With a national inquiry into long COVID due to release its findings later this month, some researchers argue that homelessness and related concerns must be part of the discussions and policy responses.
Dr Blair Williams, Lecturer at Monash University, and Chris Hartley, Research Fellow at the Centre for Social Impact UNSW, write below that systematic efforts to prevent long COVID will also help to address the drivers of homelessness and housing insecurity.
Their article highlights the importance of Health in All Policies approaches, a regular theme at Croakey.
Blair Williams and Chris Hartley write:
Homelessness and housing insecurity are a growing problem in Australia. Recently released figures from the ABS reveal that more than 122,000 people in Australia experienced homelessness on Census night, an increase of 5.2 percent from 2016.
The Albanese Government has expressed its intention to address homelessness and housing through its proposed introduction of a $10 billion Housing Australia Future Fund which aims to build 30,000 new social and affordable homes over the next five years. Sitting alongside this is a commitment to develop a 10-year National Housing and Homelessness plan to guide government policy in this area.
One of the key motivations in responding to homelessness was the emergence of the COVID-19 pandemic. In 2020, state and territory governments rapidly identified a need for and then implemented emergency housing responses to protect those experiencing homelessness from the worst of COVID-19.
In 2023, however, the housing crisis is deepening, and while governments have been making some progress on this issue, they have so far overlooked that sufferers of long COVID are at an increased risk of becoming homeless within an increasingly unaffordable housing market. Additionally, as we will discuss, the burden of this risk has fallen predominately on women.
Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is a multisystemic condition comprising a myriad of symptoms that persist for weeks or months after the initial recovery from the acute phase of COVID-19.
Its impact has been recognised by the Albanese Government through its establishment of a House of Representatives Standing Committee on Health, Aged Care and Sport (the Standing Committee), to inquire into and report on the health, social, educational and economic impacts on individuals who develop long COVID.
In December 2022, the Standing Committee released a preliminary issues paper summarising the submissions from hundreds of Australians detailing the impacts of long COVID on their lives.
The submissions make for harrowing reading, with sufferers describing the devastating impacts on their physical and mental health. One submission disclosed the drastic changes brought on upon by long COVID, such as:
Barely able to manage daily tasks like showering and feeding myself without chest pain, let alone cleaning, working, etc. Before COVID, I was fit and healthy with no prior conditions, I worked 45+ hours a day on my feet, and I used to play high intensity sports. I have grieved for my old life, with no idea if I’ll ever get back to normal.”
The submissions also included many accounts of formerly employed full health professionals, teachers and academics who have since reduced or lost capacity to work. One noticeable theme within these submissions is the severe financial stress this causes them and their family members:
I lost the ability to function in my job for months and had painful and persistent brain fog and tiredness. I lost the ability to work, I was anxious, afraid and unsure of how my family and I would continue if I didn’t find my way back to health.”
Economic insecurity
While Australian-specific data is still emerging, international studies confirm the considerable impact of long COVID on reducing capacity for work among sufferers.
Research from the United States estimates that between two to four million Americans are currently out of work due to long COVID. One study found that almost 20 percent of long COVID sufferers could not return to work within a year after infection, while another found that 46 percent had to reduce their hours.
Currently, there is little financial support for those suffering from the condition. Prior to the pandemic, it was difficult to get National Disability Insurance Scheme (NDIS) funding for autoimmune disorders like myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a similar condition to long COVID. With both conditions there is a greater prevalence among women and, due to medical misogyny, its severity is therefore undermined.
Long COVID is also not yet considered a permanent disability in Australia, which means that those suffering are unable to access disability support, such as the NDIS or the Disability Support Pension (DSP). This further exacerbates the already precarious financial position of people with long COVID in Australia.
Housing affordability crisis
Research clearly indicates Australia is in the grips of an affordability crisis which exists across the housing spectrum.
As many as one-quarter of mortgage holders were at risk of mortgage stress as of December last year – and the number is only to increase with continued official rates rises and as fixed-term loans end.
There are increasing levels of rental stress in the private market, with over one in five low-income private renters spending more than 50 percent of their household income on rent (30 percent is usually held to be the maximum tolerable share for a low-income household).
With rents forecast to rise by 11.5 percent in 2023, many people within the private rental market are likely to be particularly exposed to eviction. The private rental market also has very few affordable properties for people on lower incomes, particularly those on social security payments.
The unaffordability of the housing system, combined with a limited availability of social housing, is one of the key drivers of Australia’s growing homelessness rates.
With a reduced capacity to work and an inability to access DSP and NDIS, sufferers of long COVID are at an increased risk of becoming homeless or experiencing housing stress. The link between long COVID and homelessness has been identified as an increasing problem in the United States.
While there is currently no available Australian data on the rates of homelessness among people suffering from long COVID, public hearings of the Standing Committee have confirmed that this issue is already occurring in Australia.
This is also a gendered problem. Women make up the majority of people seeking assistance from specialist homelessness services in Australia. They also make up more than 80 percent of the increase in people experiencing homelessness since 2016.
Given long COVID has greater prevalence among women, strategies to prevent long COVID and support sufferers are needed to prevent further overwhelming the specialist homelessness system.
Address the drivers
The Government must implement a variety of strategies to address these overlapping issues. Firstly, there is a need for Australian research into the financial impacts of long COVID on sufferers, in particular on the extent to which it is causing housing insecurity.
On practical level, large-scale investment in social and affordable housing is crucial.
However, we need to also address the drivers of homelessness to prevent it happening in the first place. Given the vulnerable position of long-haulers, this must include government intervention to recognise, prevent and respond appropriately to long COVID.
In particular, the Australian Government should consider expanding the eligibility criteria of the NDIS and DSP to include individuals with long COVID and other autoimmune disorders that cause similar disabling symptoms.
Since there are currently no known effective treatments for long COVID, it is essential to focus on preventing the condition from occurring.
A population-level “Swiss cheese” model must be implemented, combining vaccinations, mask mandates, air quality safety standards, sufficient and accessible testing, infection isolation requirements, further expanded access to antivirals and, most importantly, a swift adaptation to outbreaks and changing circumstances.
Also read this recent article at Croakey: Social and economic costs of long COVID highlighted by global health experts
See Croakey’s archive of articles on housing as a health issue
