The deaths of hundreds of Australians in the latest surge of COVID-19 infections and hospital admissions is going unremarked by politicians and senior health officials, reports Associate Professor Lesley Russell.
In her latest column she takes a deep dive into the latest news on COVID and long COVID, including new research highlighting the importance of Indigenous peoples’ authority, particularly healthcare sovereignty, as a key factor of resilience to the COVID-19 pandemic and future health crises.
The quotable?
…elephants in Houston Zoo have been trained to do yoga to help them stay active and healthy…
It turns out other zoos also provide daily yoga routines for their elephants, even the largest of which are quite agile.”
Lesley Russell writes:
There’s been an hiatus for The Health Wrap while I was off on the walking trails of England and Scotland, and the news has piled up in my absence. Most notably, there are lots of new reports around COVID-19 and the ongoing impacts of the pandemic.
So this edition of The Health Wrap starts with a deep dive into the latest news and views on COVID-19 and long COVID.
COVID-19 data updates
This week I was struck by a question Professor Kathy Eagar posed in a tweet.
She asked: “Why are governments (left, right, centre) around the world deliberately downplaying COVID?” and then went on to suggest: “Maybe the answer is simply that it’s sheer defeatism. Having failed to contain the spread early in the pandemic, politicians internationally have now convinced themselves & each other that COVID cannot be contained. So let’s pretend it doesn’t exist & redefine what is ‘normal’.”
I find myself in furious agreement – and, like Professor Kathy Eagar, without answers.
Australia is now in its fifth Omicron wave, which has been brewing since February. A recent article in The Conversation indicates that the slow and drawn out nature of the current wave is most likely due to the sequential emergence and spread of new Omicron sub-variants. The current wave started with XBB.1.5, shifted to XBB.1.9.1 and XBB.1.9.2, then most recently to XBB.1.16.
This wave is seeing fewer reported infections and fewer hospitalisations, but it does coincide with outbreaks of influenza and respiratory syncytial virus (RSV).
It’s no longer easy to find the Australian national data on COVID-19 in a meaningful form: the Federal Department of Health reports the weekly data as rolling seven-day averages.
Thank goodness there are recognised experts who regularly collate and report the data.
[As an aside, it was great to see that Juliette O’Brien (@juliette_io) (founder of covid19data.com.au) and Anthony Macali (tweeting as @covidliveau) were awarded the Medal of the Order of Australia in the King’s Birthday Honours list for their efforts in tracking the pandemic and filling gaps in government reporting and transparency.]
Data from ABC News website
The reported cases for the week include 2,460 in residents of aged care facilities.
What is really shocking is that last week some 200 COVID-19 deaths were reported. Since the pandemic began, more than 21,000 Australians have died, some 4,000 this year alone. These losses go unremarked by politicians and senior health officials (I hope they do not go un-noticed).
At the very least there should be greater efforts made to reduce COVID-19 transmission in healthcare and aged care settings – settings where patients and residents are especially vulnerable and where healthcare workers need protections.
See these recent Croakey articles from Jennifer Doggett:
- Why more needs to be done to reduce COVID-19 transmission in health and aged care settings.
- Calls for a national and consistent approach to clean air in health and aged care.
The other area where more needs to be done is in addressing the burden of long COVID.
Long COVID challenge
How widespread is long COVID? Different studies have provided varying results.
A Dutch analysis of data collected before the Delta and Omicron waves, when few people were vaccinated, found long COVID in about one in eight people.
The US Centers for Disease Control and Prevention, in a large study covering the period from March 2020 to November 2021, found that that, of people who had had COVID-19, one in five adults from 18 to 64 years old and one in four aged 65 years and over experienced at least one persisting health condition.
A new study from the United States looking at people infected after December 2021 (during the Omicron wave) found one in ten met the threshold for Long COVID.
The new data come from a National Institutes of Health project, Researching COVID to Enhance Recovery (RECOVER). A strength of this study is that it follows individuals from the time of first infection – an “acute cohort” that might be more accurate than studies that enrol people several months after infection. Also, it includes a group of uninfected individuals for comparison, because many of the symptoms of Long COVID, such as fatigue, are felt by people with and without a past COVID-19 infection.
What all these studies suggest is that long COVID presents a sizable international issue. Ten percent of the nearly 700 million recovered cases worldwide would mean 70 million long COVID cases in the future and enormous looming economic and social costs.
The Australian Institute of Health and Welfare reports that between five and ten percent of COVID-19 cases in Australia self-reported symptoms persisting for more than three months. But to date there has been no study like RECOVER to accurately assess the national incidence and the symptoms.
A study that followed 94 percent of all COVID-19 cases diagnosed in New South Wales between January and May 2020 (prior to vaccination) found that approximately five percent of people had persisting symptoms twelve weeks after their initial infection.
It is postulated that upwards of eight in ten Australians have at some point likely contracted the disease, so with a Long-COVID rate of five percent, that means some one million people suffering with lingering effects.
The RECOVER study found that people who suffered infections in the early phase of the pandemic — before Omicron — were more likely to have long COVID. Among those who got the Omicron variant, it was more prevalent among those who had multiple infections. Getting vaccinated reduces the chances of getting Long COVID and it seems that getting boosted further reduces the likelihood.
As the recent parliamentary report on long COVID discusses in some detail (see Chapter 2 of the report), there is no agreed definition for this condition in terms of both symptoms and timeframes and there are no diagnostic criteria for prevalent symptoms like fatigue and brain fog. This further contributes to the impact, as patients struggle to get their ongoing illness diagnosed and treated.
The World Health Organization (WHO) notes that more than 200 symptoms have been reported. The RECOVER project identified 37 symptoms, most often present six months or more after infection, and 12 symptoms stood out: post-exercise malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain and abnormal movements.
It’s imperative that there is more research on long COVID done here in Australia. In April, at the time of the release of the parliamentary report on long COVID, the Albanese Government announced $50 million in funding from the Medical Research Future Fund (MRFF) to increase public awareness of long COVID, inform future policy and clinical guidance, and improve health outcomes. These funds will not be available until August 2023.
Previous funding for research related to long COVID includes $13 million from the MRFF and $1.6 million from the National Health and Medical Research Council (NHMRC).
Neurological consequences
An issue of growing concern is the neurological consequences of COVID-19 infection.
Persistent neurological complications are a feature of long COVID in up to one third of patients, with symptoms that include fatigue, brain fog, headaches, cognitive impairment, anosmia (lack of smell) and peripheral neuropathy.
An article published in Scientific American in March says that long COVID should be regarded as a disease of the brain and the nervous system. In people with neurological COVID-19 and Long COVID symptoms, the immune system seems to be activated specifically in the central nervous system, creating inflammation. Recent research suggests that this is due to immune dysregulation.
A paper published last year in Nature Medicine detailed the increased risk of some scary neurological conditions as a consequence of coronavirus infection. These include not just those listed above but also strokes, movement disorders – from tremors and involuntary muscle contractions to epileptic seizures, hearing and vision abnormalities, and balance and coordination difficulties as well as other symptoms similar to those of Parkinson’s disease.
This research also noted an increased risk of Alzheimer’s disease among those infected with the virus. This is thought to be due to the viral infection pushing people who already have a predisposition to Alzheimer’s on to a faster track to developing the disease.
This paper is well described in layman’s terms here.
There are concerns that the burden associated with these neurological consequences of COVID-19 infections will not be borne equally across society but will fall disproportionately on those who are already the most disadvantaged.
Self-determination matters
A paper recently published in JAMA highlights the importance of Indigenous peoples’ authority, particularly healthcare sovereignty, as a key factor of resilience to the COVID-19 pandemic and future health crises.
The paper looks specifically at the COVID-19 pandemic in remote and Indigenous Arctic communities, but it highlights the success of self-determination models of Indigenous health governance based on Indigenous control over healthcare funding and delivery in Australia and New Zealand.
In what I see as a similar vein, a paper in BMJ Global Health looks at the role and contribution of civil society and community volunteers in COVID-19 prevention and control in Burkino Faso. It outlines the development, implementation, enabling factors and constraints of the ‘Communities are committed to Eradicate COVID-19’ (COMVID) movement in Burkino Faso.
This research starts from the premise that in low-income countries, where health systems often have reduced abilities to address health challenges, the collective capacity of communities is a key resource for achieving effective health outcomes and especially for curbing the spread of epidemics.
It sees the COMVID movement as “a unique experience of community mobilisation by civil society organisations following endogenous dynamics” and concludes that it was a key factor in the fight against COVID-19 in Burkina Faso through its community-based approach.
There is an excellent analysis of how COVID-19 has impacted the health and livelihoods of Indigenous peoples and how Indigenous peoples have responded in a recent edition of Environmental Research Letters.
The review was restricted by a lack of data and publications to a limited number of Indigenous peoples in mostly high-income countries (including Australia).
It found that while Indigenous peoples experienced a range of system level challenges, many have autonomously implemented Indigenous knowledge, values, and new strategies such as roadblocks, isolating communities, and social media platforms to protect their communities.
The authors highlighted a need for ethnically disaggregated data, the application of a gender lens, and a greater exploration of government assistance and autonomous coping strategies communities are implementing – all requirements Australia should adopt.
Debate around “active ageing”
Perhaps because of my (unspecified) age and my known addiction to walking, an article headed ‘Is the WHO’s ‘Active Aging’ the Only Healthy Alternative?’ was bound to grab my attention.
It quotes a sociologist who works on ageing thus: “The idea is that the more active [older people] are, the happier they will be. But ‘doing things’ isn’t necessarily appreciated by every elderly person, nor does it automatically lead to their well-being. The fact that some find a sense of wellbeing from it doesn’t mean we have to always do the same activities across different contexts.”
In the “active aging” vision promoted by the WHO, older adults stay active, independent, and involved. Although the WHO Policy Framework clearly states that the word “active” refers to continuing participation in social, economic, cultural, spiritual and civic affairs – not just the ability to be physically active or to participate in the labour force – the push to be physically active is usually at the top of the list of attributes of ageing well.
This concept, though well-intentioned, is increasingly seen as not very realistic and discouraging for individuals suffering from the psychological or physical limitations of old age. There is also the growing realisation that it does not consider cultural differences.
In reading around this topic, I found a number of interesting papers and some new approaches to ageing to consider.
The paper cited above states: “The suggestion of aging well in terms of activity, autonomy, and a happy-go-lucky mindset clearly reflects Western values. In Eastern cultures, elderly people occupy a position reflecting their experience and wisdom, while also maintaining a contemplative mindset, which is something that is held in high regard.” For example, in rural Taiwan, older people looked for a tranquil life.
Indigenous peoples hold a holistic worldview of health and aging that also differs from Western models. Some studies involving Aboriginal and Torres Strait Islander people highlight this.
A study published last month looked at Aboriginal elders’ perspectives and priorities for ageing well in Walgett, a remote Aboriginal community.
These elders saw ageing well as connected to being respected and continuing their roles as the knowledge keepers for the younger generations and the protectors of cultural heritage. They described disruption of family relationships, cultural traditions and connection to Country as having difficult implications for Aboriginal people as they age.
Other research has also made the point that the impacts of colonisation such as loss of language and culture and ongoing grief and trauma challenge the ability of Indigenous Australians to age well.
See also this recent Croakey article raising concerns about the need for healing for ageing members of the Stolen Generations.
Systemic racism against older Aboriginal people remains widespread, including in the aged care system and the failure to provide culturally safe care for Aboriginal and Torres Strait Islander people as they age was identified as a systemic and growing problem in the recent report of the Australian Royal Commission into Aged Care Quality and Safety.
In case you missed it
The National Foundation for Australian Women has recently released its Gender Lens on the May 2023 Budget. This is always worth a read and filing away for future consultation.
The Queensland Government released its 2023 budget last week. ABC News compiled a list of winners and losers, available here.
The South Australian Budget has also just been released. The ABC News list of winners and losers is available here. SA Budget 2023: Here are the winners and losers – ABC News.
The Senate Standing Committee on Community Affairs has released the report of its inquiry into universal access to reproductive healthcare. The report, Ending the postcode lottery: Addressing barriers to sexual, maternity and reproductive healthcare in Australia, found that too many Australian women faced too many barriers to abortion, contraception, sexual healthcare and maternity services. See this recent Croakey article: Is this a turning point for sexual and reproductive health in Australia?
Two recent Croakey articles look at the need for more transparency in how funding for health, hospitals and biomedical research is delivered.
- Experts urge an end to pork barrelling with health funding.
- Scrutinising the Medical Research Future Fund.
The Productivity Commission’s Closing the Gap Dashboard has just been updated. You can access the new data here. As reported by The Australian, there is little good news in the new data.
- There has been an increase in the rate at which Indigenous youth are jailed. The imprisonment rate of Indigenous adults fell slightly in 2022 but is still higher than in 2019.
- Intentional self-harm remains the leading cause of death among Indigenous youth ages 15 to 19 and this is rising.
- Nationally, 58 percent of Aboriginal and Torres Strait Islander people aged 15 to 24 were “fully engaged in education, employment or training” in 2021. This is a small increase from 57.2 percent in 2016.
- However in very remote areas the situation has deteriorated. Just 30.2 percent of Indigenous youths were fully engaged in work or study in 2021, a fall from 33.5 percent in 2016.
- Australia is not on track to reduce the rate of Indigenous children in out-of-home care by 45 percent by 2031.
Just four of the 19 Closing the Gap targets are on track, eleven targets are not on track, and four targets can’t be assessed because of a lack of data.
Minister for Indigenous Affairs, Linda Burney summed the report up: “The gap is not closing fast enough. This is why we need a Voice to Parliament, so that the voices of Aboriginal and Torres Strait Islander people are heard on the matters that affect their communities. For too long, governments have made policies for Indigenous Australians, not with Indigenous Australians. The Voice will create structural change that will ensure that grassroots voices are heard in Canberra.”
Best of Croakey
Check out the #Lowitja2023 stream on Twitter for news from the 3rd International Indigenous Health and Wellbeing Conference, and bookmark this link to follow Croakey’s coverage.
The good news story
In ideal circumstances, elephants would not be in zoos, although there are some justifications for this, as outlined here.
That said, I was really interested in a story in The Washington Post about how elephants in Houston Zoo have been trained to do yoga to help them stay active and healthy. You can read more here.
It turns out other zoos also provide daily yoga routines for their elephants, even the largest of which are quite agile.
A YouTube video of elephants at Denver Zoo doing their yoga exercises is here.
You can read more here.
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.
