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The Health Wrap: latest on COVID, value-based care, budgeting for wellness and musical therapy

In this edition of The Health Wrap, Associate Professor Lesley Russell reports on the latest COVID-19 news, value-based healthcare and public health reforms in England.

She also explores what Australia might learn from the wellness approach to budgeting in Aotearoa/New Zealand, as well as the healing properties of music.


Lesley Russell writes:

Here’s a selection of the latest news on the coronavirus pandemic and vaccination efforts.

These past weeks the news is all about the “shemozzle” that is Australia’s vaccination rollout and most recently that the Astra Zeneca vaccine will not be the “preferred” vaccine for those under 50 years of age.

This issue has been covered so well elsewhere that there’s no need for me to do so. But here are a few valuable resources:


Long-term effects of COVID-19

Information about the long-term effects of coronavirus infections (even those that do not result in serious illness) continues to emerge.

A recent paper in The Lancet Psychiatry looks at the physical and mental neurological effects. The authors analysed the medical records of more than 230,000 patients in the UK National Health Service and found evidence for substantial neurological and psychiatric morbidity in the six months after COVID-19 infection.

One in three survivors received a neurological or psychiatric diagnosis within six months of infection (diagnoses included intracranial bleeds, stroke, parkinsonism, dementia, anxiety, psychotic disorder). Risks were greatest in, but not limited to, patients who had severe COVID-19.

Another study, from the Karolinska Institute in Sweden that was published in JAMA, found that eight months after experiencing mild COVID-19, one in ten people still has at least one moderate to severe symptom that is perceived as having a negative impact on their work, social or home life. The most common symptoms are a loss of smell and taste and fatigue.

In the United Kingdom a national study of the long-term impacts of lung damage from COVID-10 is just getting underway. Early evidence indicates that lung damage occurs in approximately 20 percent of patients discharged from hospital, but the effects on people who experience long-COVID in the community are currently unclear.


In case you missed it

New research suggests possible causes of blood clots from coronavirus vaccines

New research has identified unusual antibodies that appear to have caused, in rare cases, serious and sometimes fatal blood clots in people who received the COVID vaccine made by AstraZeneca.

This research, published in the 9 April edition of the NEJM, was conducted by separate groups in Germany and Norway. It is well summarised in an article in The New York Times here.

Australians’ responses to the plethora of news on coronavirus

Professor Deborah Lupton and Dr Sophie Lewis from the University of New South Wales have just published the first paper from their ‘Australians’ experiences of COVID-19’ project in BMC Public Health. You can read it here.

In interviews, they found that:

A constantly changing news environment raises challenges for effective communication of risk and containment advice. People can become confused, distressed and overwhelmed by the plethora of information sources and fast-changing news environment.

On the other hand, seeking out information can provide reassurance and comfort in response to anxiety and uncertainty. Clarity and consistency in risk messaging is important, as is responding quickly to changes in information and misinformation.

Further research should seek to identify any changes in use of and trust in information sources as time goes by.”

Release of the WHO report on the origin of SARS-CoV-2

After a delay of more than two weeks – almost certainly due to internal wrangling over politics, positioning, and language – the World Health Organization finally released its expert report on the origin of the SARS-CoV-2 virus.

I wrote about this and the implications of the findings for science and international politics for Inside Story here. [Editor’s note: Don’t miss this excellent read!]

American polling on the impacts of vaccination

The latest Economist / YouTube poll shows some interesting responses from Americans on vaccination and highlights how divided the Unites States remains on coronavirus issues.

The poll shows:

  • 54 percent of people who have already been vaccinated are still very or somewhat worried about catching COVID-19. But only 29 percent of people who refuse to get vaccinated are very or somewhat worried about getting infected.
  • 29 percent of Americans who have received at least one vaccine shot believe it is now safe for them to travel within the United States. By contrast, half of the one in four Americans who reject the vaccine believe it is safe for them to venture out now.
  • 52 percent of those who reject vaccines say it is safe for them to socialise, compared to just 30 percent of all Americans.

You can read more, with some interesting graphs, here.

Revamping a failed coronavirus vaccine

Last December a joint effort by the University of Queensland and CSL to develop a vaccine against coronavirus was abandoned when Phase 1 studies showed that the vaccine generated additional antibodies that led to false-positive results in some HIV tests.

This happened because the innovative vaccine approach – a molecular clamp technology – used two fragments of a protein found in HIV to hold the spike protein of the SARS-Cov-2 virus so the immune system could learn to recognise it.

There were some who sold this as Australia’s “robust” solution and “a better long-term option”.  The Morrison Government had committed to buying 51 million doses of the vaccine if it passed all regulatory approvals.

The good news is that this technology has now been re-engineered using different clamping proteins and the UQ team is aiming to have a vaccine candidate ready as part of the second wave of vaccines due sometime in 2022.


Value-based care

This month’s edition of the Australian Health Review is the second themed issue on value-based care (see Australian Health Review, 2019 for the first).

It highlights the emerging expertise being developed amongst Australian researchers, policy makers and health service providers in crafting an approach to value in healthcare that is fit for purpose in the Australian health system.

In particular I commend to you Alison Verhoeven’s editorial on ‘Achieving greater value and equity in health care’.

This is a timely volume, with Australia’s first value-based healthcare conference to be held in Perth and online on 27-28 May. More information is available here.

A paper recently published in the BMJ (sadly behind a paywall) asks the question “Would we stop overusing low value healthcare if we knew how often it hurts patients?” and argues for quantifying the preventable harm from overuse.

The US-based Lown Institute does some great work in this area (a regular browse of their website is recommended) and they have summarised this paper here.

To date, much of the discussion around overuse has focused on waste and inefficiency and saving healthcare dollars, but this is not a very strong motivation for either doctors or patients to avoid overuse. In fact, some efforts to reduce waste in healthcare are seen as rationing.

The authors find that “Framing [over-use] as a problem of cost or resource utilisation has yet to move clinicians and patients to avoid it in any meaningful way”.

Research on harm from overuse is sparse and not always easy to do. A lot of the harms from unnecessary tests and screenings come not from the test itself but from cascade events. Many low-value tests and procedures fall into a grey area because they may be appropriate for some patients but not others.

The authors conclude:

It is time to reframe this problem in a way that truly engages both clinicians and patients.

Until they have a clear understanding of all the downsides of overuse, they cannot contribute fully to decisions about the care they deliver or receive or to the creation of effective policy around healthcare improvement.”

To help make the point, a recent paper in the BMJ looks at the harms and costs of inappropriate blood transfusions – something that is now even more of an issue during a pandemic when blood supplies are scarce. (The full paper is behind a paywall, but there is an abstract here.)


More on public health reforms in England

Regular readers of The Health Wrap might recall that last September I wrote about the shock decision of the UK Government, in the middle of a pandemic, to abolish Public Health England (PHE) and replace it with a new agency – which was then to be called the National Institute for Health Protection.

At the time this generated concerns that needed prevention activities and health improvements will be neglected or even lost as the Government loses focus on work done to date and worries solely about coronavirus. Public health threats are not limited to infectious diseases.

While I have followed this closely, it seems these concerns have been noticed and addressed, at least in part.

A policy paper published in March, ‘Transforming the public health system: reforming the public health system for the challenges of our times’, outlines the role of the new UK Health Security Agency (protecting against infectious diseases and external health threats) and the new Office for Health Promotion, which will be located within the Department of Health and Social Care, to drive the  prevention agenda across government.

There will also be efforts to build population health through local responses involving the NHS, local authorities, and the voluntary sector to improve the health of their area.

Much of this is based on the White Paper ‘Working together to improve health and social care for all’ issues in February that sets out legislative proposals for a Health and Care Bill. The aim of this proposed legislation is to address the issues and problems in the NHS that have been highlighted by the coronavirus pandemic.

There are three main goals:

  • To remove the barriers that stop the system from being truly integrated
  • To remove much of the transactional bureaucracy that has made sensible decision-making harder
  • To make the system more accountable and responsive to the people that work in it and the people that use it.

The Secretary of State for Health and Social Care, Matt Hancock, has said that he sees the White Paper as the mechanism for the NHS to bring all its resources and capability to the prevention agenda.

The well-respected Kings Fund has responded to these efforts.

A media release on 29 March saw the establishment of the new Office for Health Promotion within the Department of Health and Social Care as ensuring “a nucleus of much-needed public health expertise in government”.

It said: “This expertise could be a catalyst for the cross-government action needed to improve the public’s health and tackle the health inequalities so brutally exposed by the pandemic, if it is given adequate funding and a strong remit to work across government policy.”

But there are concerns about funding, with uncertainty prevailing over the medium-term funding models for public health.

A blog post on 1 April sees challenges from splitting PHE and setting up two new agencies, especially around integration.

It sees the potential to mobilise public health expertise across government policy with the new cross-government ministerial board for prevention. It will work if other government departments see that working more closely with the Department of Health and Social Care will also help them deliver their mandates.

The conclusion is that “putting to one side the poor timing of the original announcement of these reforms, there is actually much in this paper to welcome, some things to question, and much more flesh on the bones that we still need to wait for.”

It will be interesting for Australia to watch these efforts – as we wait for progress on our National Preventive Health Strategy. The Johnson Government expects the formal transition of Public Health England’s functions to be completed by “the autumn”.


What can we learn from a wellness approach to budgeting?

The Morrison Government will bring down the Federal Budget on Tuesday, May 11.  There are big expectations about some key issues, including aged care, mental health, and primary care.

Jennifer Doggett did a great job a few weeks ago of summarising the budget submissions from key groups, which you can read here. Sadly, cynically, I am not holding my breath for anything great!

Across the ditch, Budget day also looms in the Beehive (the local name for the New Zealand Parliament House). In 2019, Prime Minister Jacinda Arden introduced the idea of a Wellbeing Budget, which looks beyond the nation’s economic strength and GDP growth to “the quality of that economic activity and how it has been shared.” I wrote about this for The Health Wrap in May 2019.

It’s a good time to examine how well this is working.

A recent article in The Guardian asked the same question and was pretty critical in response. It points out that New Zealand still struggles with deep-seated social problems including growing inequality, high rates of child poverty, high youth suicide rates, and a housing affordability crisis.

But it also acknowledges that the wellbeing budget approach has shifted the focus away from purely financial measures. “It was a positive rebalancing of that focus – to realising GDP in itself, economic growth in itself isn’t the be-all and end-all.”

A 2020 paper from the International Budget Partnership looks at whether the New Zealand approach could be used as a model elsewhere for managing public finances.  It’s an excellent analysis of the first year or so and it’s successes and failures. Basically it sees the new policies included in the 2019 Well-Being Budget as too small to be transformational, but that the innovations introduced into the budget process will make a difference.

The New Zealand Government’s 2020 Budget suddenly had to address the impact of the global pandemic. This meant reorienting the Budget 2020 package to focus on maintaining support for existing critical public services. The Budget statement talks about “putting ‘on ice’ new initiatives under priority spending areas that were announced in the Budget Policy Statement”.

This year wellbeing seems to be back on the agenda.

The 2021 Budget Policy Statement says that:

New Zealanders’ current and future wellbeing is underpinned by stocks of the four capitals as set out in the Treasury’s Living Standards Framework: human capital, natural capital, social capital, and financial and physical capital. These represent the wellbeing of our people; our environment; our communities; and our finances and built infrastructure.”

Here you can read the Wellbeing Outlook report – which considers the effects of COVID-19 on wellbeing in New Zealand and outlines how the Government has responded.

An article on the website of Huber Social looks at wellbeing as a measure of humanity. It sees GDP as an incomplete measure that fails to account for the social impact of decisions to drive economic growth.

It makes the point that just as longitude is needed alongside latitude, we need to measure wellbeing alongside economic growth to navigate the progress of humanity.


The best of Croakey

I commend to you this story by Professor Kathy Eagar and Anita Westera, from the Australian Health Services Research Institute at the University of Wollongong, examining the harmful consequences of the intersections of ageism and sexism in the aged care sector. (The article first appeared in Pearls and Irritations).


The good news story

This week there are several good news stories, all centred around a theme I find myself constantly returning to – the important and healing role of music in our lives.

A recent article in The New York Times looks at how the power of music is now being validated by medical research. It is being used in treating asthma, autism, depression and brain disorders such as Parkinson’s disease, Alzheimer’s disease, epilepsy and stroke.

A 2013 research review  concluded that “listening to music was more effective than prescription drugs in reducing anxiety prior to surgery”.

Last week the PBS Newshour had a wonderful program on how former Arizona Member of Congress Gabby Giffords, who was shot in a gun massacre in 2011, is using music to rewire her brain. You can watch it here.

Some years ago I had the pleasure of meeting Gabby Giffords and her husband, former astronaut Mark Kelly, who is now a Senator from Arizona. They are an amazing couple and despite her problems she is a very effective communicator – especially on gun violence.

And finally, there is this story, also from the New York Times, on singing in sign – making music visible. Enjoy!


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.


See Croakey’s archive of stories on healthcare and health reform.

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