Rebecca Storen, Social Policy
Key issue
The COVID-19 pandemic continues to have direct and indirect health impacts for people, as well as the health system (and its workforce). More than 2 years into the pandemic, Australia has high levels of vaccination among the population but continues to see significant numbers of cases and deaths. Attention is also turning to the longer-term impacts of COVID-19, as evidence emerges that anywhere from 10% of people who have had SARS-CoV-2 infection may experience ‘long COVID’ (post COVID-19 condition) in the weeks to years following acute infection.
A snapshot in time
As at 27 June 2022, Australia
had:
![Info graphic - An estimated 259597 active SARS-CoV-2 cases. 8612 SASRS-CoV-2 related deaths. 2570 people in hospital. An estimated 7341978 SARS-CoV-2 cases to date. 20071312 people had recieved at least one COVID-19 vaccine dose. 13717904 people had received 3+ COVID-19 vaccine doses.](/-/media/05_About_Parliament/54_Parliamentary_Depts/544_Parliamentary_Library/BriefingBook47p/COVID19ImpactsAustralianHealthSystem-000.PNG?h=313&w=677&la=en&hash=794D1FE45B6FE8E15BC9E97BA21043C22A572586)
Source: Department of Health, Coronavirus
(COVID-19) case numbers and statistics and COVID-19
vaccine rollout update – 26 June 2022, 27 June 2022.
More than 2 years into the COVID-19 pandemic, the
number of SARS-CoV-2 infections (the virus that causes COVID-19) continues to
climb, with 2022 already seeing the highest number of COVID-19 related deaths
in Australia. A range of measures have been introduced by the Australian, state
and territory governments to try and minimise transmission, ration health
services and equipment and to save lives. This article focuses on a select few areas
including hospital funding, Medicare and vaccines. Some of the direct and
indirect health implications of COVID-19 are briefly considered, with an
emphasis on the newly classified ‘post COVID-19 condition’ (also known as long
COVID) and the suggested impacts of this condition. This article does not
address mental health or the health
workforce, but
these topics are discussed elsewhere in the Briefing book.
Cases and deaths
Australia reported its first
cases of COVID-19 on 25 January 2020, its first
death on 1 March 2020 and the first
recorded case of community transmission was reported the following day.
Figure 1 provides the number of cases and deaths reported daily between January
2020 and June 2022.
Figure 1 Daily Coronavirus cases
and deaths in Australia
Note: the chart provides the daily numbers
by date they were reported to the World Health Organization (WHO). As such,
some of the large spikes in the dataset are artificial and due to reporting
patterns rather than exact cases identified on any one day.
Source: World Health Organization (WHO), ‘Daily
cases and deaths ’, COVID-19 Dashboard (Geneva: WHO, 2 June 2022).
As discussed in the 'Australia in
numbers' Briefing book article, recent
estimates from the Department of Health suggest COVID-19 may become a leading
cause of death in Australia in 2022.
Cases and deaths in residential aged care and NDIS
services
As at 24 June 2022, there have been 2,562 COVID-19 outbreaks in residential aged
care (an outbreak is defined as one or more positive residents, or 2 or more
positive staff cases). There have been:
- almost 57,000 resident cases
- more than 2,800 deaths (the majority occurring in 2022)
- more than 43,000 staff cases (p. 1).
As at 24 June 2022, of people receiving aged care services in their home 205 have
tested positive to COVID-19 and 13 have died.
As at 23 June 2022, for the National Disability Insurance Scheme (NDIS), as reported
to the NDIS Commission and the National Disability Insurance Agency, there have
been:
- over 23,600 cases among NDIS participants (active and recovered)
- 79 deaths of NDIS participants
- more than 32,000 staff cases across NDIS services (active and
recovered).
Health system
Hospitals and the National partnership on COVID-19
response
The National
Health Reform Agreement (NHRA) sets out high-level health system
responsibilities and reform objectives, and is the mechanism through which the Australian
Government funds public hospital services. In May 2020, the Australian, state
and territory governments entered
into a new agreement through an addendum to the NHRA (2020–2025). Under the
new agreement, ‘the Morrison Government has provided a funding guarantee to all
states and territories to ensure no jurisdiction is left worse off as a result
of the COVID-19 pandemic’.
On 6 March 2020 the Prime
Minister announced the National partnership on COVID-19 response (National Partnership), between the Australian and state and territory governments.
Under this agreement, from 21 January 2020, the federal government pays 50% of
costs incurred by state and territory health systems for the diagnosis and
treatment of people with, or suspected of having, COVID-19, and activities to
prevent the virus from spreading. The National Partnership is in place ‘for the
period of the activation of the Australian Health Sector Emergency Response
Plan for Novel Coronavirus 2019 (COVID-19 plan) as declared by the Australian
Health Protection Principal Committee (AHPPC), and then for sufficient
additional time to allow for the final reconciliation of any payments made
under the Agreement’ unless terminated or extended as agreed by all parties (Clauses
10 and 11). The 2022–23 Budget extends funding for the National
Partnership until 30 September 2022 (p. 2).
The National Partnership also provides for states and territories to
enter into agreements with private hospitals to ensure the
public system has sufficient hospital services capacity, the cost of which will
be equally shared between the Australian and relevant state or territory
government. The Australian Government will also contribute 100% of funding to
the states to guarantee the financial viability of private hospitals (Schedule B).
Primary care
Early in the COVID-19 pandemic a series of measures
were announced for primary health care to diagnose and manage potential and
confirmed SARS-CoV-2 cases, and to minimise transmission. These measures also covered
the provision of care and support for people’s ongoing health needs (for
example, prenatal care and managing chronic disease).
Temporary Medicare Benefit Schedule (MBS) items
A key introduced measure has been temporary
MBS items for telehealth (video and/or telephone) consultations, with some of
these items subsequently transitioned to permanent arrangements
from January 2022. The Australian Institute of Health and Welfare (AIHW) provides
a summary of the COVID-19 temporary MBS services and benefits processed
quarterly (Figure 2). Between 1 April 2020 and 30 September 2021 there were
302,125,508 services processed and approximately $16.6 billion in benefits paid
for COVID-19 related MBS items.
Figure 2 Medicare services and
benefits processed for COVID-19 related MBS items by quarter
![Graph - Medicare services and benefits for COVID-19 related items by quarter.](/-/media/05_About_Parliament/54_Parliamentary_Depts/544_Parliamentary_Library/BriefingBook47p/COVID19ImpactsAustralianHealthSystem-002.PNG?la=en&hash=AE656253F5B8E9948DAE2D10FB982755992A2AB4)
Source: Australian Institute of Health and Welfare (AIHW), Impacts
of COVID-19 on Medicare Benefits Scheme [sic] and Pharmaceutical Benefits
Scheme: Quarterly Data – Impact on MBS Service Utilisation (Canberra:
AIHW, 18 February 2022).
The Australian National Audit Office (ANAO) is
currently undertaking a performance audit of the Department of Health’s
management of the expansion of telehealth services in response to COVID-19. Its
report is due in December 2022.
Schedule A of the National
Partnership states that the Australian Government, under a separate
agreement, is responsible for 100% of funding for private pathology testing for
COVID-19 (p.15). In addition, the Australian
Government agreed to supplement 50% of the costs of COVID-19 testing
undertaken at public health testing facilities (p. 22). In the 2022–23
Budget, the Government announced it would extend SARS-CoV-2
pathology MBS items until 30 September 2022 (p.89). It is currently unclear
what funding arrangements will be in place from 1 October 2022 onwards.
Medicines
In response to the COVID-19 pandemic, the Australian
Government, in conjunction with state and territory governments, implemented
several changes to medicines regulation, including:
- extending and expanding the continued
dispensing arrangements, allowing an approved pharmacist to supply an
eligible medicine where the person has immediate need and it is not practicable
to obtain a Pharmaceutical Benefits Scheme prescription
- enabling
pharmacists to substitute some medicines in short supply without
prior approval from the prescriber if the specified medicine is unavailable
- limiting sales and dispensing of some medicines
- enabling image-based
prescriptions, allowing a prescriber to create a digital image of a paper
prescription following a Medicare-subsidised telehealth consultation.
In addition, electronic
prescriptions became more widely available from mid-2020 following
legislative changes and technical upgrades.
Vaccinations
Evaluation and regulation
The Therapeutic Goods
Administration (TGA) is responsible for evaluating and regulating
therapeutic goods (which includes vaccines) to ensure they are high quality,
safe to use and work as intended. The TGA has several
options available to fast-track the approval of therapeutic goods to enable
faster access. One of these is the provisional
approval pathway, which grants temporary registration where the need for
early access outweighs risks. This process has been used for COVID-19 vaccines.
Figure 3 provides an overview of the COVID-19 vaccines that have provisional
registration (as at May 2022).
Figure 3 COVID-19 vaccines with
provisional registration in Australia
Effective date |
Sponsor |
Name |
Type |
a. 19 January 2022
b. 09 June 2022 |
a. Biocelect Pty Ltd on behalf of Novavax Inc
b. Booster dose for individuals aged 18 years and over |
NUVAXOVID (NVX-CoV2373)
For individuals aged 18 years and over |
Protein vaccine |
a. 9 August 2021
b. 3 September 2021
c. 7 December 2021
d. 17 February 2022 |
Moderna Australia Pty Ltd |
SPIKEVAX (elasomeran)
a. For individuals aged 18 years and over
b. For individuals aged 12 years and over
c. Booster dose for individuals aged 18 years and over
d. For individuals aged 6 years and over |
mRNA |
25 June 2021 |
Janssen-Cilag Pty Ltd |
COVID-19 Vaccine Janssen
For individuals aged 18 years and over |
Viral vector |
a. 15 February 2021
b. 8 February 2022 |
AstraZeneca Pty Ltd |
VAXZEVRIA (previously COVID-19 Vaccine AstraZeneca)
a. For individuals aged 18 years and over
b. Booster dose for individuals aged 18 years and over |
Viral vector |
a. 25 January 2021
b. 22 July 2021
c. 26 October 2021
d. 3 December 2021
e. 27 January 2022
f. 7 April 2022 |
Pfizer Australia Pty Ltd |
COMIRNATY (tozinameran)
a. For individuals aged 16 years and over
b. For individuals aged 12 years and over
c. Booster dose for individuals aged 18 years and over
d. For individuals aged 5 years and over
e. Booster dose for individuals aged 16-17 years old
f. Booster dose for individuals aged 12-15 years old |
mRNA |
Source: Therapeutic Goods Administration (TGA), COVID-19
vaccine: provisional registrations (Canberra: TGA, 2 May 2022).
COVID-19 vaccine program
The Australian Government has entered into supply
agreements for several COVID-19 vaccines. On 7
September 2020, the Government announced it had signed the first agreement with
AstraZeneca for production and supply of its University of Oxford COVID-19
vaccine, if the trials proved successful. This was followed by agreements with Novavax
and Pfizer in 2020 and Moderna
in 2021.
Due to commercial sensitivities, information on the
full financial implications of the COVID-19 vaccine program is limited. However,
according to Government
estimates at the time of the 2022–23 Budget, total expenditure on the
vaccine program (including rollout) has been more than $17 billion (p. 164).
The National Partnership sets out the Australian
Government’s commitment, with the state and territory governments, to support
the COVID-19 vaccine rollout including:
- an upfront payment of $100 million, shared across jurisdictions
based on population
- a 50% contribution to the agreed price per vaccination dose
delivered by the states
- from 21 April 2021, a 50% contribution to additional costs incurred
by states to set up additional COVID-19 vaccination sites (Schedule
C).
The ANAO is undertaking a performance audit of the
planning and implementation of the COVID-19 vaccine rollout. The report is due
to be tabled in July 2022.
Health implications of the COVID-19 pandemic
Elective surgeries
In an effort to ration health resources, on 25
March 2020 the National Cabinet announced all non-urgent elective surgeries
in the public and private system would be suspended. Since then, various jurisdictions
have implemented restrictions on elective surgeries in response to subsequent
outbreaks (for example, in Greater Sydney in July 2021 and in parts
of Victoria in January 2022).
It is difficult to measure the full impact of the
COVID-19 related delays to surgery, especially given delays in public
specialist appointments and access to surgery were already issues of concern
prior to the pandemic. However, what is known is that delays to clinically
necessary surgery have social
and financial cost implications. Delayed surgery affects people’s quality
of life and may result in reduced or no capacity to work and reliance on
medication to manage pain and other symptoms, which in turn can lead to poorer
health outcomes and financial stress (p.13).
According
to the AIHW, the proportion of people waiting more than one year for
elective surgery increased from 2.8% in 2019–20 to 7.6% in 2020–21. The median waiting
time for admission for elective surgery also rose from within 39 days in
2019–20 to 48 days in 2020–21 – this was higher for Aboriginal and Torres
Strait Islander peoples, at 57 days.
Long COVID (post COVID-19 condition)
Clinical case definition and standardised data
collection
In September 2020, the WHO created International
Classification of Diseases (ICD) codes for post COVID-19 condition. The ICD
is the international system for classifying diseases, injuries, symptoms,
procedures and cause of death, and enables comparable morbidity and mortality
statistics. This coding enables Australia and the international community to collect
and compare data on people who have a history of SARS-CoV-2 infection, which is
particularly important as the long-term health implications of an infection and
the disease associated with it (that is, COVID-19) is currently poorly
understood.
Early in the pandemic it became apparent that some
people who had, or were suspected of having had, a SARS-CoV-2 infection were
experiencing symptoms weeks after the infection that could not be explained by
an alternative diagnosis. Different terms have been proposed to describe this
condition, including long COVID. To standardise clinical case definitions and
nomenclature to better support clinical care, epidemiological reporting,
research and policy making, the WHO undertook work to define a clinical case
definition of ‘post-COVID-19 condition’, through a Delphi process (which identifies
a consensus view from an expert group). The description of post
COVID-19 condition is a condition that:
… occurs in individuals with a history of
probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of
COVID-19 with symptoms and that last for at least 2 months and cannot be
explained by an alternative diagnosis. Common symptoms include fatigue,
shortness of breath, cognitive dysfunction but also others and generally have
an impact on everyday functioning. Symptoms may be new onset following initial
recovery from an acute COVID-19 episode or persist from the initial illness.
Symptoms may also fluctuate or relapse over time.
More than 200 symptoms have been reported for post
COVID-19 condition. Figure 4 provides a snapshot of common symptoms.
Figure 4 Common symptoms of post
COVID-19 condition
![](/-/media/05_About_Parliament/54_Parliamentary_Depts/544_Parliamentary_Library/BriefingBook47p/COVID19ImpactsAustralianHealthSystem-004.PNG?la=en&hash=D105096AAC526823081A945ECE31E54D04807CF6)
Source: Researching COVID to Enhance Recovery (RECOVER), What is long COVID?, (US, RECOVER, 2022).
Incidence and prevalence of post COVID-19
condition
The incidence of post COVID-19 condition is unclear,
but research to date suggests that the long-term impacts and burden of symptoms
may be high.
One of the few studies currently available that has measured the health outcomes for people 2 years
after hospitalisation from acute infection, shows:
- people experiencing at least one post COVID-19 symptom decreased
from 68% at 6 months to 55% at 2 years, with fatigue or muscle weakness the
most commonly reported symptoms
- most people (89%) improved enough to return to their original work
within the 2-year period
- participants reported decreases in anxiety or depression over time
from 23% at 6 months to 12% at 2 years
- participants still had more symptoms and lower health-related
quality of life at 2 years than the control group.
Other
research on post COVID-19 condition indicates that there is a difference
between the experience of people who have had severe COVID-19 (and been
hospitalised) and those who have had less severe symptoms. Estimates have
suggested that 10–35% of people who did not require hospitalisation may
experience at least one long COVID symptom, while for people who were admitted
to hospital, this may be as high as 85%.
The Office for National Statistics in the UK provides regular population estimates of prevalence of ongoing
symptoms following infection based on self-reported symptoms and activity
limitations. Key points from the 1
June 2022 report include:
- an estimated 2 million people (over 3% of the population) living in
private households experienced long COVID as of 1 May 2022
- 71% of these people (approximately 1.4 million) reported symptoms that
adversely affected their day-to-day activities and 20% (approximately 400,000
people) reported that their ability to undertake day-to-day activities was
‘limited a lot’
- fatigue was the most common symptom reported, (55% of people),
followed by shortness of breath, a cough and muscle aches
- the prevalence of self-reported symptoms was highest for:
- people aged 35–69 years
-
females
-
people living in ‘more deprived’ areas (as
measured by indices
of deprivation, which has 7 domains including income, employment and crime)
-
people working in social care (such as aged
care), teaching and education, and health care
- people with another activity-limiting health
condition or disability.
Association with COVID-19 vaccines
Research is emerging on the association between long
COVID symptoms and COVID-19 vaccines, although uncertainties remain.
Research
suggests that adults who were vaccinated before they had a SARS-CoV-2
infection were less likely to develop long COVID symptoms, measured at 4 weeks
to 6 months post-infection. One study found that fully
vaccinated people were 50% less likely to experience long COVID symptoms 28
days or more after infection. Other studies have suggested that the protection from long COVID symptoms offered by vaccines
may be lower, with results indicating that vaccination may reduce the
likelihood of long COVID by approximately 15%.
There is also mixed evidence that suggests unvaccinated people with long COVID who were subsequently
vaccinated may experience fewer long COVID symptoms than people who remained
unvaccinated (p. 14). This is supported by a more recent UK study of more
than 28,000 participants, which found that vaccination after SARS-CoV-2
infection appeared to be associated with reduced symptoms of long COVID for at
least a few months following vaccination. The authors note the need for long-term follow up, especially in relation to the Omicron variant of the virus.
Future considerations
Domestic
and international
attention is turning to the lessons from COVID-19 and future pandemic
prevention and preparedness. This work considers issues such as supporting
prevention activities, the importance of early warning systems and the need for
up-to-date systems that enable robust data collection and use as well as the
importance of data sharing. In Australia, the Australian
Labor Party has committed to establishing a Centre
for Disease Control, which would be responsible for leading the federal
response to future communicable disease outbreaks. Evaluating Australia’s
prevention and preparedness for future health emergencies may include a focus
on institutional and legal arrangements to enhance ways to minimise the health,
social and economic impacts of a future outbreaks and may include reviewing the emergency powers under the Biosecurity
Act 2015 and National Cabinet arrangements.
The ongoing pandemic continues to present
challenges for the Australian health system and the health
workforce (also see the article in this Briefing book on Health
workforce), with most
temporary response measures due to expire in coming months. Long
COVID clinics are opening around Australia seeking to address the chronic
health issues that are likely to emerge, especially as cumulative case numbers
continue to rise. In response to long COVID and the potential persistent
and long-term health outcomes people experience, some countries have started to
consider classifying long COVID as a disability (for example, see information from the US). The long-term
impacts of SARS-CoV-2 infection and the COVID-19 pandemic on people and the
Australian community are unknown but evidence suggests that for some people,
post COVID-19 condition may continue to impact their quality of life for years
to come.
Further reading
Emma Vines, COVID-19 Vaccines: a Quick Guide, Research paper series, 2021–22, (Canberra: Parliamentary Library, 2021).
Parliamentary Library’s COVID-19 publications.
Parliamentary Library, Pandemics and Attempts to Reform the WHO, FlagPost (blog), (Parliamentary Library, 19 May 2022).
Australian Institute of Health and Welfare COVID-19 publications and data.
Back to Parliamentary Library Briefing Book
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