Wednesday, 26 April 2023

Long COVID aka post-acute sequelae of COVID-19 (PASC) in 2023: no you are not imagining it nor being a malingerer. However research is in its infancy with regard to your often debilitating illness

 


First the good news. On 24 April 2023 the Minister For Health & Labor MP for Port Adelaide Mark Butler announced that The Australian Government will provide a further $50 million from the Medical Research Future Fund (MRFF) for research into post-acute sequelae of COVID-19 (PASC) – commonly known as Long COVID.


Bringing the Long COVID research funding pool to a total of $66.6 million and proving that parliamentary committee's can sometimes galvanise government.


The following is a slightly more mixed message, as at this stage prevention of Long COVID seems to rely on the implementation of public health measures the states and territories have long since abandoned in practice.

April 2023
CANBERRA





The 213-page report to the Australian Parliament by the House of Representatives Committee on Health, Aged Care and Sport can be read and downloaded at:
https://parlinfo.aph.gov.au/parlInfo/download/committees/reportrep/RB000006/toc_pdf/SickandtiredCastingalongshadow.pdf

The Committee accepts the World Health Organisation (WHO) definition of Long COVID as being the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation. Debilitating symptoms can be wide ranging with over 200 being recorded by WHO.

It further accepts that the number of people in Australia who were diagnosed with COVID-19 and were at risk of or possibly went on to develop Long COVID could be anywhere between 228,039 to 2,280,399 individuals. The difficulty in tying down a more definitive figure when it comes to the number of Long COVID suffers is apparently hampered by the paucity of data which has been collected to date.

The report goes on to inform government that:

At this stage it does seem that specific treatments require more evidence of benefit before being specifically recommended, but this will become clearer over time. Certainly, most of the care needs to be provided by the primary care system, such as by GPs, nurses, and allied health professionals.


We will need to help schools, universities, and workplaces adapt to allow the gradual return of people with long COVID. We will also need to train health professionals in how to diagnose and manage long COVID patients.


Mental health issues are clearly an area of concern too, particularly as many suffering from long COVID are aged between 20 and 50 years old and have many concerns, such as family and/or work responsibilities, which place additional stresses on them.....

It is also of concern that women seem more likely to be affected by long COVID than men.

The Committee is also of the view that when it comes to infectious disease and its aftermath:

the development of a national Centre for Disease Control (CDC) within the Department of Health and Aged Care would be the most appropriate mechanism for data collection and linkage with the states and territories.


Likewise, there is much that we do not understand about the virus, such as the fact that it is likely changing from being an acute pandemic virus to now an endemic form.


Research will be very important in helping us understand the best ways and means of managing its ongoing effects, particularly including long COVID. Research should include individuals from Aboriginal and Torres Strait Islander communities, culturally and linguistically diverse communities and other high-risk groups including those who are immunosuppressed.


A research program should be established to nationally coordinate and fund research into long COVID and COVID-19 generally. This could be led by the Department of Health and Aged Care — ideally the CDC — and should be the for the longer term.


Clearly, there has been a number of issues raised about reducing transmission of COVID19, such as improving air quality to reduce aerosol spread and this also has reference to broader health outcomes and requires investigation. 


In addressing the prevention of Long COVID the report states quite clearly:


The committee received evidence that emphasised that the best way to prevent long COVID is to prevent an initial COVID-19 infection.


For example, Professor Margaret Hellard, Director of Programs at the Burnet Institute, argued that while we don’t have a full understanding of long COVID, the most effective way to avoid it is to ‘try and stop COVID and reduce the number of COVID infections.


This position is supported by the National Clinical Evidence Taskforce on COVID-19 (NCET), which recommended the Australian Government clearly communicate to the public and to health care providers ‘that prevention of COVID-19 is the most-effective method of preventing long term health issues’ resulting from the virus.


However, this is difficult to achieve without access to other preventative methods given the highly infectious nature of current Omicron variants circulating in the community.


The NCET summarised:

With the shift away from mandated mask use and regular reporting of COVID-19 cases, and the recent removal of the requirement for isolation following confirmed infection, people may have the highly inaccurate impression that COVID-19 is over”. There is a lack of messaging that potential health risks related to COVID19 continue to be relevant and that vaccines, mask use in crowded indoor spaces, testing and isolation are still a valuable way to decrease the transmission of SARS-CoV-2, and mitigate the impact of long COVID.


The importance of mask wearing, physical distancing, hygiene and taking other health precautions when visiting high-risk settings cannot be underestimated.


However, the enforcement of these health measures is largely at state and territory government discretion, and to varying extents, now a matter of individual responsibility.


As for the Committee’s view on COVID-19 vaccination:


Booster doses of the COVID-19 vaccine are important to prevent waning immunity against the rapidly mutating COVID-19 virus.


On 8 February 2023 the Hon Mark Butler MP, Minister for Health and Aged Care, announced that from 20 February 2023 all adults who have not had a COVID-19 booster or a confirmed case in the past six months are eligible for a COVID-19 booster, irrespective of how many doses that person has received. Additional boosters for people under the age of 18 have not yet been announced, except where children aged 5 to 17 have health conditions that would put them at risk of severe illness.


Although COVID-19 vaccines are widely available and accessible, data suggests that many people are not electing to receive additional doses for which they are eligible. Professor Crabb AC suggested that this may be due to people becoming less aware of the risks associated with COVID-19 infections as the pandemic continues and commented on a general lack of motivation experienced by many people who received their first two doses but ‘don’t see the benefit’ in receiving booster doses......


The Committee made 9 recommendations to government which can be found on xxi & xxiv of the report.



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