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With a long COVID road still ahead, the next Federal Government must act to protect lives

Introduction by Croakey: Journalists, politicians and others who regularly talk about COVID “being over” are misleading the Australian public.

The next Federal Government must drop the “post-COVID” charade, and take determined action to reduce the ongoing toll upon peoples’ lives and health, writes Alison Barrett.


Alison Barrett writes:

Public health experts have raised concerns about a lack of election focus and policy action to minimise the risks of COVID at a time when more than 5,000 Australians have died from the virus so far this year.

They have flagged concerns about the relatively low vaccination rates among children, as well as calling for efforts to increase uptake of the third vaccine dose among adults.

As well, governments have been urged to address inequities moving forward in the pandemic, including through raising the rate of income support payments.

During a webinar hosted by La Trobe University last week, health policy expert Professor Stephen Duckett said that Australians really need to increase third dose and children vaccination rates, in addition to acknowledging that COVID-19 is still real and important.

Professor Michael Toole, Associate Principal Research Fellow at the Burnet Institute, and Duckett both commented in the webinar on the lack of election focus on these issues.

Duckett surmised that politicians were unlikely to discuss COVID-19 during the campaign, in order to avoid any “wars” or scare campaigns.

In an interview with Neil Mitchell on 3AW this week, the CEO of the Public Health Association of Australia, Adjunct Professor Terry Slevin, also discussed the lack of conversation about COVID-19 during the election campaign.

“The time at which we have seen the most enormous impact of this pandemic in the last month, we’ve had an election campaign running and there’s no active discussion about what we’re going to do about public health into the future, and it’s genuine madness,” Slevin told Neil.

Clinical epidemiologist Professor Nancy Baxter told the La Trobe webinar that it seemed, in some areas of leadership, a decision was made that “we’re done with COVID” and “we want to get back to 2019”.

Baxter said that getting rid of all protections will mean we have “consistently high numbers of COVID on an ongoing basis”.

More than 5,000 Australians have died from COVID-19 in the first four months of 2022 – more than twice as many deaths from the virus than in 2020 and 2021 combined.

Table compiled by Alison Barrett from data sources:

*ABS Causes of Death, Australia 2020

**ourworldindata.org

***covidlive.com.au, as at 4 May 2022

[It is important to note that there may be some discrepancies in the COVID-19 death data due to the to the way in which death data is collected, coded and reported, for example, coroner delays].

Context

The number of Australians who died due to COVID-19 increased after the international border opened and the Omicron variant started circulating in the country at the end of November 2021.

While the international border could not remain closed forever, most other non-pharmaceutical interventions to protect the population against COVID-19 have been removed since the end of 2021.

Currently, minimal population-wide protections exist and management of COVID risk has been largely left to the individual, according to Professor Adrian Esterman from the University of South Australia, speaking on ABC radio on Monday.

Deaths due to COVID-19 were the second most common cause of death during January, according to provisional mortality statistics released by the Australian Bureau of Statistics – with only cancer deaths being more common.

The COVID-19 death rate in January 2022 was more than the death rate for ischaemic heart disease and dementia, as highlighted in the table below.

Table compiled by Alison Barrett from ABS Provisional Mortality Statistics, January 2022. Baseline average data is comprised of data from 2017-2019 and 2021, and “serves as a proxy for the expected number of deaths”.

Trends and questions

An interesting addition to the January 2022 mortality data is that up to 31 January, 20 deaths have been classified as due to long-term effects of COVID-19.

After reaching a peak of 86 deaths per day on 31 January 2022, the number of COVID deaths decreased until they began steadily increasing again in mid-March.

The majority of COVID-19 deaths in Australia have been in NSW and Victoria and the greatest proportion have occurred in people 70 years and older.

Because of Australia’s low COVID-19 death rate in 2020 and 2021 due to our strong public health measures, the cumulative rate of COVID-19 deaths per million is far less than in other countries.

For example, Australia has had 283.46 COVID-19 deaths per million people compared to 1,033 in Canada and 2,566 in the United Kingdom.

With 56 deaths confirmed yesterday and thousands of deaths in the first four months of 2022, how many deaths are we willing to accept?

Vaccination rates and gaps

While Australia has a reasonably high COVID-19 vaccination coverage from the primary two doses, which is likely to have prevented many deaths and severe disease, the rollout of the third dose is slow.

Of the population eligible for three doses (adults 16 years and older), 95.5 percent have had two doses, compared to 65.2 percent having only three.

As previously reported at Croakey, three doses of a COVID-19 vaccination are required for best protection against the Omicron variant.

The vaccination rollout in children aged 5 to 11 years old is also running slowly – 52.8 percent have had one dose and 37.1 percent have had two.

Associate Professor Holly Seale, infectious diseases social scientist at University of New South Wales, told Croakey that “it would be fantastic to see vaccine coverage for younger children reach the coverage numbers that have been documented for adults here in Australia”.

“However, there are some challenges impacting this, including the fact that there are some parents who have concerns about the vaccines, including around side effects. Some of this comes down to a perceived lack of facts, while the issue of misinformation is also impacting here. Adding to the fact that most COVID-19 infections in young children either have no symptoms, or only mild symptoms, parents will question the rationale for moving forward. This kind of thinking is misguided and part of the problem.”

Moving forward?

Professor Michael Toole told the webinar that when we ignore cases and focus solely on death rates as a measure of Australia’s COVID-19 situation – as politicians told us to do at the beginning of this year – we are ignoring long COVID.

Nobody is really talking about lockdowns anymore – we’re only promoting those preventive measures that are least disruptive, Toole said.

Toole recommended the following actions for Australia to implement to help minimise transmission and prepare for winter and future variants:

  • Good surveillance
  • Clear messaging about flexibility and possibility that some restrictions may need to be reintroduced (for example, if we have more impactful waves in the future)
  • Messaging about vaccination needs to improve to encourage people to get both their flu vaccine and all recommended boosters, and for children to have the recommended two doses
  • Ventilation and air quality could be improved
  • Improve education about benefits of masks.

In his interview on 3AW, Slevin recommended:

  • Build up public health workforce to deal with future pandemics
  • Clear communication about why different states and territories may have different COVID-19 policies
  • Mask mandates indoors.

Seale told Croakey that, as more people are traveling interstate and overseas and public health measures are relaxed, “this will be an interesting winter” with “transmission of COVID-19, influenza and other respiratory pathogens in a way that we haven’t experienced in the last couple of winters”.

Seale recommends that people stay at home if sick with a respiratory infection, even if not COVID-positive as “other [respiratory] infections can have serious complications including for those people with medical conditions, the elderly and those who are pregnant”.

“While the opportunity to work from home has been commonplace during the COVID pandemic, businesses appear to be winding back on this and encouraging people to come back into the office,” she said.

“COVID has provided an opportunity to shift the norm here and to encourage people not to work through illnesses, even mild respiratory infections. Pressure needs to continue to be placed to ensure that casuals and other workers who do not have sufficient paid personal leave, can access paid leave. It is also a call to businesses to offer onsite vaccination programs to provide access to both COVID boosters and the flu vaccine.”

COVID-19 in the Kimberley

Vicki O’Donnell, CEO of Kimberly Aboriginal Medical Services (KAMS) in Western Australia, highlighted the value of vaccinations, good systems and planning in their response to the pandemic.

“We continue to see people recovering from COVID and others becoming infected. In general, our community members have fared well and remained well enough to be cared for at home and in community. This is especially so for those who are fully vaccinated. We are pleased that our two years of planning and getting systems in place is standing us in good stead,” O’Donnell told Croakey.

She said they continue to advocate for physical distancing, hand hygiene, mask wearing in  clinics and supported isolation for COVID patients.

O’Donnell said they “are currently thinking and working on what does COVID look like moving forward and what are the implications of long COVID for some of our people?”

Focusing on equity

The COVID-19 pandemic has heightened existing inequities and impacted people from lower socio-economic areas disproportionately.

In Australia, people who live in the most disadvantaged areas are three times more likely to die due to COVID-19 than those in the least disadvantaged areas.

Director of the Menzies Centre for Health Governance at the Australian National University, Professor Sharon Friel, told Croakey that we must learn from the COVID-19 experience to protect people and keep them well, from flu and future variants and pandemics, and that this requires attention to the underlying conditions which structure society in unequal ways.

“This means action to ensure a decent standard of living (income support schemes); housing that is affordable and decent quality; equitable access to culturally acceptable health and social services,” she said.

Friel said the following actions are needed to address inequities moving forward in the pandemic:

  • Redress the social inequities that are affecting health
  • Act to address the quality and access issues in aged care
  • Major reform of the privatisation model of health and social services
  • Raise the rate of income support schemes – “social policy is public health policy”.

She said the widespread precarious employment situation creates major problems for health.

“Action is needed to redress this otherwise the associated financial insecurity, stress of job insecurity and harmful conditions of such employment situations will continue to cause mental and physical health problems,” she said. “This will widen health inequities given that precarious employment tends to be experienced by already socially disadvantaged groups.”

Recommendations from People with Disability Australia

Samantha Connor, President of People with Disability Australia, provided Croakey with the following comments, suggestions and recommendations for Australia’s management of COVID-19 moving forward.

“As winter approaches, our public health system will once again become overwhelmed as influenza and pneumonia patients join those with COVID in hospitals. Staff surge workforces will be urgently required, as well as disability and aged care workers. Continuity of care plans for disability and aged care service providers must be put in place to make sure nobody is left behind.

Future variants of SARS-CoV-2 may be more lethal, severely affect different cohorts (for example, children) or be more transmissible.

The politicisation of COVID must stop – the community urgently needs timely, sensible and reliable health advice as well as adequate government responses.

Supply of oral anti-viral treatments must be sufficient for all disability and aged care facilities, with outbreak sites prioritised for delivery.

In addition, the National Medical Stockpile must ensure that sufficient treatment courses of Lagevrio (Molnupiravir) are available to medical centres and hospitals who are treating COVID patients, especially those who are at risk.

Medical facilities and hospitals must ensure that they adopt and implement ethical decision making principles to ensure people with disability and older Australians are not discriminated against.

A model format and principles has been developed by the disability sector at this link. This is especially important in times of stretched resource allocation.

Schools must ensure ventilation and filtration systems are in place, with air flow modelled to create optimal ventilation settings and identify locations for HEPA filters.

Early learning environments, schools, post-secondary and universities must ensure that students with disability are offered a safe learning environment and/or a remote or flexible learning environment as an accommodation in line with their responsibilities under the Disability Discrimination Act.

Similarly, employers should ensure that disabled employees are able to work safely and that mask mandates are maintained, especially in indoor environments with poor ventilation or frequent contact. Workers compensation should be accessible to workers who contract COVID, as should paid leave.

Where masks are mandated or used, high quality respirators should be recommended. Widespread education on wearing better quality masks and respirators properly and improving fit should be implemented.

A public health campaign highlighting the issues faced by those with a disability who are unable to access the community safely should be implemented with a focus on youth in schools and people in employment.

Promoting the message that individuals can make the choice to keep their community healthy may help combat anti mask and vaccination sentiment.

All public messaging must be accessible to people with disability, including community education campaigns.

Vaccine rates must be raised and third and fourth dose boosters made available immediately, especially for those who are at risk.

A campaign should accompany the program to educate the public about the importance of vaccinations (including the flu vaccine).

The defined at risk cohort must be widened to include Aboriginal and Torres Strait Island people, all people with disability who receive care and people in residential care settings, including boarding houses.

Research shows that 37 percent of people get long COVID symptoms, especially those who receive high viral loads. Long COVID may cause serious long-term complications – research shows that COVID can cause twice the risk of heart attacks, stroke, heart failure and blood clots even a year after infection.

Other changes include lung and brain damage, with emerging evidence of liver damage in children. Modelling should be undertaken so that we can understand the impact on the NDIS and Medicare systems.

RATs and masks should be provided free of charge to the community, with a Closing the Gap style PBS model making additional RATs and masks available to Aboriginal people and people with disability and chronic health conditions, carers, support workers and others who may be at risk.

Accurately report the deaths of NDIS participants (using the AIR and NDIS data) and people who are in receipt of the DSP, carers pension and other allowances by.”

Improving vaccination rates in children

Seale said that, as outlined by Dr Elizabeth Murray, a paediatric emergency medicine physician in Rochester, New York, and a spokeswoman for the American Academy of Pediatrics, for children who are “not too sick, this still can mean miserable with fevers and muscle aches for a week. It can also mean MIS-C [multisystem inflammatory syndrome] or long COVID.”

To help parents navigate issues about COVID-19 vaccinations, Seale highlighted a COVID-19 decision aid for children that has been developed to help parents and carers decide about getting a COVID-19 vaccine for their children.

“The tool was developed by Dr Jane Frawley from the University of Technology Sydney and a group of public health researchers, social scientists and clinicians using the best available research about COVID-19 and COVID-19 vaccines,” Seale said.

“In highlighting the rational for these vaccines, it is important that we include in our conversations about the fact that the COVID vaccination might help prevent school closures and disruptions to extra-curricular activities. Lastly, it is important that we highlight that this is becoming a norm within our communities. Working with schools, childcare centres, as well as other parent forums, we need to hear the stories about why parents are choosing to get their children vaccinated.”

A challenge to the next Federal Goverment

In summary, as much as we are tired of the pandemic, it is still far from over.

In particular, it is impacting children, older adults, thousands of grieving families, people with disability and people living in the most disadvantaged areas of Australia.

In the absence of political leadership, Australians are being forced to make individual decisions to manage their way through the pandemic, most often without appropriate structures and systems, such as paid sick leave, in place to support them.

As highlighted by the experts quoted in this article, the incoming Federal Government should develop and communicate a clear plan for the future, incorporating suggestions provided in this piece to minimise transmission and deaths, increase vaccination uptake and protect the lives of Australians.


From Twitter


See Croakey’s archive of articles on COVID-19.

 

 

 

 

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