Introduction by Croakey: So much of the political rhetoric around COVID-19 focuses on the short-term as evidenced by repetitive talking points about peaking case numbers.
What we need, however, is leadership with long-term agendas and priorities – whether around sustaining and developing the health workforce into the future or pushing through long-overdue system reforms, as have been urged by so many (including in the latest MJA Insight).
Then there is Long COVID. As the BMJ reported recently, many countries have established Long COVID clinics with more than 80 such clinics in the United Kingdom alone.
Scott Willis, National President of the Australian Physiotherapy Association, is speaking from personal experience when he argues below that there is an urgent need for integrated, multidisciplinary care for people with Long COVID.
(Croakey notes that our first article calling for attention to the long-term needs of COVID patients was published in July 2020.)
Scott Willis writes:
Managing Long COVID will be the next crisis confronting the health sector, and we are unprepared. In the two years since the novel coronavirus was first reported, the failure of domestic pandemic strategies – diagnosis, testing and treatment – has plagued most countries.
The health system is strained to breaking point with overwhelming case numbers. Healthcare workers are stricken with the virus, further depleting the health system’s capability. The transition from continuous, ongoing emergencies to robust health services working as one must be a priority for National Cabinet.
As case numbers spiral to frightening levels, the number of Australians requiring ongoing, post-COVID care will continue to place massive strain on health services. This will likely occur at a time when exhausted health workers are emerging from the latest (Omicron) variant.
The focus on hospitalisation numbers and infection rates is understandable. However, planning for the management of longer-term respiratory conditions and other debilitating effects and lingering symptoms, should be more advanced across all jurisdictions.
Last year, the Australian Physiotherapy Association (APA) wrote to the Federal Government and all state and territory health ministers, urging them to work with physiotherapists. Our rehabilitation treatment is, and will continue to be, essential to the recovery of thousands of Australians afflicted by COVID-19. This is a condition that involves various symptoms, including both physical and mental fatigue, requiring rehabilitative care that extends across a full, multidisciplinary team.
Governments need to move fast in advancing pathways to COVID-19 recovery. Response plans that allow rapid scaling-up of long-term care where COVID-19 control measures fail, are also necessary.
Thousands of Australians with COVID-19 are going to put additional pressures on our already stretched and exhausted health workforce, and need the rehabilitation pathways and recovery programs.
A rollercoaster
Having experienced COVID-19 first hand, I know what lies ahead for many Australians.
After contracting the virus from the North West Regional Hospital here in Tasmania, the past 18 months has been the proverbial rollercoaster. Persistent and intermittent symptoms including malaise, shortness of breath, lack of energy, emotional issues, and reduced exercise tolerance have taken their toll. These spasmodic, long-term effects are the most frustrating. Symptoms are inconsistent and I cannot predict when they will rear their head.
The severity of the virus is not an indicator for the likelihood of developing Long COVID. It impacts on multiple body systems and recovery can be variable, unpredictable and non-linear. Some early estimates suggest that at least 10 to 30 percent of people will continue to have symptoms for up to 12 weeks after their acute infection.
Recommendations that Long COVID be recognised as a distinct and separate disease entity to acute COVID-19 should be considered. Being prepared means adapting and working simultaneously on definition, prevalence and cause. Our ability to accurately capture data will be essential in managing the prolonged disease effects. The absence of specific multidisciplinary Medicare Benefit Scheme (MBS) item numbers for Long COVID means we are not only failing to capture this impact, but that we are failing patients. The ongoing outreach and support is just not there.
In the past, we have seen the medical system act too late in understanding and recognising certain health conditions, such as chronic fatigue syndrome. Too many Australians don’t know where to get assistance from.
Importantly, late last year the Commonwealth updated its advice, acknowledging that the duration of symptoms of long-COVID is unknown, citing a United Kingdom survey that showed nearly 10 percent of people with COVID, reported at least one symptom 12 weeks after their initial infection.
Looking at reports from across the world, the evidence shows that many people will require access to integrated, multidisciplinary healthcare, including physiotherapy.
Our health system has barriers around funding and delivery models that are not being resolved at a national level.
For example, beyond current and very limited MBS chronic disease items, physiotherapy remains unfunded for patients to access. Yet, physiotherapy offers Long COVID patients tailored, individualised treatments that enables them to regain function.
I know this as both a deliverer of physiotherapy treatments and a Long COVID patient.
The aim is to support patients to full mobility; to be able to do ‘normal’ activities by helping pace them through fatigue. Cardio-respiratory physiotherapists in particular, who treat patients with conditions affecting the heart and lungs, and specialise in chronic respiratory and other long-term conditions, will be central to the solution.
We need MBS and Pharmaceutical Benefits Scheme benefits that adequately support patients living with Long COVID, to reduce out-of-pocket costs.
Omicron isn’t necessarily the final variant in this pandemic. We don’t know what lies ahead, but we can predict with some certainty that the future demand will be from those suffering ongoing health problems post-infection.
Integrated healthcare is the best way to provide the ongoing care needed.
I live and breathe the effects of long-COVID, and professional teamwork from doctors and nurses to specialists and physiotherapists, among many other allied health practitioners, is going to be the mechanism that will see Australia transition out of the COVID-19 crisis.
Scott Willis, the first Indigenous man elected National President of the Australian Physiotherapy Association, is a skilled physiotherapist and one of more than two million Australians who have contracted COVID-19. On Twitter, follow @ScottSwillis.
See Croakey’s archive of stories on Long COVID.
