Chair's Foreword
Australia hasn’t faced a pandemic like this since the Spanish influenza at the end of the First World War. Predictions of an event like the COVID-19 pandemic were being made for many years, yet when it began three years ago many experts were taken by surprise.
Luckily, we have a health system that is resilient and well-resourced, which for the most part was able to deal with important areas of the pandemic and governments across all three levels were able to work together to achieve best outcomes.
Further, with remarkable tenacity and insight, scientists and researchers were able to develop vaccines to reduce the spread and impact of COVID-19, which has helped lead to a global recovery from this debilitating virus. Pharmaceutical companies have worked tirelessly to get access to vaccines as quickly as possible too.
We have health experts across the public spectrum from virologists, infectious disease experts, intensivists, general practitioners (GPs), nursing staff and allied health staff who worked tirelessly to get the best health outcomes for patients.
Special mention needs to be made of our emergency department physicians, nurses and other staff because of their frontline exposure, particularly in some areas to large numbers of patients which stretched resources considerably.
All members of the health system, from GPs to pharmacists, nurses, allied health staff and pathology workers did their duty and helped get through the most acute phases of the pandemic.
Often forgotten in this acute phase was the role of cleaners, retail staff, logistics workers and teachers who worked tirelessly to keep our society moving. As a result, it was often workers within these industries who were at higher risk of being infected by the virus and who in turn, are managing its effects post-infection.
For most of the pandemic, many of us have been in the learning-as-we-go mode and it is apparent that as time has progressed, there is increasing acknowledgement of long-term effects of COVID-19, in terms of long-term complications (such as cardiac, haematological and neurological effects) and it does appear that many people suffer from long-term inflammatory consequences and a new term ‘long COVID’ arose, which first appeared on social media in May 2020.
Hence, the need for an inquiry looking into long COVID and how Australia manages this going forward. Following discussions with the Minister for Health, the HonMarkButler MP, the Standing Committee on Health, Aged Care and Sport announced that an inquiry into long COVID had been established, titled long COVID and repeated COVID infections, and that from the 5 September 2022, submissions would begin to be received.
The primary focus of this inquiry was our national management of long COVID, with further attention being placed on additional effects of this condition including the economic and mental health impacts, potential treatment and management options, and repeated COVID infections.
It is important to note that during the inquiry, we were hampered by a lack of specific data and the lack of a concise definition of what constitutes long COVID. At the present time, we accept the World Health Organization (WHO) definition as the most useful for clinical practice; however, this may need to be modified as further information becomes available.
It is clear that long COVID is a significant problem and estimates vary, indicating that between twopercent to 20per cent of those infected with COVID-19 may develop long COVID. Even if it is the lower figure of two per cent, this is still many people requiring help and support.
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 important that mental health support is affordable and accessible to individuals, and it is also important that access to support is provided to outer metropolitan, rural and regional areas in an equitable manner.
Further, digital health and telehealth services need to be expanded to cater for individuals who cannot obtain in person consultation or treatments due to their location or mobility issues.
It is also of concern that women seem more likely to be affected by long COVID than men.
Our primary health providers need to be educated on how best to support and diagnose long COVID. The role of specific long COVID clinics as a resource for primary health providers is very important to allow adequate services for major complications, and these clinics may help in providing treatment plans.
These long COVID clinics should also have the ability to refer to specialists and it is also important to fund teaching hospitals to provide these services, as well as encourage outreach services in outer metropolitan, rural and regional areas to provide these services too.
Clearly, immunisation and reduction in the spread of the virus has an important role in prevention of long COVID. It is important the messaging around this is improved and properly provided to the wider population.
It is important that data about immunisation rates, complications and the rare instances of post-immunisation deaths be collated and investigated, as well as any underlying risk factors.
During our inquiry, many questions were raised about issues relating to the pandemic that were not strictly within our terms of reference.
There is a distinct difficulty in obtaining verifiable data about many of these issues and it is the Committee’s view that 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 COVID-19, such as improving air quality to reduce aerosol spread and this also has reference to broader health outcomes and requires investigation.
We have received many submissions from individuals suffering from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Whilst there may be some crossover with long COVID, we believe that long COVID is a separate issue to this.
Nevertheless, the ME/CFS community should be supported and researched developed to assist them and provide support.
The topic of the national pandemic response and handling came up often during our inquiry, with the Committee being asked many questions about the Australian Government response to the pandemic and what the future holds for our national plan going forward.
The Committee believes that a wide-ranging summit into the pandemic, as well as the government response, should be held. The summit should also examine what future management of the present pandemic should be. It is imperative that future plans be undertaken at some stage to prepare, prevent and manage future pandemics.
Regarding submissions, I would like to thank all those who made submissions and/or appeared in person, as well as those who have met and discussed with Committee members, for their contribution to this inquiry.
Almost 600 submissions were made, plus many conversations and many questions were asked of the Committee. It is important that our nation, through government, research institutions and healthcare professionals, continue to search for answer and be as transparent as possible in the interest of better healthcare for all.
I would like to thank the Deputy Chair, Melissa McIntosh MP, and the Committee members: Ms Peta Murphy MP, Ms Jenny Ware MP, Ms Anne Stanley MP, Dr Gordon Reid MP, DrMonique Ryan MP, the Hon Mark Coulton MP and Dr Michelle Ananda-Rajah MP, for their time, dedication, and interest in this important national issue.
There has been a considerable amount of work done to make as much information available to the Committee and this has required a huge effort by the Secretariat.
I would like to thank the Secretariat, particularly Clare Anderson, Kate Portus, Kate Morris, Cassie Davis, and Cathy Rouland. Without their enormous professionalism, diligence, experience and unfailing goodwill and good humour, this inquiry would not have been achievable.
Further, I would like to thank the Minister for Health and Aged Care, the Hon Mark Butler MP, for his support, interest, and guidance throughout this inquiry, particularly his contribution and support for the Terms of Reference.
Lastly, I take full responsibility for any omissions and mistakes, and I do hope that this inquiry will be a good, informative framework for the future.
Dr Mike Freelander MP
Chair