Introduction by Croakey: The COVID-19 wave is far from over. While many politicians and others appear to have their heads stuck in the sand about the long-term implications of the pandemic, there is an urgent need to address related issues, including overcrowded housing, prevention of infection, and Long COVID, writes Alison Barrett.
Alison Barrett writes:
Many countries across the globe are in the midst of another wave of COVID-19 cases, largely due to the more transmissible Omicron sub-variant, BA.2.
Currently, nearly 500,000 Australians have COVID-19, though actual numbers are likely to be far higher due to under-reporting of cases.
Cases are also increasing in the United Kingdom, Canada and China – where many people and cities are now in lockdown as part of efforts to maintain their zero-COVID strategy.
While preliminary evidence indicates the BA.2 variant is 30 percent more infectious than BA.1, the latest epidemiological update by the World Health Organization on global COVID-19 indicates that overall global cases and deaths have declined in recent weeks.
See below tweet by Dr Eric Topol for a comparison between Omicron BA.1 and BA.2 variants.
While case numbers do not tell the whole picture, particularly if greatly under-reported, they provide an indication of what may come. More cases will eventually result in more hospitalisations, severe disease and deaths.
Melbourne University clinical epidemiologist Professor Nancy Baxter told The Sydney Morning Herald “even though Omicron [BA.1] appeared less severe and the fatality numbers were lower, the sheer number of infections meant a substantial number of people died and got ill in a short period”.
Today, 2,811 Australians are in hospital, down from 2,836 yesterday and 114 are in intensive care. During the pandemic, 6,462 Australians have died from COVID.
It is estimated that the BA.2 wave will peak in Australia mid-April.
Ongoing housing concerns
Increasing COVID-19 case numbers are placing substantial pressure on Aboriginal and Torres Strait Island healthcare workers and communities across Western Australia, and highlighting longstanding concerns about inadequate housing.
The Kimberly Aboriginal Medical Service (KAMS) CEO Vicki O’Donnell told Croakey that AMS staff were extremely busy managing COVID-19 in the community whilst also providing the usual primary healthcare.
“You’re still dealing with primary healthcare because we’ve got the highest rates of chronic disease. So, you’re still dealing with all of those normal daily things in the clinics you would normally have and COVID has just escalated even more,” she told Croakey.
O’Donnell, who is also the chairperson of the Aboriginal Health Council of Western Australia (AHCWA), said one of the biggest challenges for AMS workers across the state is helping people to isolate when they live in overcrowded housing.
“That was always the case because there hasn’t been any money spent on, or new, houses in our rural or remote areas for 20 years. So that was always going to have an effect on us once you’ve got COVID cases. And you’re isolating people all in their overcrowded houses,” she said.
Other challenges highlighted by O’Donnell include ensuring people in the community had access to food, information and education about using a rapid antigen test (RAT), and access to the internet to report RAT results.
AMS staff are critical in providing social support as well as healthcare in their communities.
O’Donnell told Croakey that many of these challenges were identified 18 months ago and that while many of the issues such as food security and transportation are “starting to be ironed out”, she said it was “disappointing that it’s taken this long to get things in place.”
She reiterated the biggest ongoing challenge they have is housing.
“I can’t highlight enough about the housing issue. Overcrowded homes are one of the biggest issues we have through all of this,” O’Donnell told Croakey.
“Overcrowding has been highlighted repeatedly to government as a problem for over 20 years, and now we are in the midst of a COVID-19 pandemic and people need to isolate and can’t adequately and no other options are offered. We are going to see a rise in health issues and spikes in preventable diseases such as Strep A infection, trachoma, Rheumatic Heart Disease and other environmental health diseases just to mention a few.”
Long COVID
While also beneficial for predicting if/or when hospitalisations may increase, COVID-19 case numbers provide an indication of how many people may get long COVID and require care beyond the acute phase of the illness.
Speakers at a webinar hosted by the Australian Healthcare and Hospitals Association last week highlighted that although knowledge about long COVID had increased over the past two years, we are still in the early stages of learning about it.
Some challenges in researching long COVID include the wide variety of post-COVID-19 symptoms reported, small population samples and the relatively short duration of study follow-ups.
Dr Itzchak Levy from Sheba Medical Centre in Israel told the audience that in a review of studies his research team found that approximately 20 percent of people who acquired COVID-19 went on to get long COVID.
However, they also found that the quality and certainty of evidence in the studies was low and the results should be interpreted with caution.
Professor Martin Hensher from the University of Tasmania told Croakey that one of the challenges with long COVID research in Australia was the limited number of COVID-19 cases we had prior to the end of 2021.
Small studies were conducted but they do not “give you the statistical power to really tell you what’s happening,” he said. Ideally, he would like to see large-scale data surveillance similar to that by the UK Office for National Statistics (ONS).
“I do think that either the ABS [Australian Bureau of Statistics] or Australian Institute for Health and Welfare need to be doing big surveys like the ONS has been. I particularly think the ABS needs to be linking in with labour force and disability surveys to see what kind of impact this is having on rates of disability etc,” he said.
Hensher’s research team use estimates from the ONS for their modelling, which indicate approximately five to 10 percent of people with confirmed COVID might get long COVID.
In addition to short follow-up durations, many of the long COVID studies are based on people who have been hospitalised with COVID-19 and “for reasons which might not have anything to do with long COVID, particularly are sicker and probably stay sick for longer,” Hensher told Croakey.
The National Institute for Health and Care Excellence (NICE) definition for long COVID, consistent with the World Health Organization’s definition, is:
- when signs and symptoms of COVID-19 that develop during or after infection continue for more than 12 weeks and are not explained by an alternative diagnosis.
Acute COVID-19 is when signs and symptoms of COVID-19 occur for up to four weeks post infection, and ongoing COVID-19 is when signs and symptoms occur from four to twelve weeks post infection.
Slide source: Dr Gail Allsopp, Clinical Lead for Clinical Policy and General Practitioner, UK
The most common long COVID symptoms include fatigue, “brain fog”, memory impairment, shortness of breath, insomnia and exercise intolerance.
The general consensus from the presenters is that support and care for long COVID requires a multidisciplinary approach including primary care, physiotherapists and mental health professionals.
Patients also need to be taken seriously with a thorough diagnostic investigation to determine if persistent symptoms are long COVID or another condition.
Hensher also suggested during his presentation that it is important to involve patients in long COVID research and the co-design of services.
Australian guidelines for caring for people with COVID-19, including long COVID can be viewed here.
Dr Gail Allsopp, General Practitioner and Clinical Lead for Clinical Policy at the Royal College of General Practitioners, told webinar attendees that support for the healthcare workforce is also required.
Many healthcare workers have caught COVID-19 while at work and require sufficient time to recover. Allsopp said occupational health and sick leave is not universally provided across the UK and many are running out of paid sick leave.
Hensher told Croakey that the trajectory and duration of long COVID is still unclear but “most people who develop long COVID are probably not going to have it for long” and will generally recover within one year.
While different to long COVID, emerging evidence about damage to various organ systems in people who have had COVID-19 highlights “another track of people who will need some degree of long-term care and for whom COVID will have long-term health consequences,” Hensher said.
Prevention is still important – as Hensher said: “Every case we can prevent, is somebody who won’t go on to develop long COVID or these more serious impairments.”
With all that is known about long COVID, in addition to the uncertainty, it is surprising that more is not being done in Australia about long COVID.
As previously discussed at Croakey by Professor Lesley Russell Wolpe, the “Morrison Government has conspicuously failed to address the issue”.
See Croakey’s archive of articles on COVID-19.
