is running an $11 million six-week campaign to encourage people to get vaccinated for both COVID-19 and influenza this winter and highlighting the availability of antivirals for those most vulnerable to severe effects of COVID-19.

Despite Butler acknowledging the need for action on a range of fronts, the lack of focus on a vaccines-plus strategy is notable, although World Health Organization and other experts have been stressing for a very long time now that vaccination is only part of the response needed.

Perhaps the promised COVID inquiry will investigate why this has been the case, as well as why so many public health measures are being wound back at such a time, especially given concerns about new Omicron variants and reinfection rates.

Most recently, the WHO’s Dr Maria Van Kerkhove, an infectious diseases epidemiologist, expressed her frustration at countries that are winding back public health measures at a time when globally millions are being infected each week and people are dying unnecessarily.

“Far too many countries have abandoned public health measures (masks indoors, distance), not invested (ventilation, PPE, HCW), continue to politicize COVID-19 undermining the effectiveness of tools that work… all of which allows the virus to continue to circulate intensely,” she tweeted.

“This also results in too many deaths (four percent from last week globally), more Long COVID, more health worker burnout, further inequities in access and care…and this risks more variants emerging that are more transmissible, may be more severe, may have more immune escape…

“What keeps me up at night is the complacency, people suffering, death, the dismantling of surveillance, testing, sequencing, workforce… Pandemic preparedness should be happening now… while we are fighting the current pandemic. Invest now. What are we waiting for?”

Croakey notes that Van Kerkhove’s frustrations have been echoed by many others, as per the tweets at the end of this article.

Another key question for the promised inquiry will be Australia’s response to long COVID.

As Butler said this week, “When you get the sorts of numbers of COVID that we have here in Australia – literally millions and millions of Australians – that is going to translate into very big numbers of people experiencing long COVID symptoms. We don’t yet know enough about it, but what we do know from across the world is this is going to be a major health challenge for the coming couple of years at least.”

Butler said he was “very keen to talk with clinicians, with researchers, have a look at the international research as well, and start to make sure that our health system is prepared for what will be a very big wave of people experiencing these very long symptoms, whether it’s brain fog, fatigue, headaches”.

As the article below suggests, another key issue for the inquiry is what more can be done to address the inequitable toll, not only of the acute illness and the impact of pandemic measures, but also of Long COVID.

It is clear the inquiry will need to consider the adequacy of Australia’s social as well as health responses and their equity implications.

The article below, first published at The Conversation, is by Dr Danielle Hitch Senior Lecturer in Occupational Therapy at Deakin University, and Allied Health Research and Translation Lead at Western Health; Dr Aryati Yashadhana, Research Fellow, Centre for Primary Health Care and Equity, and Visiting Fellow, School of Social Sciences, UNSW Sydney; and Evelyne de Leeuw, Professor, UNSW Sydney.


Danielle Hitch, Aryati Yashadhana and Evelyne de Leeuw write:

Disadvantaged communities not only suffer disproportionately from COVID, they are even more likely to be impacted by the cascading effects of long COVID.

With a new federal government, now is the time to engage in transformative planning to address a range of societal issues, including the impact of the pandemic on the most disadvantaged Australians.

We outline three policy areas to address the impact of long COVID on disadvantaged communities.


Read more: Australia is failing marginalised people, and it shows in COVID death rates

Disadvantaged communities already at risk

The greater impact of pandemics on disadvantaged communities was recognised before COVID.

Along with medical risks such as obesity, these communities already contended with social risks such as poverty, unhealthy environments and disability.

The interaction between these risks produces sustained and multiplied disadvantage, compounding existing barriers to health care and other supports.


Read more: Pandemic pain remains as Australia’s economic recovery leaves the poor behind


Then came COVID

While the pandemic has taken a toll on everyone, there is growing international evidence of greater effects on disadvantaged communities.

Communities with greater insecure employment, housing density and linguistic diversity recorded a higher incidence of COVID infections.

Risk factors for poorer clinical outcomes from COVID – such as hypertension (high blood pressure), diabetes and respiratory disorders – are also more common in disadvantaged communities.

While many developed countries achieved good vaccine uptake, studies report greater vaccine inequity and hesitancy in these communities.

Low-paid, precarious, essential and manual workers also struggled to adhere to stay-at-home orders and social distancing in the face of food and financial insecurity.

All these factors – some in place before COVID, some new – contribute to a higher risk of COVID for disadvantaged communities. That’s even before we start considering the impact of long COVID.


Read more: As lockdowns ease, vaccination disparities risk further entrenching disadvantage


How about long COVID?

Most people with COVID make a full recovery. But for some, symptoms linger. The World Health Organization defines long COVID as new, persistent or fluctuating symptoms present three months after COVID infection, lasting at least two months, and not attributable to other diagnoses.

Globally, 43% of people with COVID have ongoing symptoms affecting daily life six months after infection. Fatigue and memory problems are the most commonly reported of the diverse symptoms linked to long COVID. However, an Australian study of long COVID estimated 5% of people have symptoms after three months.

So we need to learn more why these percentages differ.


Read more: Fatigue after COVID is way more than just feeling tired. 5 tips on what to do about it


Long COVID hits disadvantaged communities harder

In addition to the higher risk of exposure to COVID in the first place, disadvantaged communities lack accessible services and resources to support full recovery.

You can see how issues such as the rising cost of living and the lack of sick pay for casual workers can have a disproportionate impact on disadvantaged people who need to return to work before they are fully recovered.

In disadvantaged communities, there are also more barriers to accessing health care, excluding people already experiencing disadvantage.

For example, we know asylum seekers and undocumented migrants have experienced worse mental health, social isolation and access to health care than other groups during the pandemic.

While telehealth has opened up access for some, it increases barriers for others.

Geographical location is also a barrier for many Australians with long COVID, with most specialist clinics in metropolitan health services.


Read more: Five tips for young people dealing with long COVID – from a GP


A growing problem

The human and financial costs associated with the complex disadvantage resulting from COVID (and long COVID) are vast.

One analysis estimated there would be up to 60,000–133,000 long COVID cases as Australia eased restrictions.

Analyses by the Bank of England and the United States Brookings Institute flag long COVID as a significant factor in future labour shortages.

However, we have few mechanisms to measure and track any impacts. Even putting an accurate figure on the number of COVID cases is difficult due to the greater reliance on rapid antigen tests, rather than PCR tests.

Read more: We calculated the impact of ‘long COVID’ as Australia opens up. Even without Omicron, we’re worried


What needs to happen next?

The relationship between long COVID and disadvantage is a collision between two highly complex issues. With new variants and reinfections, long COVID will be with us for years, further increasing an already complex (or “wicked”) problem.

However, we are yet to see leadership from local, state and territory, and federal governments on this issue.

Disadvantaged communities (particularly those most affected) are yet to be mobilised, to identify and tackle the local problems most affecting their recovery from COVID. Policies to tackle the disproportionate impact on them are yet to be developed.

These three actions would make a meaningful impact on health equity for everyone with long COVID.

1. Measure and track the issue

We urgently need high-quality data on long COVID to understand the trajectory and duration of recovery, and its interdependence with social determinants of health, for example, living in rural/remote Australia or being unemployed.

Investment in nationwide standardised data collection would enable targeted support for the communities that need it most.

2. Acknowledge diversity and intersectionality

A reductionist approach to long COVID or disadvantage that targets single aspects of someone’s identity will not work.

That’s because long COVID symptoms can be multiple and diverse, affecting all body systems. People may also experience multiple layers of disadvantage. So an “intersectional” approach acknowledges how various factors – such as health, poverty, gender or visa status – interplay.

3. Work with disadvantaged communities

Disadvantaged communities are the ones most affected by long COVID. So any policy needs to be developed with their meaningful involvement.

People know what tangible outcomes would work best (or fail) in their community. So it’s crucial to have this input if we are to make real improvements.

Dr Danielle Hitch Senior Lecturer in Occupational Therapy at Deakin University, and Allied Health Research and Translation Lead at Western Health.

Dr Aryati Yashadhana, Research Fellow, Centre for Primary Health Care and Equity, and Visiting Fellow, School of Social Sciences, UNSW Sydney

Evelyne de Leeuw, Professor, UNSW Sydney


From Twitter

Read Professor MacIntyre’s Twitter thread.


See Croakey’s archive of stories on Long COVID

 

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