Elderly Australians are bearing the burden of the surging COVID caseload, and United States experts have proposed a new definition for long COVID, according to the latest edition of The Health Wrap.
Dr Lesley Russell also reports on the challenges confronting emergency departments, discrimination against people because of their weight, and how medical research is short-changing older women, as well as highlighting the importance of innovation and evaluation in healthcare, and previewing an international social prescribing conference that will be held in Sydney next week.
The quotable?
Long COVID is an infection-associated chronic condition that occurs after SARS-CoV-2 infection and is present for at least three months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems.”
Lesley Russell writes:
This edition of The Health Wrap is a week late because I’ve been hiking on Kangaroo Island. I did the relatively new Kangaroo Island Wilderness Trail at the western end of the island (the part that was so badly burnt out in the 2019-2020 bushfires).
The walk – about 66 kms over five days – is a long, relatively flat terrain that is alternatively quite rocky and packed sand (at one point you actually walk on the beach).
It highlights the amazing recovery from the fires (and in spring with wildflowers the trail would be even better) and the rugged coastline.
There were lots of birdlife, seals, kangaroos and echidnas. It was a wonderfully rejuvenating week.
COVID-19 rages in Australia and internationally
Sadly we are back to having COVID-19 as the lead story on The Health Wrap. Even more sadly, it is not the lead story on mainstream media.
In Australia, the CovidLive website shows over 1,000 Australians were in hospital with COVID-19 on 14 June.
It’s impossible to know how many people are getting infected, but so many people I know have reports of self or friends with COVID-19.
It seems that most of the disease burden is borne by the elderly.
The Department of Health and Aged Care reports that, as of 13 June, there were 4,147 active COVID-19 cases reported in 487 active outbreaks in residential aged care homes across Australia.
That represents an increase of 180 outbreaks, 48 new resident deaths and 3,779 combined new resident and staff cases reported since 6 June 2024.A major factor is the drop-off in current vaccinations: 17,619,300 Australians have not had a booster shot in the past six months and only 40.3 percent of permanent aged care residents have received a COVID-19 booster shot within the past six months.
There is also a surge in cases in Europe and the United States.
The increase is apparently driven by new FLiRT variants of the Omicron strain. Within the FLiRT family, one variant in particular, called KP.2, has risen to prominence. KP.2, which is very infectious and seems to be better at evading the immune system, is already in Australia.
Australia is being hit not just by a COVID surge but also a raft of other respiratory illnesses – RSV, influenza, pertussis (whooping cough), and pneumonia.
Long COVID – progress in addressing treatment needs or not?
The US National Academies of Sciences, Engineering, and Medicine has developed a new definition of long COVID with the aim of improving consistency, documentation, and treatment for both adults and children.
“Long COVID is an infection-associated chronic condition that occurs after SARS-CoV-2 infection and is present for at least three months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems.”
There is a positive commentary on what this definition means for clinicians and patients here and negative commentary here.
Earlier this year, Croakey’s Alison Barrett reported a range of opinions about the Australian Government’s decision to use the terminology, ‘Post-Acute Sequelae of COVID-19’ or PASC, when almost all media and public communications use ‘long COVID’.
The failure to properly recognise the burden of long COVID for individuals, the community and the economy has substantial consequences, as outlined in the Twitter/X thread below from Professor Brendan Crabb.
A recent study shows COVID-19 infections can cause new health problems even three years after infection.
Some of the long-term effects and disabilities are outlined in a consensus study report from the US National Academies of Science, Long-Term Effects of COVID-19: Disability and Function Following SARS-CoV-2 Infection.
Obesity and equality in the workplace
In the 21 May edition of The Health Wrap, I looked at some of the measures in the 2024 Federal Budget aimed at addressing inequalities, with a particular focus on women.
Here’s an issue that was not covered: discrimination against women who are perceived to be obese.
The data are from the United States and the United Kingdom, but I think we can be pretty sure the findings apply in Australia.
Findings published last year by the UK-based Institute for Employment Studies found weight-based stigma and discrimination were “common and pervasive” in the jobs market and in employment settings.
Up to 45 percent of employers said they would be reluctant to employ a candidate living with obesity and many in positions of power are convinced that discrimination against the people living with obesity is justified.
There is a report of the Institute’s work in this area here.
An analysis of US data shows that there is an “obesity pay gap”; this also exists for men, but is less than that for women.
I did find an Australian paper from 2021 that indicated that Australians (especially young women) felt discriminated against on the basis of their weight when apply for jobs.
Last May, New York City enacted a law to ban on discrimination based on a person’s weight. The law adds weight and height to the list of characteristics that are protected from discrimination, along with race, gender, age, religion and sexual orientation, and will apply to employment, housing and access to public accommodations.
Innovation in Emergency Departments – what’s happening?
For two decades, the demand for emergency department (ED) services in Australia has outpaced population growth and wait times have increased.
While demand is a contributing factor, EDs are currently being impacted by various factors across the entire health system. They have been described as the canary in the coalmine of the healthcare system.
There have been lots of proposals about how to tackle this. Indeed, I have boldly offered my own ideas (see Suggesting some disruptive solutions to the crisis in Emergency Departments).
Others with more experience have done better (see At a time of looming crisis, a vision for health system transformation from Dr Clare Skinner).
That paper from Dr Skinner was published in 2020 and, despite the endless media stories (you can track some of them in the Croakey archives here), nothing much seems to have happened.
In February 2022, then Health Minister Greg Hunt announced the Morrison Government would invest up to $24 million (from the Medical Research Future Fund) in research to improve acute care systems and reduce waiting times in hospital Emergency Departments.
The ten projects to be funded were announced in May 2022.
As far as I can determine, there are no results yet available from this research.
In February this year, the Emergency Medicine Foundation launched a $1.3 million fund for new research grants dedicated to addressing the pressing issues in emergency care to improve patient outcomes in Australia.
Studies from the United States (see here and here and here) show that addressing health-related social needs (including housing) is effective in reducing frequent Emergency Department visits by so-called “frequent flyers”.
The Minns Government established a taskforce to tackle Emergency Department wait times last December.
The NSW Budget handed down this week has $480.7 million in a package of initiatives that, it is claimed, “will help to avoid an estimated 290,000 visits to emergency departments each year once fully implemented”.
This announcement does not mention the Taskforce, so we can only assume the initiatives are based on the recommendations it has made (if it has made any – I can’t find any references to a report on the internet).
Meanwhile the urgency for substantive reform is plain. The Bureau of Health Information Healthcare Quarterly report for the first quarter of 2024 shows that ED attendances are at the highest level since reporting began 15 years ago.
Clearly this situation is not helped by the burgeoning caseload of COVID-19 and other respiratory illnesses.
US Supreme Court and health
Too often these days we are confronted with news from the United States that has us wondering where that country is headed. One of particular concern is women’s rights with respect to reproductive health.
Increasingly these issues are ending up in the courts, and make their way to the US Supreme Court, where the conservative justices are dominating the decision- making.
The Court’s 6-3 conservative supermajority has already overturned Roe v. Wade, sharply limited affirmative action, expanded gun rights, and hampered the government’s ability to address threats like climate change, and LGBTQ+ discrimination.
A number of decisions are due for release by July that could further reshape health policy in the United States.
There was, however, some good news last week when the Court unanimously ruled (9-0) that a law suit brought by a group of anti-abortion doctors that argued that the Food and Drug Administration had not properly approved the drug mifepristone (approved nearly 25 years ago for medical abortions) did not have legal standing.
Good explainers of the decision and its consequences are here and here.
Do not, however, see this as the end of this attempt to end women’s access to medical abortions.
While Trump has sent mixed messages on this very contentious issue, restricting access to the drug is certain to be part of his efforts should he win the presidency again.
In case you missed it
Here are some quick summaries of interesting topics.
Advancing health equity through value-based care
The Medicare and Medicaid Innovation Center at the US Centers for Medicare and Medicaid Services (instituted as part of Obamacare) has health equity as one of its five strategic objectives.
Models or pilot programs based on this objective incorporate requirements for socio-demographic data collection and reporting, development of health equity plans, and screening and referral for health-related social needs.
Many models also include innovative payment policies and supports for providers and suppliers caring for underserved populations.
A recent paper in Health Affairs outlines progress in this area.
I often push for Australia to adopt such an innovation centre as a way of testing and tweaking new models of care and financing. It recognises that changes in the original model are always needed, that monitoring and measuring progress is critical, and that it takes time to see outcomes.
Older women are being significantly shortchanged by medical research
In a recent article in The Washington Post, research on older women’s health is described as “completely inadequate.”
“It’s assumed that women’s biology doesn’t matter and that women who are premenopausal and those who are postmenopausal respond similarly,” said Dr Stephanie Faubion, director of the Mayo Clinic’s Center for Women’s Health.
“This has got to stop: The FDA has to require that clinical trial data be reported by sex and age for us to tell if drugs work the same, better or not as well in women.”
In the United States, the Biden Administration has recently established A White House initiative on women’s health research.
The 2024 Budget from the Albanese Government has $160 million for what is described as “a tailored women’s health package to tackle gender bias in the health system, upskill medical professionals and improve sexual and reproductive care”.
While much research around pharmaceuticals is driven from outside Australia, let’s hope that some of the current biases, including the fact that women (and especially older women) are under-represented in medical research, will be recognised and addressed.
Better targeting and tailoring of eating disorder research and treatments needed
An article on the University of NSW media page from researchers at the Australian Eating Disorders Research and Translation Centre highlights the fact that one-third of people with an eating disorder are neurodivergent, and traditional eating disorder research and treatments are not meeting the needs of these individuals.
They explain how neurodivergence such as autism and ADHD impact eating and body image, and the importance of developing more informed and effective eating disorder care.
Progress on the Australian Centre for Evaluation
I’ve been keenly following what’s happening with the Australian Centre for Evaluation, which has been particularly championed by Dr Andrew Leigh, who serves as Assistant Minister for Competition, Charities and Treasury and Assistant Minister for Employment.
The Centre was established a year ago within the Treasury Department, with a modest budget and staff. It aims to encourage government agencies to use its services.
Leigh’s recent speech to the Australian Evaluation Showcase is here.
In this speech he announces that the Paul Ramsay Foundation has provided support ($2.1 million) to support the work of the Centre.
Some of the policy areas that will potentially be evaluated with this funding are outlined in an article in The Mandarin.
Demonstrating that preparedness saves lives
The 2024 report on Epidemics that Didn’t Happen from Resolve to Save Lives makes fascinating reading.
It highlights that many of the disease outbreaks featured in the report were associated with severe weather events – events expected to become more common due to climate change.
We need more reporting like this to drive better prevention and preparedness.
When your GP retires
A paper from French researchers, published in BMJ Open, looks at how French patients view the retirement of their GP.
Most patients choose their GP based on qualities or skills they value and their choice reflects a certain loyalty to their doctor. Links are strengthened through care and family interactions.
When a GP retires, this link is broken. The researchers found patients’ reactions can range from indifference to real grief. Retiring (and relocating) doctors need to plan for the impact on their patients.
This is an experience I can relate to: several years ago, my GP for some thirty years retired and moved away. She had become a trusted friend and I still miss her (even though I have found another great GP).
Good news on Indigenous health
A great story in MJA InSight+ outlines how Royal Darwin Hospital is using native landscapes, well adapted to climate change, to enhance patients’ wellbeing, Indigenous cultural security and to improve local biodiversity.
Every hospital should be acting along these lines.
(Croakey has also reported on this work a number of times; see here, here and here.)
BTW: this fits in perfectly with a recent Croakey article: Gardening is good for our health. How can we make it more accessible?
Best of Croakey
EACH24 – ASPIRE’s International Social Prescribing Conference will be held in Sydney on 25-27 June.
Dr Ruth Armstrong previews the conference with her article Social prescribing hits the spotlight, with international conference set to profile innovative health and social solutions.
Make sure to follow #EACH24 next week, where Dr Amy Coopes will be live-posting on X/Twitter from the conference, and bookmark this link for more reports from Dr Ruth Armstrong.
And here’s a link to how social prescribing is being used in Australia.
The good news story
At our house we are both reading An Unfinished Love Story: A Personal History of the 1960s by Doris Kearns Goodwin (she’s a very well-known American biographer and historian). The book is really an ode to her late husband Richard Goodwin.
We were both taken with this passage from the 1960 John F Kennedy presidential campaign. Hopefully you will be inspired with reminders of what now seems like the good old days, although of course they were quite troubled.
“Kennedy began with good-natured flattery, referring to himself as ‘a graduate of the Michigan of the East, Harvard University’. He then fell back on his familiar argument that the 1960 campaign presaged the outcome of the race between communism and the free world.
But suddenly, he caught a second wind, and swerved from his stock stump speech that was shot through with pledges and promises of what he would deliver as president. Instead, he asked the gathered young people what they might be willing to contribute for the country:
‘How many of you, who are going to be doctors, are willing to spend your days in Ghana? Technicians or engineers, how many of you are willing to work in the Foreign Service and spend your lives traveling around the world? On your willingness to do that, not merely to serve one or two years in the service, but on your willingness to contribute part of your life to this country, I think will depend the answer – whether a free society can compete’.”
This was the beginning of the Peace Corps (founded in March 1961).
Croakey thanks and acknowledges Dr Lesley Russell for providing this column as a probono service to our readers. Follow her on Twitter at @LRussellWolpe.
Previous editions of The Health Wrap can be read here.
