In the United States, some 30 experts writing in a new book, ‘Lessons from the COVID war’, say the pandemic revealed “a collective national incompetence in government”.
In her latest column, Adjunct Associate Professor Lesley Russell warns that “Australia should not – indeed cannot – say, ‘that’s not us’.”
Ahead of Health and Aged Care Minister Mark Butler’s address to the National Press Club tomorrow, Russell also identifies key health reform matters.
The quotable?
More than three quarters of farmers believe that the role they play is undervalued by the Australian public. They also believe that rural and remote communities are forgotten about and left behind when it comes to public policies and services.”
Lesley Russell writes:
As I write this, the 2023-2024 Federal Budget looms and the Minister for Health and Aged Care Mark Butler is scheduled to speak at the National Press Club tomorrow (2 May).
I confess I have been pretty cynical about what might be in the Budget for Health, but last week’s announcement of $2.2 billion over the forward estimates for primary care is very encouraging and has buoyed my optimism.
Delivering funding is an essential part of reform, but it’s the easy part – now the hard work and the politicking begin. We need to know much more about how these funds will be spent, the longer term commitments to Medicare (and prevention and acute care reforms), and the investments in other essentials such as workforce.
So I’m deliberately setting discussion of these issues aside until after I’ve read the Budget Papers.
Croakey Health Media will have a concerted focus on budget issues over the next few weeks. Make sure you check in regularly and follow the hashtag #HealthBudget2023.
And bookmark this link to follow our coverage of the Budget and health (you will find there is already plenty of reading on related matters).
Long COVID-19 report and associated news
The much anticipated report from the parliamentary inquiry into long COVID (aptly entitled ‘Sick and Tired: Casting a long shadow’) is finally out. The House of Representatives’ Standing Committee on Health, Aged Care and Sport, led by Dr Michael Freelander, has done sterling work.
If you can find time, it’s also worth reading some of the hundreds of submissions received (although a warning – in many cases tissues are needed!).
The report’s findings have been well covered in a series of articles on the health and economic impacts of long COVID in The Sydney Morning Herald. You can access them all here.
It’s interesting to note that the Murdoch News Limited papers have had comparatively little to say.
The key recommendations:
- Establishment and funding of a single COVID-19 database to be administered by the new Centre for Disease Control to capture data on: COVID-19 infections, complications, hospitalisations, and deaths as well as recurrent COVID infections (with high risk populations highlighted); long COVID diagnoses including post COVID complications; COVID-19 vaccination rates, vaccination side effects and post vaccination deaths.
- Use of the World Health Organization’s definition of long COVID clinically, but this to be regularly reviewed and updated.
- The development of evidence-based guidelines for diagnosis and treatment. These to incorporate tiered care including referral pathways and must be co-designed with patients with lived experience.
- Nationally coordinated research funding for COVID-19 and long COVID.
- Federal Department of Health to update and improve the COVID-19 vaccination strategy, working in conjunction with the States and Territories.
- Improving the availability of antivirals to treat COVID-19 infections (note that one recommendation is that pharmacists should be able to initiate antiviral treatment).
- Funding to be provided in partnership with State and Territory health departments for selected public hospitals to develop multidisciplinary long COVID clinics for patients with challenging long COVID complications and for the provision of outreach clinics in rural and regional areas.
- Mental health support for those with long COVID must be provided in an affordable, timely and equitable manner.
- Telehealth and digital health resources to be leveraged to make self-management and access to primary care easier.
- Australian Government to establish and fund a multidisciplinary advisory body to oversee an assessment of the impact of poor indoor air quality and ventilation (with particular consideration given to high-risk settings such as hospitals, aged care facilities, childcare and educational settings) and to lead the development of national indoor air quality standards. This is seen as a preventive measure.
My Croakey colleague Jennifer Doggett has written in detail about the recommended action on clean air. You can read her article here.
As noted in the submission from the Burnet Institute, if long COVID follows the pattern of COVID-19, it is more likely to impact people with social and structural disadvantage and people with previous health issues.
This inevitably means that low-income households will be disproportionately affected. Over time, that will exacerbate existing social and economic inequalities.
Mike Seccombe interviewed Dr Freelander for The Saturday Paper (here but paywalled). He highlights several issues from the report:
- Government, the medical profession and the public generally have not taken long COVID and repeat infections seriously enough.
- There are lots of unknowns.
- We don’t know why some people develop long COVID and not others, how to diagnose it accurately and efficiently, how to treat it, and how to best manage the symptoms.
- We have no accurate data about how many people have been affected by it, how many more could be, or even an agreed definition of what constitutes long COVID.
- Currently the only way to certainly prevent long COVID is to avoid any COVID-19 infection.
“We know that immunisation is not 100 percent preventative of illness, but it is 70 percent or so effective in preventing severe illness. We think for long Covid, that’s also true,” Freelander told Seccombe.
There is no clear picture of the long-term health consequences or personal and economic costs.
Addressing this last point, an economic analysis released in the same time frame as the long COVID report highlights just some of the potentially huge costs of long COVID to the economy (healthcare costs are not included).
It is estimated that at least 35,000 people, and maybe up to 197,000 people, have had their daily activities significantly limited by long COVID. The cost to the GDP of people unable to work because of long COVID is estimated as be at least $5.7 billion a year and could be as high as $46 billion a year.
In the wake of the parliamentary report, the Minister for Health and Aged Care Mark Butler has announced $50 million for research funding. These funds are from the Medical Research Future Fund. The first grants are expected to be available in August.
This funding is in addition to funding that has already been provided for long COVID research ($13 million from the MRFF, $1.6 million from the NHMRC, $5 million to the Australian Partnership for Preparedness Research on Infectious Disease Emergencies).
Butler’s media release also states that “The Department of Health and Aged Care has been tasked with developing a national plan to respond to Long COVID, taking into consideration the committee’s findings.”
Croakey Health Media now has a long COVID category where you can access all relevant Croakey articles on this topic.
On the United States pandemic response
An increasing number of reports is emerging on how the United States handled/is handling the pandemic (see, for example, this article in The Lancet). I have previously written about some of these in The Health Wrap.
However, there is thus far no federal government response to call for a federal commission (essentially the American equivalent of a Royal Commission).
Most recently some 30 experts, known as the Covid Crisis Group, have written a book on how the United States lost what they call “the pandemic war”.
The book ‘Lessons from the COVID War’, published last week and also referenced in Croakey’s latest ICYMI column, is deliberate in its use of military metaphors.
Group members held “listening sessions” with nearly 300 people, and in the absence of a federal commission on the topic, say they felt a duty to speak out about what they found. They argue COVID-19 should have been attacked like a foreign invasion, but that too often the nation’s leaders were absent from the battlefield.
You can watch a video discussion by some of the authors on YouTube here.
Their verdict: The United States, once the paragon of can-do pragmatism, of successful moon shots and biomedical breakthroughs, fell down on the job in confronting the crisis. The pandemic, the experts say, revealed “a collective national incompetence in government”.
They state: “The leaders of the United States could not apply their country’s vast assets effectively enough in practice.” The United States has “more capabilities than any other country in the world.” But it ended up with more than one million dead.
“The COVID war is a story of how our wondrous scientific knowledge has run far, far ahead of the organised human ability to apply that knowledge in practice.”
The language is very tough, but Australia should not, indeed cannot, say, “that’s not us”.
You can read more in this Washington Post story and in this transcript of a PBS NewsHour segment on the book.
Just as this report came out, Dr Anthony Fauci gave an extensive interview to The New York Times about the hard lessons of the pandemic and the decisions during the pandemic that will define his legacy. It is compelling reading, here.
Specialist care matters
Decreasing access to specialists and increasing costs are undermining the universality of Medicare.
Last week ABC radio and TV ran a series of reports highlighting the findings of an ABC investigation into public specialist outpatient waiting times across Australia.
The data are only available for Victoria, Tasmania, South Australia and Queensland (because, shockingly, the other States and Territories don’t report these data!).
This work echoes that published last year by the Australian Medical Association (available here).
Professor Graeme Stewart from the Westmead Institute for Medical Research described the figures as “unconscionable”.
In an opinion piece for the Pearls and Irritations blog, Stewart points out that these are mostly people with serious health problems that the GP can’t manage without help from a specialist and who can’t afford the out-of-pocket expenses for a private consultation or for procedures that may follow specialist assessment.
“This breaches one of the most fundamental tenets of Medicare: that no Australian should be prevented from timely, essential healthcare due to the cost involved or fear of the cost involved,” he wrote.
He calls for funding to build more outpatient clinics and to support the clinicians who would staff them:
“The Commonwealth would have to provide the cost of both but the better model for employment of the staff would be with the state hospital to facilitate modern integrated and multidisciplinary models of care. The goal is to provide sufficient rate of consultation to bring waiting times down to the clinically appropriate period.”
It is wonderful (and a big relief) to see the Albanese Government launching the reform of primary care.
Details to date are scarce, but one thing that seems to be missing is ensuring that patients (especially those with chronic and complex conditions – who seem to be at the heart of the proposed reforms) have timely and affordable access to specialist care.
This is essential to ensure improved patient outcomes and to relieve some of the pressure on GPs, many of whom must manage sick patients without specialist support.
Tackling heart disease and sudden cardiac deaths
Sudden cardiac death is one of the biggest killers of Australians under 50 and is five times more likely to affect men. The primary cause in adults 35 and over is coronary heart disease. In younger people (under 35) it is congenital heart conditions and heart rhythm disorders.
There are so many stories of fit men literally dropping dead from a heart attack.
Just a few examples: journalist Michael Gordon who died while competing in a swimming event, aged 62; satirist and comedian John Clark who died on a bushwalk, aged 68; US reporter and author Tony Horowitz (husband of well-known Australian author Geraldine Brooks) who collapsed and died while out walking, aged 61. And then there was my husband Bruce Wolpe, who would have dropped dead within months if his heart problems had not been revealed when he was being treated for sepsis.
The nation’s leading heart disease institutes have recently issued a plea for an overhaul of Australia’s outdated guidelines on screening for cardiovascular disease, which fail to detect hundreds of thousands of patients at risk of having a sudden heart attack.
As part of this call to action, the Cardiac Society of Australia and New Zealand, the Baker Heart and Diabetes Institute, and the Victor Chang Cardiac Research Institute have recommended the widespread adoption of a test known as a CT scan calcium score, which can detect heart disease in those who “sit under the radar” of risk calculators but have plaque in their arteries despite being asymptomatic (it was agreed by the specialists we saw that this test – which is not currently funded by Medicare in the majority of cases – would have caught earlier the threat from Bruce’s blocked arteries.)
As an aside, here’s a recent article on what you should ask your doctor about your risk of a heart attack.
The current clinical guidelines for identifying, preventing and managing an individual’s risk for cardiovascular disease, along with substantial other materials for healthcare professionals, are on the Heart Foundation’s website.
The Australian Institute of Health and Welfare (AIHW) has good information on cardiovascular risk factors, although some of the data are old. In 2014 – 2018, 57 percent of Australians had three or more modifiable risk factors for cardiovascular disease.
The AIHW report does not acknowledge that over the past few years, new coronary risk factors have emerged. These are detailed in a recent editorial in The American Journal of Medicine that describes their role and their impact on cardiovascular health.
The new risk factors are: systemic inflammation, gout, rheumatoid arthritis, systemic lupus erythematous, inflammatory bowel disease and psoriasis.
Other recent research has shown that pregnancy complications such as pre-eclampsia and gestational diabetes contribute to heart risks for women.
In April 2019, the Morrison Government introduced two new Medicare items to allow GPs (item 699) and some other medical practitioners working in primary care (item 177) to conduct 20 minute or longer Heart Health Checks for people aged 45 and over.
In November 2019, the rebate percentage for these MBS items was increased from 85 percent to 100 percent of the fee. The fee is indexed and currently is $76.95 for item 699 – this compares favourably to the fee for MBS item 701 (health assessment, under 30 minutes) which is currently $62.75.
Further changes were made from July 2021 to make people aged 30 and over eligible for Heart Health Checks.
At the time of their introduction, it was stated that these new items would be “reviewed and evaluated over the next two years, in consultation with the profession, to help inform their effectiveness and any future improvements”.
While I can find no evidence of a publicly available evaluation, the MBS items for Heart Health Checks are to cease on 30 June. The Heart Foundation and other research bodies that work on cardiovascular disease are running a campaign against this decision.
I assume the items are being withdrawn because the uptake has been poor.
A recent article in the Australian Journal of General Practice found that item 699 (Heart Health Checks done by a GP) accounted for just nine percent of all health assessment item claims since its introduction. It blames the COVID-19 pandemic for a 27 percent reduction in claims for item 699, although claims for other health assessment items declined by only 7 percent over the same time frame.
My analysis of the uptake of MBS item 699 is below (the uptake of item 177 is tiny, averaging about 1,000 services per quarter, so I have ignored this).
Given that 90 percent of Australians have at least one risk factor for heart disease, and many of these risk factors are modifiable, the uptake of this item was shockingly low. Yes, uptake was definitely impacted by the pandemic, but is now on the increase again (note that’s it’s common to see a fall in health services in the first quarter of the year as people are on vacation).
The risk of heart and blood vessel issues is significantly increased in those who have had COVID-19, even when hospitalisation was not required.
So it does seem that more attention should be paid to heart check-ups. Let’s see what that federal Budget brings.
Mental health crisis on the farm
New research released late last month presents a saddening picture of the mental health of Australian farmers. The National Farmer Wellbeing Report finds:
- 30 percent report a decline in their mental health over the past few years
- 45 percent have felt depressed, with almost two thirds (64 percent) experiencing anxiety. For one in seven (14 percent), that’s a frequent experience
- 45 percent have had thoughts of self-harm or suicide
- 30 percent have attempted self-harm or suicide
- 27 percent say feelings of loneliness or isolation, combined with limited access to mental health services, have had the biggest impact on their mental health over the past five years.
The report is well summarised by ABC News, here.
Earlier research has shown that a farmer dies by suicide every 10 days and Australian farmers are twice as likely to die by suicide when compared to the general population.
Findings from the report:
- Many farmers are suffering in silence. More than half (51 percent) not wanting to burden family or friends with their problems or are simply not comfortable discussing them.
- 17 percent did not want to seek or receive help.
- 11 percent felt too embarrassed to seek help.
- Finding mental health services is too often a challenge: 15 percent of farmers reported difficulty accessing suitable services in their community.
- The top three factors impacting farmer mental health were weather or natural disasters (47 percent), financial stress (36 percent) and inflation and cost pressures (35 percent).
- 88 percent of Australian farmers have had their farming operation significantly impacted by natural disasters over the past five years, with an average cost of $1.4 million per farm.
- More than three quarters (76 percent) of farmers believe that the role they play is undervalued by the Australian public. They also believe that rural and remote communities are forgotten about and left behind when it comes to public policies and services.
Make sure to follow #NSPC23 this week for news from the National Suicide Prevention Conference, as recently previewed for the Croakey Conference News Service by Marie McInerney: Focus on the systemic drivers of suicide – including hazardous workplaces.
For assistance
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Check-In (VMIAC, Victoria): 1800 845 109
Lived Experience Telephone Line Service: 1800 013 755
The best of Croakey
Adjunct Professor Janine Mohamed, CEO of the Lowitja Institute, and Deputy CEO Paul Stewart were among those attending the 22nd session of the United Nations Permanent Forum on Indigenous Issues (UNPFII), which was held from 17-28 April.
Mohamed called on the UN and member nation states to take full responsibility for decolonisation and anti-racism when addressing climate change and its impacts on Indigenous peoples’ rights, health and wellbeing. 
Good news story
Two bird stories to interest and amuse you.
A lonely male eagle, unable to fly, kept trying to hatch a rock. But he has been able to put his paternal feelings to good use, playing step-dad to an orphaned eaglet. You can read more here and here.
Parrots are sociable birds and they like interactions with humans and with other birds.
Researchers in the United Sates recruited a group of 18 parrots and gave each of them a small bell to ring. When a bird rang its bell, researchers provided it with an iPad that had photos of the other birds in the study. The bird then picked one of those photos, which triggered a FaceTime call.
You can read more – with some great photos – 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.
