Complacency and a lack of information and awareness about the ongoing risks of COVID are a major concern, according to health and aged care leaders, who describe how health services and workers, as well as priority populations, are being affected.
Alison Barrett writes:
While we are no longer in the emergency phase of the pandemic, it is continuing to affect many individuals and families and place additional burdens on the healthcare system.
As Adjunct Associate Professor Lesley Russell recently wrote at Croakey, national COVID data is lacking – Australia has “no effective national surveillance or no standardised national collection of epidemiological and genetic data”.
Without this data we will struggle to plan for future waves, identify accurate prevalence of long COVID, and evaluate the effectiveness of interventions and treatments.
Due to incomplete data on long COVID and wide variations in prevalence and definitions, it is challenging to determine how many Australians are affected.
The Australian Institute of Health and Welfare estimates the prevalence of long COVID in Australia to be 5-10 percent of people who have had COVID. The Office of National Statistics in the UK has recently estimated prevalence of long COVID to be four percent of first infections and 2.4 percent of re-infections.
Croakey’s series about the ongoing impacts of the COVID-19 pandemic has highlighted the pandemic’s burden on the health system, healthcare workers and disproportionate outcomes on priority populations.
The second article in the series argued that governments could do more for an equitable approach to managing the pandemic, including having a greater focus on reducing transmission, facilitating clean air and a more effective communications strategy, tailored to specific contexts and population groups.
Longstanding systemic issues
Dr Clare Skinner, President of the Australasian College for Emergency Medicine, said that COVID-19, alongside other seasonal viruses and infections, is exacerbating longstanding pressures and systemic issues in Australian emergency departments.
“Negotiating the pandemic’s lasting stressors – while ensuring we also equally address the multitude of other significant, systemic issues our health systems and communities are facing – must remain a core concern for all involved in Australian acute healthcare in the short, medium and long-term,” Skinner said.
She told Croakey that emergency clinicians across all states and territories continue to describe “some of the busiest shifts they have experienced”.
“Managing COVID-19, like other challenges in our EDs, requires complex, systems-based thinking and a willingness from all governments and health stakeholders to lead and collaborate.”
In a recent article at Croakey, Andrew Hewat, Executive Officer of the Victoria Allied Health Professionals Association, described the impact that COVID was having on the health system and healthcare workers.
“COVID has taken regular healthcare workload pressure and put it on steroids,” he wrote. Many healthcare workers are burnt out and suffering mental health stress.
The longer term impact on healthcare workers has also been highlighted by a recent Victorian study.
Increased burnout and reduced optimism, wellbeing and resilience were more frequently reported by health and aged care workers during late 2021 and mid-2022 than in mid-2021, it found.
National Aboriginal Community Controlled Health Organisation Medical Advisor Megan Campbell told Croakey that “COVID-19 continues to spread and affect many people across the country, including ACCHO clients and staff”.
Read the article about Dr Fiona Mackintosh’s experiences with long COVID.
Disproportionate outcomes in aged care
Between 13 December 2021 and 24 January 2022, COVID cases, hospitalisations and deaths occurred more frequently in residential aged care facilities located in disadvantaged quintiles (based on the Socio-Economic Indexes for Areas or SEIFA), according to a recent study.
The study of 86 residential aged care facilities in southeast Queensland found that approximately 12 percent of residents acquired COVID during the study period, as did approximately 14 percent of staff.
In 59 percent of the RACFs, at least 90 percent of the residents had received at least two vaccines.
The study found that the likelihood of hospitalisation and death was higher for residents who had received zero, one or two vaccine doses than for those who had received three doses.
With all the data pointing to inequitable outcomes for priority populations, why isn’t more being done to protect them?
Complacency risk
“Complacency is the biggest risk with COVID for all Australians,” according to Tom Symondson, CEO of Aged and Community Care Providers Association (ACCPA).
It’s vital we don’t become complacent, and that we do everything possible to minimise the risk of COVID-19 as well as other infections for all Australians and particularly older Australians who remain among the most vulnerable to COVID-19, Symondson said.
“Throughout the pandemic, aged care providers have strived to minimise the risks of COVID-19 and other infections for older people.”
Symondson told Croakey that ACCPA recently contributed to revising the Sector Code for Visiting in Aged Care Homes with COTA Australia and the Older Persons Advocacy Network.
The revised guidelines were developed with the “aim of creating a balance between isolation and resident safety,” he said, supporting access for an “essential visitor for aged care residents, even during lockdowns”.
“We know that isolation away from family is difficult and these new guidelines are about improving the lives of older Australians, while protecting them,” Symondson said.
ACCPA encourage all Australians to keep their vaccinations up to date, particularly older Australians.
Symondson said the Association encourages family and friends to follow the new guidelines when visiting aged care facilities. “If you are sick and have any symptoms, it’s best to protect loved ones and delay visiting them.”
Consumer voices on long COVID
Paige Preston, the Senior Manager Policy, Advocacy for the Lung Foundation Australia, told Croakey that many people are not aware that long COVID is “a very real condition, or even what it is”.
The Foundation is urging people to “remain vigilant as COVID continues to be a major health concern” and to ensure they are up-to-date with COVID and other vaccinations, particularly during winter while other respiratory viruses are circulating.
“The incidence and impact of long COVID cases is an increasing public health concern,” Preston said.
Involving “significant consumer and clinician input”, Lung Foundation Australia created a comprehensive resource hub for people living with long COVID, to be a “vital bridge” in the knowledge gap of long COVID.
Preston told Croakey that their “resources are designed to help people navigate their long COVID journey and outline common symptoms, provide helpful self-management tips, treatment information and expert advice on how to discuss the condition with healthcare professionals, family and friends”.
“More is needed to meet demand and ensure that Australians living with lung disease, lung cancer, or now long COVID, have the support they need,” she said.
Lung Foundation Australia supports the nine recommendations from the Federal Government’s parliamentary inquiry into long COVID and repeated COVID infections, particularly recommendations on “research investment, establishing a single COVID-19 database administered by the upcoming Centre for Disease Control, developing guidelines for long COVID diagnosis and treatment, and improving the current vaccination communication strategy.”
The Lung Foundation Australia looks forward to contributing to the Department of Health and Aged Care’s development of a national plan to respond to long COVID, Preston said.
Healthcare concerns
Professor Tania C Sorrell, Professor Martin Hensher and Professor Lena Sanci recently wrote about the need for “innovative solutions to care adequately for people with post-COVID-19 conditions”.
“Long COVID is precisely the kind of challenge the current Australian health system finds most difficult: a non‐fatal, chronic condition manifested as complex combinations of symptoms, without a simple diagnostic test or definitive pharmacotherapy, and causing distress to people with the disorder, who may need considerable face‐to‐face and other contact care,” they wrote in The Medical Journal of Australia.
The response to long COVID should be co-designed with patients and there must be equitable access to appropriate multidisciplinary healthcare, they said.
Professor Kathy Eagar, Foundation Director of the Australian Health Services Research Institute, and previously a columnist at Croakey, said:
“I’m a realist about COVID. The genie can’t be put back into the bottle and COVID is here to stay. But we can be doing a much better job in minimising spread by implementing sensible public health measures.
“The reality is straightforward. Like other investments, investments in public health can only be warranted if there is a return on that investment.
“If we don’t do a better job containing COVID, hospitals will necessarily consume a bigger percentage of the health dollar every year. And failure to better contain COVID will be largely to blame.”
• Note, the Department of Health and Aged Care has provided a response to some of the concerns raised in the articles in this series, which will be published in a future article.
