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The Health Wrap: long COVID, health finances, public sector reform – and a special song

Amid growing concerns about long COVID, the Australian Government is strangely silent on a topic that some modelling estimates will affect hundreds of thousands of Australians, at significant cost to their wellbeing, the healthcare system and workplace productivity.

In her latest column, Associate Professor Lesley Russell also shares a more upbeat note on the sounds of silence; don’t miss the very special rendition of an old Simon and Garfunkel tune, in honour of the victims of gun violence.


Lesley Russell writes:

Studies have shown that infection with SARS-CoV-2 can lead to post-acute sequelae in nearly every organ system, including an increased risk of mental health disorders.

The Washington Post recently published a good summary of what is known to date about long COVID. The lasting misery of COVID-19 long-haulers is documented here.

The costs to individuals, families and the healthcare system of long COVID are yet to be measured but will be enormous.

This past week the results of two major studies highlight two of the most serious post-infection consequences of COVID-19.

Increased risk of developing mental health problems

A large study published in the BMJ shows that people who have had COVID-19 (even mild cases) are experiencing increased rates of adverse mental health outcomes, including depression, anxiety, and stress and adjustment disorders. There is also evidence of increased risk of substance use disorders, neurocognitive decline, and sleep problems.

The results show that those who had COVID-19 were at higher risk of mental health problems when compared both to contemporaneous controls of people who were not infected but were exposed to the same stressors of the pandemic and to an historical control group from the pre-pandemic era.

Those with COVID-19 were 39 percent more likely to have depressive disorders and 35 percent more likely to show an increased risk of incident anxiety disorders over the months after infection.

They were also 38 percent more likely to be diagnosed with stress and adjustment disorders and 41 percent more likely to be diagnosed with sleep disorders.

COVID-19 patients were 80 percent more likely to develop neurocognitive problems and 34 percent more likely to develop opioid use disorders.

It is concerning that these findings come at a time when the delivery of mental health services are under enormous pressures.

It’s always informative to see what Dr Eric Topol has to say about major new findings such as these.

Heart disease risk soars

A large study published in NatureMedicine in February shows a long-term, substantial rise in risk of cardiovascular disease, including heart attack and stroke, after a SARS-CoV-2 infection. The article is here and the summary is here.

People who had recovered from COVID-19 showed stark increases in 20 cardiovascular problems over the year after infection. They were 52 percent more likely to have a stroke than the contemporary control group, and the risk of heart failure increased by 72 percent.

These risks were elevated even for those under 65 years of age and for those who lacked risk factors such as obesity or diabetes. The prevalence of such diagnoses has experts projecting a ‘tidal wave’ of cardiovascular cases related directly and indirectly to the coronavirus

Here is what Dr Topol had to say about this paper.

Where are Australian efforts to address long COVID?

To date, the Morrison Government has conspicuously failed to address this issue – or even indicate that they are thinking about them.

Professor Adrian Esterman effectively nails the issues with this article, ‘Long COVID is the elephant in the room, but it seems invisible to Australian politicians’, published last December in The Guardian.

This failure effectively demonstrates the short-term focus of this Government and its unwillingness to address the nation’s long-term societal, health and healthcare needs.

A recent briefing paper from the Deakin University Institute for Health Transformation looks at the potential scale of long COVID cases from the Omicron wave and makes some excellent suggestions for what must be done.

The Deakin paper conservatively estimates that Australia will see hundreds of thousands of people with ongoing long COVID symptoms for weeks, months and, for some people, even years. This will mean a significant burden of ill health and social and economic distress that will be costly to the healthcare system and workplace productivity.

The Deakin paper recommendations include:

  • Establish a National Long COVID Care and Support Taskforce to ensure a whole-of-government response to long COVID across the health, disability/welfare and  employment sectors of federal and state and territory governments.
  • Establish a National Centre of Excellence to oversee research, treatment guidelines and dissemination of information.
  • Establish centres to provide coordinated care and rehabilitation.
  • Ensure that the Medicare and PBS safety nets catch these patients and that they are not burdened with large out-of-pocket costs.
  • The capture and utilisation of surveillance data to ensure effective targeting of services and improved health outcomes.

As the authors note, the time for doing this is now – it cannot wait for months or even until after the election.

Meanwhile, this recent article in Nature, ‘Pandemics disable people – the history lesson that policymakers ignore’, notes that long COVID is the latest reminder that epidemics have long tails – biologically, as well as psychologically, economically and socially.

“Since the persistent effects of COVID-19 were recognized six months into the pandemic, up to 200 symptoms have been reported in 10 organ systems, including the skin, brain, heart and gut. The recurring core of these comprises loss of mobility, lung abnormalities, fatigue and cognitive and mental health problems,” says the report.

“Yet it continues to be overlooked by decision makers, who still present the costs and benefits of COVID-19 containment in terms of data on cases, hospitalisations and deaths alone. This means that in many countries, a burden of future disability is being created that could have been prevented, or reduced.”


Impact of the pandemic on healthcare spending

A new release from the Australian Institute of Health and Welfare looks at the impact of the pandemic on medical services and prescriptions. It compares MBS and PBS data from the quarter ending September 2021 with that from the quarter ending June 2021 and the September 2020 quarter.

Comparing the June 2021 and September 2021 quarters:

  • GP services have increased since the June 2021 quarter, due primarily to visits for coronavirus vaccination advice. In the quarter ending September 2021, there were 9.5 million attendances to assess a patient’s suitability for a vaccination – this was 18.4 percent of all GP attendances in the quarter, and an increase of 193.7 percent on the quarter ending June 2021.
  • The 13.8 percent increase in pathology services seen since the June 2021 quarter was driven by COVID-19 testing.
  • The number of original and repeat prescriptions dispensed at the same time rose by 16.3 percent from the June 2021 quarter to the September 2021 quarter. This rise was attributed to an increase in domestic and overseas travel, as a result of the easing of border restrictions.

Comparing the September 2020 and September 2021 quarters:

  • There was a decrease in the percentage of services delivered via telehealth consultations from 13.3 percent of all MBS services or 15.5 million telehealth consultations in the quarter ending September 2020 to 11.0 percent or 14.5 million telehealth consultations in the quarter ending September 2021.
  • A big decrease was seen in optometry services (down by 20.1 percent). This is seen as due to lockdowns which meant optometrists were generally limited to only providing essential or time critical services to patients.

There are some interesting comparisons with what is happening with healthcare spending in the United States. Most of this data is from the Peterson-KFF Health System Tracker.

In the US the pandemic disrupted healthcare spending and utilisation. In April 2020, health spending dropped precipitously as providers cancelled elective care and patients practising social distancing avoided health facilities.

Utilisation of healthcare services now remains somewhat lower than predicted based on levels before the pandemic (shown dramatically in the figure below).

Telehealth use, which soared from less than one percent of outpatient visits before the pandemic to 13 percent of outpatient visits in the first six months of the pandemic, has now declined.

Two points to note from these data from both countries:

  1. It seems that, if available, most patients prefer face-to-face consultations over telehealth.
  2. In both Australia and the United States, we are yet to see the effects of delayed and forgone care on health outcomes and healthcare spending.

Essential medicines increasingly unaffordable

The results of a survey conducted by the Pharmacy Guild of Australia (PGA) highlight the impact of rising PBS co-payments on people’s ability to buy their essential medicines.

Nearly a third (31 percent) of middle-income households ($60,000 to $100,000) without a concession card have found it difficult to afford prescription medicines. In marginal electorates 13 percent of people have gone without needed medicines because they could not afford them. Women aged 35 to 54 were the most affected.

The knowledge that a significant segment of the Australian population struggles to afford PBS medicines is not new. The ABS data show that more than 900,000 Australians delayed or didn’t get a script filled in 2019-20 due to cost.

What is shocking about this report is that it lists the medicines most likely to be skipped. These include medicines for diabetes, heart failure, Crohn’s Disease, schizophrenia, for the prevention of stroke and thrombosis, and long-acting contraceptives.

While more than six million Australians with concession cards are somewhat protected from the costs of prescription medicines, many other households and individuals must pay a co-payment that increases yearly and has more than doubled since 2000. This year the PBS co-payment is $42.50; in 2000 it was $20.60. Generic medicines can help ease the cost, but these are not always available or suitable.

It’s obvious that failure to take medicines needed to treat chronic conditions will lead to additional costs elsewhere in the healthcare system.

Will this be an election issue? It certainly deserves to be.


Reforming the Australian Public Service

As we head into election time and the focus is on policy suggestions and development (at least from the policy wonks on the outside) and election commitments (from the