6. Responding to long COVID

Overview

6.1Long COVID is still a relatively new condition, which is not yet fully understood. It is consequently unsurprising that the Committee received considerable evidence about issues and inconsistencies in terms of access to care and models of care for long COVID in Australia.

6.2Some of the issues that will be discussed in this chapter include:

• Current challenges and opportunities for improving the diagnosis, treatment and management of long COVID
• Current and potential models of care for long COVID, in particular the roles of primary care - including general practitioners (GPs) and allied health professionals – and specialist multidisciplinary long COVID clinics
• Current Australian Government funding to support the care of long COVID patients, as well as calls for new or amended funding
• Awareness, education and training regarding long COVID for Australia’s health workforce.

Diagnosis

6.3As discussed in Chapter 4, the Committee heard from many individuals who have either experienced significant difficulty obtaining a formal long COVID diagnosis or been unable to do so.

6.4Professor Michael Kidd AM, the Deputy Chief Medical Officer of the Department of Health and Aged Care (the Department), expressed concern about the potential underdiagnosis of long COVID:

The feedback that I get from our colleagues is that some people are seeing lots of people with long COVID and some people are seeing very few people with long COVID. I am concerned that people may be being missed.[1]

6.5When someone with long COVID does not receive a timely diagnosis, this can lead to negative outcomes, such as delayed access to treatment and stress.

6.6People who cannot obtain a long COVID diagnosis from a healthcare practitioner may self-diagnose. A survey of 607 people with long COVID found that 30 per cent were initially self-diagnosed with long COVID.[2]

6.7An accurate diagnosis of long COVID is important, because as the Australian Academy of Science and the Australian Academy of Health and Medical Sciences jointly noted:

It is important to exclude alternative explanations… when diagnosing long COVID. This is crucial to enabling health professionals to determine the most appropriate treatments and management approaches.[3]

6.8Apart from the lack of a nationally consistent definition for long COVID (discussed in Chapter 2), the evidence received suggested that there are two major challenges to diagnosing long COVID:

• the lack of a widely available diagnostic test, and
• medical practitioners’ poor confidence to make the diagnosis.
  9. These points, and suggestions from witnesses and submitters to improve the timeliness and consistency of long COVID diagnoses, are covered below.

Lack of simple and accepted diagnostic procedure

6.10The Committee heard from many submitters and witnesses that there is currently no simple and widely accepted diagnostic test for long COVID, making the condition difficult to diagnose.[4]

6.11NSW Health explained:

There is no definitive test for long COVID which means it is a diagnosis of exclusion and it is therefore difficult to be precise. COVID-19, like many other viral illnesses can cause lingering symptoms and after-effects. It can be challenging to determine the point at which these constitute long COVID.

Additionally, long COVID includes a range of different clinical profiles – from mild to severe; with single or multiple symptoms, reoccurring or continuous illness, with varying impacts on breathing, circulation, and inflammatory responses. It can be difficult to tell the difference between long COVID and similar conditions such as chronic fatigue syndrome.[5]

6.12Due to the large number of possible long COVID symptoms – the Burnet Institute acknowledged there are ‘up to 200 symptoms in 10 organ systems’[6] – ruling out other conditions is particularly challenging.

6.13The diagnosis of exclusion approach can be time consuming. Dr Benjamin Gerhardy, a respiratory physician with the Nepean and Blue Mountains Local Health District, explained that due to the need to conduct investigations and exclude other possible explanations, ‘…making the diagnosis [of long COVID] can’t be done very quicky...’[7]

6.14Another problem associated with the current diagnosis of exclusion approach is the potential for healthcare practitioners to conduct excessive testing, at a cost to taxpayers and/or the patient. This risk was acknowledged by the National Clinical Evidence Taskforce (NCET), which recommended that ‘to avoid adding burden to the person’, healthcare practitioners ‘limit investigations to those that are necessary for determining care.’[8]

6.15This situation likely contributes to patients’ reported delays and difficulties and cost associated with receiving a diagnosis. The Royal Australian College of General Practitioners quoted a GP who observed:

I believe that there is great difficulty in diagnosing long COVID resulting in diagnostic delay and subsequent management. I believe this to be a major factor impacting the patient experience.[9]

6.16The Royal Australasian College of Physicians also acknowledged the negative impact this has on patients:

With no diagnostic test available, individuals are often left understandably frustrated as to how to manage their symptoms or where to seek assistance.[10]

Healthcare practitioners’ capability and attitudes

6.17The Committee heard various perspectives regarding healthcare practitioners’ capability, willingness and confidence to diagnose cases of long COVID.

6.18Some healthcare practitioners reported that long COVID clinics or GPs are respectively ‘pretty good’ at diagnosing long COVID.[11]

6.19However, the Committee heard many reports from individuals with long COVID that some healthcare practitioners are reluctant to make the diagnosis.

6.20For example, the Australia Long Covid Community Facebook Group conducted a survey with 607 of its members and found that:

When seeking care for Long Covid, many patients experienced disbelief by healthcare professionals as well as minimising... Often the symptoms were blamed on anxiety and depression. About two thirds [of those surveyed] also experienced unwillingness to diagnose Long Covid.[12]

6.21Some experts and peak bodies also echoed concerns about there being a reluctance to diagnose long COVID. Professor Steve Wesselingh, President of the Australian Academy of Health and Medical Sciences, acknowledged that:

…there's also a lot of people out there who are either worried/afraid of making the diagnosis or for a variety of reasons [are not making the diagnosis] and are therefore not helping their patients or sending their patients elsewhere.[13]

6.22The Australian Healthcare and Hospitals Association noted anecdotal reports from its members suggesting that:

…the lack of consistent diagnostic, referral and treatment pathways for people with long COVID has resulted in some primary care and allied health service providers (private businesses) actively choosing not to treat people suffering from long COVID.[14]

6.23One factor that may be relevant is whether healthcare practitioners have sufficient education and training to support patients with long COVID. This is discussed later in this chapter in the section titled ‘Health workforce: awareness, education and training’.

6.24Another factor that could influence healthcare practitioners’ perspectives on diagnosing long COVID is whether they see a practical utility of the diagnosis, given there is currently no known treatment and supporting the patient therefore involves managing their symptoms (see the section ‘Treatment and Management of long COVID’ for further discussion).

6.25A diagnosis of long COVID may hold greater clinical benefit in the future if treatments are identified. Professor Michael Kidd AM, Deputy Chief Medical Officer of the Department, considered this possibility:

There are people who may present, as we mentioned earlier, with other symptoms, as part of the spectrum. That gets managed. As long as it's being managed, that's probably the most important thing that happens… As we understand more, if there are tests available, and if there are more treatments available, we will get more understanding about who will benefit the most from the multidisciplinary interventions.[15]

Opportunities to improve diagnosis

6.26The current diagnostic approach, as referenced above, could lead to multiple suboptimal outcomes including some people not receiving a diagnosis, delayed diagnoses, unnecessary diagnostic tests being conducted, and excessive ambiguity for healthcare practitioners. Multiple suggestions were received throughout the inquiry as to how the diagnosis of long COVID could be improved, and some of these potential issues addressed.

6.27First, the Committee heard that a diagnosis is important for demystifying long COVID. Associate Professor Nada Hamad, a physician living with long COVID, stated:

One of the first things they talk about in the UK [United Kingdom], in the papers on guidelines, is that you must document it as long COVID. You must write it down. I still don't have it written down anywhere in my documentation. There is a reluctance to call it or look at it. It is because we keep talking about, 'Oh, it's just a bunch of symptoms. It's really hard to figure out.' But it actually isn't. We know that people with chronic illnesses manifest in different ways, but if we keep talking about how difficult and how nebulous it is, we will never move on.[16]

6.28In terms of specific avenues for improvement, the Committee heard that standardising the diagnostic assessment process or developing a diagnostic model would assist. Professor Greg Dore, an epidemiologist at the Kirby Institute, explained:

It’s a very difficult diagnosis because there’s no easy diagnostic test… That assessment process could be somewhat standardised in terms of the tests that are ordered, the investigations that are covered and the referral pathways that are utilised.[17]

6.29While discussing long COVID priorities, Professor Steve Wesselingh also called for a diagnostic model. He advocated:

If we could very quickly develop a relatively simple model with the right tests to exclude the diagnosis of other diagnostic opportunities, but also then lead to the

diagnosis and share that widely with primary care, I think that would be probably the most helpful aspect.[18]

6.30Professor Brendan Crabb AC, Chief Executive Officer and Director of the Burnet Institute concurred. He suggested: ‘At a high level, the most important [thing] is being able to diagnose the different forms of long COVID, assess the risk associated with each and, of course, come up with a treatment plan for each.’[19]

6.31Multiple witnesses also referenced that in the future there may be new tools to help effectively and accurately diagnose long COVID utilising biomarker research (see Chapter 3 for further discussion).[20]

6.32Professor Jeremy Nicholson, Director of the Australian National Phenome Centre, explained to the Committee that biomarker research conducted by him and his colleagues was recently able to predict who would develop long COVID. Professor Nicholson told the Committee that ‘We think that in the future we’ll be able to predict systematic subsets of long COVID as well.’[21]

6.33Professor Crabb AC commented that in the future, testing for long COVID biomarkers could form part of the long COVID diagnosis process:

For diagnosis… we’ll start off quite clinically and, as biomarkers improve-biomarker research… we’ll be able to add those concrete biomarkers into clinical [diagnostic assessments].[22]

6.34The Burnet Institute submitted that such a tool would have significant benefits, including that it could ‘be easily deployed in medical practices across the world, at low cost.’[23]

6.35Dr Jen Kok, Medical Virologist, Australian Society of Microbiology; Institute of Clinical Pathology and Medical Research; and NSW Health Pathology, also saw value in biomarker tests for long COVID. At the same time, he acknowledged that further research is needed:

…it would be very elegant if we did have a biomarker or a set of biomarkers to test people for long COVID. I don't think we're quite there yet, and there are different syndromes, if you like... If you have pulmonary predominant long COVID versus neuropredominant long COVID, those sets of biomarkers potentially could be very different.[24]

6.36The Australian Academy of Science and the Australian Academy of Health and Medical Sciences also suggested ‘structured clinical assessments and laboratory investigations for conditions or disease that may be confused with long COVID’ to exclude other conditions. They further argued that ‘This would require our health system to support increased and standardised screening and a workforce with the knowledge and capacity to undertake these assessments.’[25]

Treatment and management of long COVID

6.37The Royal Australasian College of Physicians summarised the current situation, when it noted that ‘Knowledge about Long COVID is still emerging and therefore treatment and support options provided are limited at present.’[26]

6.38This section reflects evidence received regarding the current state of treatments and management of long COVID in Australia. It first discusses the current lack of any evidence-based treatments and considers potential emerging treatments. Then, current and emerging best practice for the management of long COVID symptoms are discussed.

Treatments for long COVID

6.39Many witnesses and submitters highlighted that there are currently no known, evidence-based treatments for long COVID.[27] As Professor Crabb AC put – ‘At the moment, we don’t have medical solutions and technical solutions to long COVID.’[28]

6.40However, the Committee received evidence from many individual members of the public, as well as some healthcare practitioners and medical researchers, about emerging treatments being studied for the condition. These included medications such as Aspirin, Naltrexone and antihistamines, and vitamins or minerals such as vitamin C, vitamin B, zinc and magnesium.[29]

6.41The Australia Long Covid Community Facebook Group identified 33 specific treatments that its’ members had trialled, further illustrating the breadth of potential treatments being discussed. This group noted that ‘many potential treatments (those requiring prescription, healthcare professional involvement) are not readily available to Long COVID patients in Australia’.[30]

6.42Noting a need to improve access and information regarding long COVID treatments, the Australia Long Covid Community Facebook Group proposed running more clinical trials of potential treatments, and educating health professionals of simple, cost-effective treatments.[31]

6.43As discussed in Chapter 2, some consider long COVID to be an umbrella term that may in fact encompass multiple conditions or symptomatic clusters. If this is found to be the case, it is possible that some overarching treatments may be effective for all affected individuals, and/or different treatments may be needed for different symptom presentations. Professor Dore explained:

…I think the solution will be some therapeutic interventions. There'll probably be different interventions for different clusters. I think a neurocognitive cluster, for example, will need a specific intervention. There may be some immunological interventions that are much more broadly focused, in terms of trying to dampen down the hyperactive immune response.[32]

6.44The need for research and clinical trials into treatments for long COVID is discussed in Chapter 3.

COVID-19 antivirals as long COVID treatment

6.45The Committee was particularly interested in evidence regarding the potential for COVID-19 antivirals to be used to treat long COVID.

6.46Chapter 5 discusses the potential use of COVID-19 antivirals as a preventative measure in relation to long COVID, both in terms of preventing the development of long COVID or preventing individuals with long COVID from being reinfected. Chapter 5 also outlines the regulatory framework under which COVID-19 antivirals are listed on the Pharmaceutical Benefits Scheme.

6.47In Australia, there are two oral antiviral treatments for COVID-19 currently available: molnupiravir (Lagevrio®) or nirmatrelvir and ritonavir (Paxlovid®). Neither of these antivirals is currently authorised or approved for use as a treatment for long COVID, although the Department continues to monitor relevant emerging research.[33]

6.48Multiple individuals with long COVID noted the potential for antivirals to treat long COVID symptoms and/or called for access to antivirals for this purpose.[34] For example, one submitter stated: ‘Although the treatment is relatively new, there are emerging case studies about the use of the antiviral Paxlovid in treating long COVID.’ This submitter described two case studies with single individuals that suggest antiviral treatment may reduce long COVID symptoms.[35]

6.49The Committee heard from Pfizer Australia about two studies that are currently underway, which will evaluate the potential for Paxlovid® antivirals to be used as a treatment for people with long COVID.[36]

6.50However, as the Public Health Association of Australia noted, ‘more research is required’ regarding the use of antivirals as a treatment for long COVID.[37]

6.51The Burnet Institute summarised the current theory and state of research regarding antivirals as long COVID treatment:

Several antivirals are used against acute COVID-19. Some researchers think these drugs could ease the symptoms of long COVID, too — particularly as evidence grows that a lingering SARS-CoV-2 reservoir could trigger the condition. But there are still no registered studies directly looking at whether these antivirals — which are expensive and in relatively short supply compared with generic drugs — could ease long-COVID symptoms.[38]

Current official advice

6.52The Committee appreciates that suggestions regarding potential treatments for long COVID are intended to help people who are experiencing poor health and associated hardship. The Committee notes that people seeking potential treatments may be doing so because of the current absence of any established, evidence-based treatments. However, while the Committee does not intend to issue any health advice in this report, it does note the sensible evidence from the Australian Patients Association and OzSAGE, which suggests that experimenting with untested medications or other interventions may be harmful as there is the potential for over-dosing, misuse, and interactions with other drugs.[39] This is why potential treatments undergo rigorous testing in pre-clinical and clinical phases including through clinical trials pathways.

6.53The Royal Australian College of General Practitioners cited advice from the NCET’s ‘Australian guidelines for the clinical care of people with COVID-19’ (the guidelines).[40] These guidelines currently recommend:

In patients with continuing symptoms after COVID-19, do not use unproven therapies outside of guidelines or randomised trials with appropriate ethical approval.[41]

6.54Detailed advice regarding some of the potential long COVID treatments proposed throughout the inquiry is available via the NCET guidelines[42], and on the Australian Government’s healthdirect website.[43] Individuals seeking health advice are encouraged to contact their GP.

Managing long COVID

6.55This section discusses approaches to managing long COVID. It is noted that in some instances, witnesses and submitters appear to have used the term ‘treatment’ to refer to activities that would be technically classified as management or supportive care, as they aim to control or reduce (rather than fully resolve) long COVID symptoms.

6.56Given that there are currently no known effective treatments, healthcare practitioners supporting patients with long COVID aim to manage their symptoms and provide supportive care.

6.57This means that the current goal is to effectively manage long COVID symptoms, rather than treat (i.e. cure or fully resolve) the condition. Associate Professor Alex Holmes from the Royal Australian and New Zealand College of Psychiatrists pointed out the difference between management and treatment:

Essentially, there are no effective treatments… People talk about care and treatment as if they’re the same thing… In five or 10 years time maybe that will change, but we need to acknowledge that mostly we’re… helping people deal with an awful event that isn’t getting better.[44]

6.58The Committee was informed that there is currently no conclusive evidence about how to best manage long COVID.[45]

6.59The Burnet Institute noted ‘there have been no published clinical trials evaluating long COVID management strategies.’[46] The guidelines from NCET further state that:

Evidence for specific management of post COVID-19 is not available. Established symptom management approaches are likely to be beneficial.[47]

6.60In the absence of any evidence-based management approaches specific to long COVID, the Committee heard descriptions of the general approaches that healthcare practitioners are taking. For example, Professor Shidan Tosif, a Consultant of General Medicine and Clinical Lead at the Melbourne Royal Children’s Hospital’s Post-COVID Clinic, described:

The mainstay of our management is supportive, holistic care with symptom control and assessment of treatable complications. What we try to do is hear the patient's story and validate the experience of the family, which is often a very challenging and anxiety-provoking experience for the child and the parents. We utilise our clinical experience with other post-viral fatigue syndromes, such as chronic fatigue syndrome and myalgic encephalitis. On a case-by-case basis we recommend activity management through, for example, pacing or prioritising activities, focusing on sleep, graded physical activity, prioritising school and social engagement, and trying to set limits around areas such as screen time. We sometimes do use medications when needed. I would say it's fairly rarely, but they are at times needed for symptom control. We monitor for other complications such as autonomic instability and weight issues.[48]

6.61Like Associate Professor Tosif, Associate Professor Irving from the Royal Melbourne Hospital’s Post-Covid Clinic for adults also highlighted that patient validation is an important part of providing care. He told the Committee:

…we based our model of care on exactly what GPs do in terms of validating symptoms, supporting the patient, not dumping the patient but keeping in touch with them and then using targeted tests or targeted referrals to rule out the very occasional, nasty thing, such as myocarditis or Pes [pulmonary embolisms] or asthma, and so on.[49]

6.62The Committee also heard examples of health practitioners providing evidence of their long COVID patients’ symptoms and/or advocating on behalf of their patients to facilitate appropriate adjustments or support from employers, health insurance companies and other relevant bodies.[50]

6.63These aspects of patient management – acknowledging patient symptoms and experience and advocacy to facilitate their access to care and engagement with employers - align with some of the key values that the NCET identified via focus groups as important for long COVID patient care.[51]

6.64Although following established symptom management strategies is useful guidance for many healthcare practitioners, the current lack of evidence regarding long COVID may make this difficult in areas such as psychological support. Psychologists from the COVID Recovery Clinic at the Royal Melbourne Hospital drew the Committee’s attention to:

…the lack of evidence based psychological and cognitive treatments and interventions for long COVID, causing difficulties for both clinicians and patients. Clinicians indicate that it is difficult not having strong evidence about whether the psychological and cognitive issues have a clear biological basis, or if they are secondary responses/reactions to the other factors of long COVID (medical complications, fatigue etc).[52]

6.65The psychologists from the COVID Recovery Clinic further explained:

This impacts on the types on psychoeducation the psychologists can provide to patients, and whether their first line of treatment approaches should be restorative/symptom targeted or acceptance/compensatory based.[53]

6.66A common theme throughout the evidence was the need to manage long COVID patients as individuals and identify appropriate interventions for their symptoms on a case-by-case basis. Associate Professor Tosif illustrated this tailored approach with paediatric long COVID patients:

It really comes down to a case by case assessment and trying to, firstly, optimise all the nonpharmacological means through which the child may have benefit—through those measures I discussed earlier. In some children where they perhaps have pain as a prominent symptom—headaches is a common one. After we have tried simple analgesia, if the headache is really impacting their function and quality of life then we may consider something similar to what we would use for migraine prophylaxis, for example.[54]

6.67The Committee also received evidence that rehabilitation services may play a role in helping some patients with long COVID.[55]

6.68The World Health Organization, as cited by the Rehabilitation Medicine Society of Australia and New Zealand, defines rehabilitation as a ‘set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment…’.[56] A number of healthcare professions provide rehabilitation services including specialist rehabilitation doctors, physiotherapists, occupational therapists, speech therapists, psychologists, dieticians and social workers.

6.69The NCET guidelines recommend that- ‘In patients with persistent symptoms or functional impairment following COVID-19, begin rehabilitation as soon as possible, as appropriate to the individual’s circumstances, setting and tolerance.’ The guidelines further note that rehabilitation services which could be appropriate may include physical or occupational therapy, speech and language therapy, vocational therapy, neurological rehabilitation or dietary interventions.[57]

6.70The Department’s advice, titled ‘Getting help for long COVID’, similarly notes that depending on an individual’s symptoms, it may be appropriate for their GP to refer them to health professionals for various rehabilitation services.[58]

6.71The Committee heard that this advice is being put into practice by many healthcare practitioners. For instance, the Long Covid Clinic at St Vincent’s Hospital in Sydney outlined that:

The management approach taken is based on general rehabilitation principles and the principles of managing treatable traits such as breathlessness, fatigue and cognitive impairment. Diagnostic review also forms part of the services of the clinic.[59]

6.72Other healthcare practitioners also discussed the importance of rehabilitation services via allied health professionals. Dr Benjamin Gerhardy, a respiratory physician with the Nepean and Blue Mountains Local Health District, commented that from his experience ‘The mainstay of therapy at the moment is getting patients to be involved with physiotherapists and occupational therapists.’[60]

6.73Associate Professor Holmes shared a similar view, commenting that ‘The hero ingredient is in fact the exercise physiologists.’[61]

6.74However, many witnesses and submitters contested the appropriateness of exercise as part of a management approach for long COVID patients and suggested it may in fact be harmful.[62]

6.75Professor Anne Holland, Head of Post COVID Service and Head of Respiratory Research at Alfred Health and Professor of Physiotherapy at Monash University, suggested there is an evidence gap regarding the ‘role of exercise rehabilitation or graded exercise therapy’ in managing long COVID. Professor Holland noted:

Certainly, there are people for whom the graded exercise therapy interventions are not helpful and can be harmful, but there’s also I think a group of people with long COVID perhaps with persistent respiratory disease for whom those interventions are actually quite helpful.[63]

6.76Relevantly, the NCET guidelines state:

In patients with post-exertional fatigue, use a conservative physical rehabilitation plan involving consultation with physiotherapy or exercise physiology for cautious initiation and pacing of activity or movement.

For most patients gradual return to exercise as tolerated may be beneficial.

Additional caution and specialist review should be sought before commencing exercise programs in patients who are known to have myocarditis. Clinicians should assess whether exercise exacerbates symptoms, and adjust rehabilitation plans as necessary…[64]

Emerging best practice management

6.77Throughout the inquiry the Committee received evidence indicating that multidisciplinary care, early intervention, and self-management approaches (for appropriate patients) may all constitute best practice management of patients with long COVID.

Multidisciplinary care

6.78The Rehabilitation Medicine Society of Australia and New Zealand submitted that since most individuals with long COVID have multiple symptoms, multidisciplinary care (which involves healthcare practitioners from different disciplines) will often be required.[65]

6.79Many submitters and witnesses either recommended or are implementing multidisciplinary rehabilitation care arrangements for patients with long COVID.[66] For example, the Royal Melbourne Hospital informed the Committee that it has found a multidisciplinary approach beneficial:

A multidisciplinary team (MDT) approach has been very helpful in the RMH [Royal Melbourne Hospital] COVID Recovery Clinic, given the variety of symptoms in people presenting with long COVID. As such an MDT approach is recommended as best practice...[67]

6.80Ms McConnell, a physiotherapist leading the Royal Melbourne Hospital’s allied health-led long COVID clinic, further described what their multidisciplinary approach looks like:

We have a 12-week multidisciplinary program that we run for patients that is very much tailored to the unique needs of the individual patients. We have a physiotherapist, an exercise physiologist, a clinical psychologist, a neuropsychologist, a social worker and so on. So we have quite a large array, and patients are referred to the disciplines that they need to best treat their symptoms.[68]

6.81The Long Covid Clinic at St Vincent’s Hospital also outlined its use of multidisciplinary case conferences:

Every patient consulted is discussed at the multidisciplinary case conference, which includes specialist physicians in rehabilitation respiratory medicine as well as psychologists’ physiotherapists and our clinical nurse consultant. Treatment plans are developed based on combined experience and available resources.

Specialists in [particular] areas such as psychiatry and cardiology are invited to the clinic to allow us to present specific cases and to obtain information, referral pathways, and up to date research and opinion for management.[69]

6.82The Department noted that multidisciplinary care is also being employed by many other countries. It submitted:

Most of the international approaches to the management of long COVID identified at Attachment C involve a multidisciplinary team providing care through community health clinics, general practice, rehabilitation programs, or COVID-19 clinics. This multidisciplinary team may include GPs, specialist doctors, and allied health professionals.[70]

6.83The NCET also supported multidisciplinary care, advising the Committee that:

Best practice would include a multidisciplinary team. This could be accessed through general practice, community health, rehabilitation programs or post-COVID-19 clinics, where these are available.[71]

Early intervention

6.84The benefits of early intervention to manage long COVID symptoms was a theme that ran throughout the inquiry. Like with any health condition, not receiving timely support for long COVID negatively impacts an individual’s recovery, potentially allows untreated symptoms to worsen, and/or causes additional stress and suffering.

6.85Illustrating this point, the Royal Melbourne Hospital submitted:

Psychologists in the RMH COVID Recovery Clinic have noticed that those presenting with the longest duration of long COVID symptoms, appear to be having the more entrenched issues with their mental health and functional cognitive difficulties. Once symptoms are entrenched, including resulting patterns of behaviour change, these can be harder to remediate through therapy/intervention.[72]

6.86Beyond helping affected individuals, ensuring people with long COVID have early access to care may have broader positive effects. Professor Margaret Hellard, Deputy Director of Programs at the Burnet Institute, noted the financial benefits of early intervention. Professor Hellard expressed the importance that:

… they [patients] actually get the care that they require and they don't have to wait months and months, because that is a cost to the community. The moment somebody is not actually engaging in their family life, their social life and their work life, that's a cost anyway. It's costing us money, so it's a false economy to not do that.[73]

6.87Multiple submitters advocated for early intervention for people with long COVID.[74] The Western Health COVID Recovery Collaboration argued:

In the absence of health promotion and/or prevention, early intervention in the disease course of Long COVID is urgently [needed]. Ideally consumers would receive rehabilitation and other supports as soon as it becomes clear they are experiencing sustained problems, and some jurisdictions include symptoms lasting longer than 1 month in their case criteria. Early referral for rehabilitation is recommended in the World Health Organisations Clinical Management of COVID-19 Living Guideline but is predicated on the availability of services. Without rapid access to the care they need, consumers experience aggravated deconditioning, loss of valued roles and social isolation as they remain on waiting lists for many months – all of which further impact on their potential to achieve optimal recovery.[75]

Self-management

6.88Many submitters and witnesses advocated for self-management resources and tools for patients with less severe long COVID symptoms, in addition to support for multidisciplinary care and early intervention.[76]

6.89As outlined in Chapter 2, although the prognosis for people with long COVID is not yet clear, at least some long COVID cases involve symptoms on the milder end of the spectrum. The Committee heard that for this group of patients, a self-management approach, via online tools and information, is likely to be appropriate.

6.90Dr Danielle Hitch, a Senior Lecturer in Occupational Therapy at Deakin University, reported that much of the attention and resourcing for long COVID focuses on individuals with severe symptoms. While acknowledging that addressing this group is important, she states that:

…addressing the needs of people with milder long COVID is critical also. Even a five per cent reduction in function is significant in the short and longer term… People with milder long COVID usually don’t meet the criteria for the long COVID clinics, so they are kind of falling into a gap at the moment.[77]

6.91The NCET recommends that healthcare practitioners utilise education and skills training, to support patients with long COVID to self-manage their symptoms.[78] The Committee heard that some healthcare practitioners, such as the Post-COVID Clinic at the Melbourne Royal Children’s Hospital, are already supporting a self-management approach for patients with mild functional impact.[79]

6.92The Committee received evidence emphasising that while self-management approaches have merit, they will not be suitable for all long COVID patients. Dr Tuan-Anh Nguyen, Head of Department, Senior Staff Specialist, Rehabilitation Medicine at Campbelltown Hospital, discussed whether allied health support could be outsourced to self-management systems. Dr Nguyen said:

I guess it comes back to what the symptoms are. If it's general fatigue symptoms, I feel a lot of them can be self-managed… There may be some specific symptoms in terms of breathlessness where there may be disordered breathing patterns, where a specific form of rehab may be useful, and in that case some expertise in terms of managing some of the more complex breathing disorders may be useful. But, for the majority of patients with long COVID symptoms, an approach where there's self-management tools, where there's pacing strategies [management of activity to avoid over-exertion] and education around how to manage those… would be quite useful...[80]

6.93Dr Nguyen further commented that self-management resources need to:

…be easy to understand, potentially allow for individualisation of treatment approaches based on symptoms and functional impact, be scalable, be cost-effective, and provide guidance on how, when and where to get further help.[81]

6.94The need for self-management resources and information to be accessible for culturally and linguistically diverse and Aboriginal and Torres Strait Islander populations was also mentioned.[82] The Rehabilitation Medicine Society of Australia and New Zealand additionally noted that self-management resources would likely be of most benefit to individuals with ‘reasonable education standards and adequate health literacy.’[83]

6.95While self-management may sound like it does not involve contact with a healthcare practitioner, Associate Professor Holmes suggested that there may be a need for a GP to facilitate and provide supportive care to patients with long COVID utilising a self-management approach.[84]

6.96Throughout the inquiry some submitters and witnesses cited the United Kingdom’s (UK) ‘Your COVID Recovery’ digital program as an example of international best practice for supporting long COVID patient self-management and advocated for Australia to adapt the UK version or develop something similar.[85]

6.97Dr Brett Gardiner, Clinical Network Director, Subacute and Ambulatory Medicine at Western Sydney Health District, told the Committee that the UK ‘Your COVID Recovery’ digital program and the COVID-19 Recovery Course are ‘an efficient way of doing things and also being able to get things out for the population.’[86] He advised that the UK has an open access platform, and providers can grant patients access to a program of up to 12 weeks, which provides additional resources and support.

6.98Ms Carly McConnell, ReCOV Team Leader at the Royal Melbourne Hospital, also complimented the UK’s ‘Your COVID Recovery’ program. She described that the program allows patients to enter and monitor their symptoms and communicate with the relevant health service. Ms McConnell suggested that:

A great way of scaling our [long COVID clinic] service up would actually be to triage the milder symptoms into a program like that so that they can self-manage, and then the tertiary services can really focus their resources where they're needed more, in severe disease.[87]

Settings and models of care

6.99When people with long COVID engage with Australia’s healthcare system, they typically do so via primary care (entry level services such as GPs), specialist long COVID clinics, and/or allied health providers.

6.100This section first discusses the various roles that primary care (including GPs and allied health) and long COVID clinics play in supporting patients with long COVID and considers benefits and drawbacks of the current approaches. Some apparent inconsistencies in long COVID care across Australia are examined, including regarding the roles and operations of long COVID clinics.

6.101The current state of affairs in terms of models of care for supporting long COVID patients are then considered, and potential opportunities to improve models of care for long COVID patients are discussed.

Current settings for care

Primary care

6.102The current advice from the Department is that people with persistent symptoms after COVID-19 should seek first advice from their GP. The Department further advises that:

It is likely that many symptoms can be managed through primary care services, including GPs and allied health professionals such as physiotherapists, occupational therapists, dietitians, speech pathologists, psychologists, social workers and exercise physiologists.[88]

6.103The NCET supports GPs being the first port of call. It submitted that:

General practitioners are well placed to undertake initial investigations and diagnosis of long COVID, including determining if symptoms are related to or exacerbated by comorbid conditions. In some instances, patients may require additional assessment by more than one specialist to exclude other conditions contributing to their symptoms.[89]

6.104The issue of whether GPs are appropriately funded to manage long COVID patients is discussed later in this chapter in the section titled ‘Australian Government funding for long COVID care’. Likewise, whether GPs have the relevant knowledge, education and training to effectively support long COVID patients is discussed in the section titled ‘Health workforce: awareness, education and training’.

6.105The Committee heard different perspectives on whether GPs are equipped to support long COVID patients from a demand perspective.

6.106The Australian Medical Association called for greater support for general practice. It argued that:

GPs will be on the front line and will need appropriate resourcing to manage the

expected increase in [long COVID] patients. GPs cannot be expected to take on this additional burden with no additional resources as they have throughout the pandemic.[90]

6.107The South Australian Minister for Health and Wellbeing, the Hon Chris Picton MP, shared this view that long COVID is likely to result in an increase in patients seeking care. Citing self-reported data from long COVID patients in the UK that indicates a considerable number have symptoms for one to two years after their COVID-19 infection, Minister Picton stated that this supports GPs taking a central role. He said:

Given that a large proportion of Long COVID patients have such chronic symptoms, it reinforces the ideal position of primary care to support the majority of these patients, while the resource-intensive multidisciplinary acute sector teams care should be reserved for a minority of complex and severe patients.[91]

6.108However, Queensland Health presented a different view. Its submission outlined that a focus group convened to advise on the demand and design of support services for people with long COVID, advised that it did not currently observe a significant demand in primary care services. Queensland Health noted that the focus group further advised that ‘the management of long COVID did not warrant the establishment of tertiary specialist services in Queensland’s context’, and instead suggested that long COVID ‘be managed within primary care’.[92]

6.109Thus, the Committee heard some perspectives or forecasts regarding high numbers of people being severely impacted by long COVID and requiring care, and others anticipating a lesser impact on Australia’s healthcare system. In some instances, these varying forecasts may explain the different views regarding whether general practice currently has the capacity to effectively support long COVID patients. In other instances, regardless of disagreement on the prevalence or prognosis of long COVID, some stakeholders agreed that primary care is well placed to manage the majority of long COVID cases.

6.110Relevant to long COVID, community based care is generally considered to include allied health practitioners. As discussed under the section ‘Managing long COVID’, allied health often plays a role in supporting patients with long COVID. This includes allied health involvement via GP referrals.

6.111Noting that GPs and allied health are often both involved in supporting long COVID patients, Allied Health Professions Australia reported that allied health practitioners consider GPs as ‘central to managing long COVID patients at many stages of their care’. Allied Health Professions Australia further advocated that GPs should also ‘help coordinate and structure an effective multi-disciplinary plan for the patient.’[93]

Benefits of primary community care response

6.112The Committee heard various reasons why primary care should play the central role in supporting people with long COVID.

6.113Professor Mark Morgan, Chair of the Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, NCET’s Primary and Chronic Care Panel, noted that GPs are well suited to provide coordinated care for long COVID patients because there are GPs across the country, they are reasonably accessible, and GPs as generalists are ‘able to manage a multisystem disease, which has psychosocial impacts.’[94]

6.114Professor Bennett noted that from a practical point of view, GPs are likely to be where many individuals with long COVID symptoms first seek help, regardless of any official models of care or government advice. She explained:

People won't necessarily know that they have long COVID. They may not even know they've had a COVID infection, particularly if they had a very mild or asymptomatic or atypical COVID infection. They might not even know that it could be long COVID. So I actually think, just thinking about it from a referral point of view, that you have to support this from the GP level up...[95]

6.115Given the role they play, another potential consideration is that GPs may have greater knowledge of a patient’s history than other healthcare practitioners. The Royal Australian College of General Practitioners mentioned that: ‘GPs are experts in providing patient-centered, continuous, and coordinated care. GPs know their patients, their medical history, backgrounds, social and mental health circumstances.’ At the same time, they cautioned that:

General practice cannot work in isolation to provide effective long COVID management, particularly for more complex cases of long COVID and, other medical specialists and allied health professionals must be engaged in a coordinated manner.[96]

6.116Noting this idea that GPs are often a trusted healthcare practitioner, the Hon Chris Picton MP, the South Australian Minister for Health and Wellbeing, reported that GPs may consequently be appropriately placed to support long COVID patients who experience any related mental health concerns. Minister Picton stated that:

…a range of mental health disorders have been reported in patient cohorts recovering from COVID-19… primary care GPs are well placed to leverage the trusted steady relationships with their patients, in conjunction with psychologists and mental health support programs, to support patients in their mental health recovery over the long term.[97]

6.117Dr Kenneth McCroary, a GP and Director of Macarthur General Practice, noted that GPs also often have experience managing post-viral syndromes and people with chronic illness.[98] Given the current advice is to utilise established symptom management approaches[99], such experience may be transferrable to long COVID patients.

6.118Another potential advantage that GPs may have over more specialised colleagues is being more integrated within the local community. For instance, while discussing challenges conducting effective community outreach with culturally and linguistically diverse populations from a long COVID clinic perspective, Dr Gardiner observed that ‘patients often go to the GPs that speak their native language’.[100]

6.119Throughout the inquiry and as previously noted, the Committee received evidence that self-management approaches and/or management via primary care (specifically GPs) are likely to be appropriate and effective for many long COVID patients.[101] If this is correct, using primary care to manage lower-risk, less complex cases of long COVID may avoid escalating patients to specialists unnecessarily.

Drawbacks of primary community care response

6.120However, the Committee also received evidence regarding multiple disadvantages of utilising GPs to manage people with long COVID.

6.121First, as outlined in the previous section titled ‘Healthcare practitioners’ capability and attitudes’, the Committee heard that some individuals have found GPs to be unable or unwilling to diagnose and support patients with long COVID.

6.122As another issue, multiple submitters and witnesses noted that it can be challenging for people to attend an appointment with their GP due to attendance often involving out-of-pocket expenses and/or their limited availability.

6.123Dr Archana Sud, an Infectious Diseases Physician and Clinical Director Medicine at the Nepean and Blue Mountains Local Health District, noted that out-of-pocket fees would probably be an issue for some individuals, and would represent a barrier for lower socioeconomic populations.[102]

6.124Dr McCroary, a GP and Director of Macarthur General Practice, agreed there is often ‘difficulty in attending’ a GP, and attributed this to ‘the increased crisis that general practices are facing in terms of numbers and particularly distribution.’ Dr McCroary further observed that ‘it’s going to cause a lot of challenges and a put a lot more burden on our hospital system and emergency presentations if people are expected to pay these out-of-pocket funds.’[103]

6.125The Rural Doctors Association of Australia submitted the issue of shortages of practitioners in rural areas as another potential challenge with relying upon GPs.[104]

6.126Thus, as Dr Danielle Hitch commented ‘Not everyone has a GP. Not everyone accesses their GP either.’ Dr Hitch emphasised that given there are different groups with long COVID that have different needs and different access to care:

Having a range of options is more likely to actually reach all Australians or the vast majority.[105]

6.127From a patient perspective, the Committee heard that some individuals find seeking help via a GP slow and expensive. For instance, Dr Kyaw-Myint, an individual with long COVID, commented:

Everything is so siloed. You get referred to so many specialists. The specialist writes back to the GP. Sometimes you wait six months to see a specialist. You don't get to even speak to the specialist again because you have to wait another six months... I don't feel like GPs are the answer. We need multidisciplinary centres of excellence for long COVID.[106]

6.128During a public hearing, another individual with long COVID, Ms Karren Hill, noted that GPs are under tight time constraints[107], which may impact their ability to communicate efficiently with specialists.

6.129In addition to the aforementioned broader issues with accessing GPs, the Committee heard that some GPs may not have the necessary expertise to support long COVID patients. Mr Robin Austin, a person with long COVID, shared his perspective:

My understanding has always been that you need the GP as the first port of call. If it's relatively simple, the GP works with you and fixes your problem. But if it's complex, they need to refer you to specialists. When it's complex and mysterious, there is no way that most GPs will ever begin to be able to address that with you on their own. They need to refer you to the specialists who are working on this all day, every day, learning as they go, so that we have access to the best knowledge, the best international knowledge. My wonderful GP will never begin to be able to get anywhere near that. He needs to be able to say… 'Go to the experts in the multidisciplinary clinic’.[108]

Long COVID clinics

6.130A major theme throughout the inquiry was the establishment of long COVID clinics in some parts of the country, to provide services to patients with long COVID. This section first provides a brief overview of where these long COVID clinics are, what roles they play, and the services they provide. Various benefits and drawbacks of these long COVID clinics as raised throughout the inquiry are then discussed.

6.131Long COVID clinics typically provide specialist, dedicated and multidisciplinary services to people with long COVID, and are connected to a tertiary hospital. The Australian Patients Association referenced that 89 long COVID clinics have been set up around Australia, in both rural and urban settings.[109]

6.132At least six Australian states and territories have established one or more long COVID clinics.[110]

6.133At the time of writing Tasmania does not appear to have any long COVID clinic.[111] The Northern Territory has not established any, and the Northern Territory Department of Health explained the rationale for this decision:

Currently, there is no centralised long COVID referral pathway or multidisciplinary long COVID service in the NT. This decision was made due to the NT context where there is remote community focus on primary care management of patients with multidisciplinary input through in-reach and out-reach models of care. The current models of multidisciplinary care for chronic disease are therefore ideally accessed for these patients in community, rather than establishing urban teams which require additional staffing and travel of patients or staff.[112]

6.134The Northern Territory Department of Health elaborated:

The best practice approach for the management of long COVID has been described as a dedicated multi-disciplinary long COVID service. In our context, from a financial, service and patient perspective, having a centralised service for such a large and remotely spread potential pool of patients long term is not the preferred model. In our context skilling primary care and outreach multi­ disciplinary teams to identify and undertake initial management supported by urban specialists (including by telehealth) is a more sustainable model for the NT.

As our understanding of the regional and local impact of long COVID across the NT emerges it may be that a focussed model is developed.[113]

6.135Other countries including the Belgium, Canada, France, Germany, Spain, the UK, and the United States have also reportedly established specialist long COVID clinics.[114]

6.136Throughout the inquiry the Committee heard from multiple long COVID clinics operating around the country. These clinics can differ in multiple ways, including in terms of:

• The referral pathways to access the clinic and admission criteria
• The clinic’s role, in particular whether a clinic is designed to provide initial assessment and diagnosis of patients, and/or support and facilitate specialist care for patients with more severe symptoms; and
• The variety of health disciplines incorporated within the clinic.
  137. Funding for long COVID clinics is discussed later in this chapter in the section titled ‘Australian Government funding for long COVID care’.
  138. Many long COVID clinics that provided evidence to the inquiry advised that they either require or prefer a referral from a GP to attend the clinic.[115]
  139. However, some long COVID clinics accept a wider range of referrals. For example, the Post-COVID Clinic at the Melbourne Royal Children’s Hospital accepts referrals from GPs, other internal areas of the hospital, other hospitals, hospital emergency departments, and even interstate referrals.[116] In addition to GP referrals, the Royal Melbourne Hospital’s allied health-led long COVID clinic also accepts self-referrals from hospital staff.[117]
  140. Another point of difference between long COVID clinics was the admissions criteria they set for patients. Some long COVID clinics only accept referrals for individuals who live within the relevant catchment area. For instance, the temporary long COVID clinic being trialled at Bentley Health Service in Western Australia ‘requires referral from a general practitioner (GP) for people who live in the catchment area.’[118]
  141. Others, such as the Royal Melbourne Hospital’s allied health-led long COVID clinic, will accept referrals for patients outside their hospital’s catchment area if the patient’s area does not have a comparable service.[119]
  142. Similarly, some long COVID clinics require that patients are diagnosed with long COVID by their GP before they can attend the clinic. The long COVID clinic at St Vincent’s Hospital is one such example, and additionally requires that patients have undergone certain tests prior to admission. It explained:

Patients cannot be admitted to the clinic unless they have been referred by a GP and a diagnosis of long Covid has been made. This indicates that the diagnosis is one of exclusion. Other comorbidities that the patients suffering with are optimally managed. Tests that need to be completed prior to admission include a chest x-ray, a D-dimer test, and a CRP. Further the Yorkshire long Covid questionnaire must be completed online... Communication with the patient needs to be undertaken as well as communication with the GP either online or by telephone.[120]

6.143In contrast, other long COVID clinics described that their approach includes assessing and diagnosing long COVID cases. Associate Professor Shidan Tosif, a Consultant of General Medicine and Clinical Lead at the Melbourne Royal Children’s Hospital’s Post-COVID Clinic, outlined that:

Our approach is to assess children according to a standardised definition for PCC [Post-COVID conditions, i.e. long COVID]. We consider PCC what we call a diagnosis of exclusion, which means we have to evaluate at times for other medical and mental health diagnoses which may present in a similar way, with similar symptoms, before confirming the diagnosis.[121]

6.144Related to differences in the approach to diagnosis, is whether the individual clinics view their role as being to support early intervention in cases of long COVID, and/or to manage complex and/or severe cases of long COVID.

6.145Associate Professor Tosif explained that the Post-COVID Clinic at Melbourne’s Royal Children’s Hospital aims to ‘take more of an assessment and early management role’. He noted that ‘We would try and prioritise seeing those children early and provide some initial assessment and advice and try to set them up as soon as possible for self-management where we can.’[122]

6.146In contrast, some other long COVID clinics exclusively aim to be a specialist service for patients with severe long COVID symptoms or complex needs, meaning that these clinics would not see most patients with mild long COVID symptoms. For instance, under South Australia’s state-wide long COVID model of care, only ‘patients with substantial disability or uncertain diagnoses’ are referred to hospital long COVID clinics.[123]

6.147The Committee also heard of alternative approaches to support long COVID patients without establishing long COVID clinics. For example, Western Sydney Local Health District described that its ‘approach to-date has really been to support general practice with access to existing sub-specialty clinics and services. We have yet to establish a long COVID clinical service.’[124]

6.148Another area in which long COVID clinics are not consistent is in terms of the health disciplines that lead the clinics and are incorporated within them.

6.149Dr Danielle Hitch, a Senior Lecturer in Occupational Therapy at Deakin University, noted that: ‘Some of the long COVID clinics are allied health led, and they're the key rehabilitation experts for chronic and complex conditions.’[125]

6.150Two examples of this approach are the allied health-led long COVID clinic at the Royal Melbourne Hospital that runs in conjunction with a respiratory service, and Western Australia’s temporary long COVID clinic.[126] Both of these allied health-led long COVID clinics are led by physiotherapists.

6.151The Long COVID clinic at St Vincent’s Hospital is different; it is led co-led by a respiratory physician and a rehabilitation physician.[127]

6.152The Committee also heard that some long COVID clinics have internal staff from a range of disciplines. For instance, the Royal Melbourne Hospital’s allied health-led multidisciplinary long COVID clinic includes a range of allied health professions including ‘a physiotherapist, an exercise physiologist, a clinical psychologist, a neuropsychologist, a social worker…’.[128] The Long COVID clinic at St Vincent’s Hospital, by contrast, has fewer allied health practitioners in-house: a clinical psychologist, physiotherapist, and clinical nurse.[129]

6.153The Committee heard that where some long COVID clinics may not have allied health or specialists such as cardiologists in-house, they often have relationships with rehabilitation services and specialists at the hospital, through which patients can receive support where necessary.[130]

Benefits of long COVID clinics

6.154One benefit of long COVID clinics is that they should facilitate the health practitioners working there to develop expertise and specialise in supporting long COVID patients. Through focusing on a single condition there is also potentially a greater opportunity for long COVID clinics to collect relevant data and contribute to and stay abreast of emerging research.

6.155Brimbank Community-Led Long Covid Group emphasised these benefits of a specialist and dedicated service, recommending that:

Specialist Long COVID clinics rather than GPs or the already stretched hospital system are best placed to provide a dedicated, caring and specialist approach and a significant source of important community data on his disease, that in our opinion must be maintained.[131]

6.156As an example of how long COVID clinics may facilitate long COVID research, the clinic at St Vincent’s Hospital reported close research ties with the ADAPT study, and that it is supporting an ongoing research project to identify outcomes and qualitative approaches to the management of long COVID patients.[132]

6.157Another advantage of long COVID clinics from the patient perspective is that these often provide more affordable access to care, including in some instances from allied health professionals and specialists.

6.158Long COVID patients often encounter out-of-pocket expenses to access allied health services in the community[133], however as outlined above, these services may be free if accessed as part of a long COVID clinic.

6.159Dr Irani Thevarajan noted that accessing specialists is a significant challenge for some Australians:

Getting access to a cardiologist, getting access to respiratory physicians, getting access to a psychiatrist and a neurologist—I can't imagine that they would be easy areas for someone who has socioeconomic limitations.[134]

6.160In addition to supporting better patient access to care in a financial sense, the Committee also heard that long COVID clinics may be easier for patients to physically attend and may enable greater coordination of care among treating healthcare practitioners.

6.161Ms Karren Hill and Dr Su Mon Kyaw-Myint, two individuals with long COVID, respectively commented that long COVID clinics are ‘one place to go’, and that ‘it’s not as tiring going to one place.’[135] Ms Hill further outlined the benefits of long COVID clinics:

They [long COVID clinic staff] talk between themselves about what treatment plan they would put forward… You would hope that over time they will get more knowledge about overseas, because we seem to be behind with what's happening with research. They will get to know what is happening. They may apply it. They may see a pattern of patients where something is working or not.[136]

Drawbacks of long COVID clinics

6.162Some witnesses and submitters took a different view and highlighted various drawbacks of long COVID clinics. For example, the Australian Long Covid Community Facebook Group reported that of its 607 members surveyed:

Over 70% of participants reported that Long Covid clinics are not a helpful source of information... This may be partly due to the long wait for these clinics and the variation in the quality of these clinics around the country with some offering outdated therapies such as graded exercise therapy and cognitive behavioural therapy.[137]

6.163The long wait lists to access long COVID clinics was a common criticism throughout the inquiry.[138]

6.164Multiple long COVID clinics acknowledged that they were struggling to meet patient demand, and their wait lists were growing.[139] For instance, the long COVID clinic at StVincent’s Hospital reported that as of November 2022, its respiratory physician and rehabilitation physician are respectively booked out until April and October 2023.[140]

6.165Associate Professor Tosif noted that he expects the waitlist for the long COVID clinic operating out of the Royal Children’s Hospital in Melbourne to continue to grow, since it ‘can take some time for the recognition of post-COVID conditions’.[141]

6.166Dr Zinta Harrington, Head of the Department of Respiratory and Sleep Medicine at Sydney’s Liverpool Hospital, noted that wait lists are a common problem for specialist clinics. She commented that from her perspective:

I think speciality clinics create workflow problems in terms of bottlenecks. I have six different speciality clinics, all with long waiting lists. If we create another one then it will find a long waiting list too.[142]

6.167Dr Harrington further questioned whether long COVID clinics are the most appropriate solution to managing long COVID patients. In querying this, Dr Harrington noted that relevant contextual factors include that specialist clinics are ‘highly expensive’ to taxpayers, and the lack of evidence-based treatments or specific symptom management strategies for long COVID. Dr Harrington explained:

I do think that there's been a jump to creating a solution that's not necessarily tailored to the problem… If there were something very specific that the hospital only could provide, then I think we should provide it…[143]

6.168Apart from the wait lists, the Committee received some evidence questioning the idea that long COVID clinics do possess specialist expertise in managing long COVID. In its submission, the UNSW Fatigue Clinic and Research Program describes itself as the only specialist service in Australia ‘with expertise to diagnose and manage patients with Long COVID or other post-infective fatigue states… notwithstanding the birth of many ‘Long COVID clinics’ with uncertain expertise in evidence-based management’ post-infection fatigue.[144]

6.169Whether or not long COVID clinics do in practice provide effective and coordinated multidisciplinary care was also contested. Associate Professor Nada Hamad noted that in her experience long COVID clinics did not provide well-coordinated care. She commented:

…I am in a long COVID clinic. I can tell you, from my perspective and in my opinion, the model of care in a long COVID clinic does not work. It includes a combination of clinicians who don't talk to each other. The systems don't talk to each other. They each manage their own system. I got multiple conflicting advice from various clinicians because they're still working in their own silo.[145]

6.170Some witnesses additionally noted that long COVID clinics may not be accessible to all people, and there are indications that they are predominantly being accessed by those with greater health literacy and/or who are English-speaking.

6.171Dr Jason Agostino, Senior Medical Adviser at the National Aboriginal Community Controlled Health Organisation, expressed concern that standalone long COVID clinics ‘will likely be difficult to access for many Aboriginal and Torres Strait Islander peoples’.[146]

6.172Dr Hitch expressed similar concern, and observed that:

the specialist long COVID clinics… can be inaccessible for some, especially …people living in poverty, people from culturally and linguistically diverse backgrounds, and marginalised communities generally…[147]

6.173The Committee heard some reports indicating that these concerns may be warranted. Associate Professor Tosif commented from the perspective of the Post-COVID Clinic run out of Melbourne Royal Children’s Hospital:

…I do fear that we're seeing, potentially, those higher health-literate and English-speaking families that are able to recognise this condition and access services. It does raise concerns for us about the awareness of this condition more broadly in children and their families who are culturally diverse with non-English-speaking backgrounds. I don't think we are yet seeing a broad enough representation in our clinic of what we should be seeing in some of those groups, who may not have access or the awareness due to the barriers of language and health literacy.[148]Ms McConnell echoed similar concerns in relation to the Royal Melbourne Hospital’s allied health-led long COVID clinic and respiratory service:

… I think both of our services are quite open to selection bias, being that we're located within the hospital. I would comment, from our perspective, we see around one-third of our patients being staff, but we're advertised within the hospital. When we look at our population as a whole, only two per cent require an interpreter. Clearly, the messaging is getting out to our staff and our English-speaking, educated, health-literate population but potentially not to our non-English speaking population. So I think we're quite heavily biased in that regard...[149]

6.174Dr Benjamin Gerhardy, a respiratory physician with the Nepean and Blue Mountains Local Health District, noted that their long COVID clinic also shared this concern:

… the group that it feels like we are missing, just from seeing the patients who come to the door every day, is the non-English speaking groups because we just don't get very many. We know that a lot of them have had COVID, and some of them quite severely. So I do feel like our clinic doesn't adequately capture the disease burden that's in the community with regard to that group…[150]

6.175Some submitters also raised people living in rural or remote communities not having physical access to long COVID clinics as an issue, since these are predominantly based in metropolitan centres.[151] It is noted that while this is a challenge, many long COVID clinics conduct services via telehealth.[152]

Models of care

6.176As outlined above, the Committee received evidence highlighting multiple issues and inconsistencies regarding the ability of people with long COVID to access effective and efficient care.

6.177This section accordingly discusses current models of care by which Australia’s overall healthcare system delivers care to long COVID patients, and subsequently considers opportunities for improvement.

Current models of care

6.178This chapter previously highlighted inconsistencies both among and between primary care providers, specifically GPs, and long COVID clinics. These inconsistencies include different conceptualised roles and different services provided to long COVID patients. This section considers system-wide models of care, including pathways by which long COVID patients navigate different settings of the healthcare system.

6.179Commenting on the broader models of care for patients with long COVID, the Victorian Post acute Covid-19 sequelae research group observed that:

At present long COVID care is offered through a range of models of care that have been established by individual organisations and clinicians to meet the needs of people with long COVID. There is however much variation across these models, lack of a systematic approach and an absence of clear pathways between these models for patients whose care needs change.[153]

6.180A review of the submissions received from Australian state and territory health authorities demonstrates the lack of a national approach to supporting long COVID patients.

6.181South Australia is the only state or territory that reported it has developed a model of care setting out care pathways for adult patients with long COVID. Key aspects of South Australia’s model of care include:

• Comprehensive initial assessment of patients with suspected Long COVID by the GP, including thorough history, examination, and investigations to exclude alternative causes for the symptoms.
• An estimation of the severity and functional limitation of symptoms, with these factors primarily guiding the degree of intervention the patient will need.
• The promotion of supported self-management strategies for all patients.
• Referral of patients with substantial disability or uncertain diagnoses to Long COVID clinics in hospitals. The clinics have access to physicians from multiple disciplines, diagnostics and therapy teams. In addition, they have access to programs provided by specialist rehabilitation teams…
• The hospitals provide outreach activities and centralised telehealth (assessment) telerehabilitation services for rural and remote clients to ensure equitable access to specialist rehabilitation teams.[154]
  182. NSW Health advised that it is currently developing a model of care for long COVID. Its submission further notes that:

NSW Health has a state-wide approach in place which provides evidence based clinical management guidance for primary care providers with local referral escalation pathways and specialist services based on need.[155]

6.183In Victoria, the Victorian Department of Health informed the Committee that there is work underway to:

• better identify demand for long COVID support
• map the service models of existing clinics supporting long COVID patients; and
• develop state-wide criteria for referrals to multidisciplinary services for long COVID patients.[156]
  184. The evidence received from the Western Australian Department of Health and Queensland Health does not mention any model of care for long COVID patients.[157]
  185. However, the submission from Queensland Health recommends that ‘Primary Care is the main setting for the management of patients experiencing a longer recovery from COVID-19’ and notes that additional support is required for better ‘access to community allied health services, to which GPs could refer patients for symptom management (rather than a dedicated long COVID-19 service).’ Queensland Health additionally states that it ‘continues to monitor the demand across its health system for long COVID services.’[158]
  186. The Northern Territory Department of Health’s submission outlined that long COVID patients are being managed via primary care, with possible multidisciplinary support via ‘in-reach and out-reach models of care’, and/or specialist support – including via telehealth- as required.[159]

Strengthening models of care

6.187The Committee received considerable evidence outlining potential ways to create or improve models of care to better support long COVID patients.

6.188The Australian Academy of Science and the Australian Academy of Health and Medical Sciences observed that ‘Australia can improve access to healthcare for patients experiencing long COVID and develop better and clearer care pathways within the health system.’[160]

6.189The NCET agreed, and stated that currently there is ‘no clear pathway for patients and their care team to determine the most appropriate setting of care and how to facilitate transition between these settings.’[161]

Most long COVID managed via primary care

6.190The need for primary care, in particular GPs, to manage the majority of individuals with long COVID was a theme that ran throughout the inquiry.

6.191The NCET noted that its guidelines recommend a ‘biopsychosocial approach to care, within the local context’ for patients with long COVID, given the large range in symptoms.[162] The NCET further recommends that:

The primary health care team is well placed to coordinate person centred care and should remain a central point in the care team along with the person's carer or significant other.[163]

6.192Many witnesses and submitters assumed a pragmatic view that primary care managing most long COVID patients was the most practical solution.

6.193For instance, Dr Zinta Harrington, Head of the Department of Respiratory and Sleep Medicine at Liverpool Hospital, noted that specialist clinics generally have long wait lists, and that GPs are generally more accessible. She stated:

I think it [support for people with long COVID] belongs in primary care… The way to deal with a big problem is to diversify the people who can then address that problem. The more practitioners you have, you don't have an access problem.[164]

6.194Professor Greg Dore, an Epidemiologist with the Kirby Institute, agreed and commented that ‘I think a lot of it has to be managed in primary care… We can't manage it all through so-called centres of excellence… we do want most of it to be able to be managed at the primary care level.’[165]

6.195Dr Brett Gardiner, Clinical Network Director, Subacute and Ambulatory Medicine at Western Sydney Health District, further agreed, stating that ‘…our belief is that the general practices are the gatekeepers or the primary people who need to be involved with this.’[166]

6.196Dr Gardiner additionally noted that ‘A lot of the patients, we know, can be treated at scale’, and raised the potential for many patients to be managed more efficiently, using online self-management resources and/or support.

6.197The potential for supporting many individuals with milder long COVID symptoms via self-management tools and resources is discussed earlier in this chapter in the section titled ‘Self-management’.

6.198The Victorian Department of Health generally noted that a major benefit of most long COVID care being provided in primary health care settings is that this will ‘assist in reducing hospital care and emergency department presentations for most low-risk, long COVID cases.’[167]

6.199While many discussed the merits of primary health care leading the management of most long COVID patients, the Committee heard that there may be insufficient information available setting out models of care for patients that initially see their GP but require additional support. The Australian Healthcare and Hospital Association submitted that:

In Australia, service models for long COVID in primary care are not well (if at all) established, with GPs in many areas highlighting the absence of referral pathways from general practice to specialised long COVID supports for patients presenting with long COVID symptoms. This is problematic given that Australian Government advice recommends seeing your GP if you are experiencing long COVID symptoms.[168]

Pathways to escalate severe and/or complex cases

6.200Multiple submitters and witnesses highlighted that while primary care settings could support many long COVID patients, there needs to be pathways for escalating patients with more severe symptoms and/or complex needs, such as multimorbidity (the presence of multiple diseases and medical conditions in a single person).

6.201The Committee also received evidence that these pathways need to be clear. One individual submitter with long COVID expressed that there is a ‘Lack of clarity on care pathways and what it means to be a long covid clinic’ and noted that both patients and healthcare practitioners could benefit from clear information ‘on what these services are and are not.’[169]

6.202Some of the evidence emphasised a general need for escalation options. For instance, Dr Tuan-Anh Nguyen, Head of Department, Senior Staff Specialist, Rehabilitation Medicine at Campbelltown Hospital commented:

We acknowledge that, even though primary care in communities is where most patients with long COVID should be managed, and our primary care colleagues are doing as much as they can with what they have, they cannot do it on their own and will need support from secondary and tertiary care providers for some patients. The question remains how to best provide these services for the number of patients who may actually need them.[170]

6.203Professor Catherine Bennett, Chair in Epidemiology at Deakin University, similarly noted that referral pathways will be important given emerging research indicates that long COVID can sometimes involve more complex symptoms. She advised that:

There has to be a balance between looking after people with more generic symptoms where they can be supported or can self-manage with good guidance and those with more advanced neurological symptoms. Another study has just come out talking about 44 different neurological syndromes or disorders associated with COVID. So you probably need a balance between some specialisation so that you can refer people to clinics where there are medical experts who understand—whether it is thinking about it from a cardio or neuro point of view, for example.[171]

6.204Others specifically argued that specialist long COVID clinics should exist as a referral pathway for patients requiring specialist and/or multidisciplinary support. The Royal Australasian College of Physicians told the Committee that:

It is recognised that most post-COVID issues resolve and are managed via primary care. However, for ongoing or more severe issues, patients will require access to specialist multidisciplinary clinics or ‘Long COVID clinics’ run collaboratively across medical specialties.[172]

6.205Professor Morgan outlined that a model of care wherein most long COVID cases are managed in primary care and complex or high needs cases are escalated to a long COVID clinic, would make sense given the nature of long COVID. He explained:

Long-COVID clinics will pull together expertise and would be a convenient place for GPs to refer the most severe or troubling people with long-COVID symptoms, who need that level of expertise that's been gathered, and equipment and testing facilities, within long-COVID clinics. It's very similar to the way we interact with other specialist providers. We manage the majority in general practice, but we need to be able to refer to other people when symptoms are particularly severe or need equipment and testing that's not available in general practice. Having a one-stop shop makes a lot more sense for a multisystem disease state than trying to refer a person to a multitude of separate care providers.[173]

6.206The Department also considered that long COVID clinics could play a role for supporting those most impacted by long COVID. The Department’s Secretary, Professor Brendan Murphy AC, said:

We feel that they [long COVID clinics] probably have a very narrow role for a small subset of quite long-standing and very disabled people who need intensive, highly specialised care. Most people are probably best managed in primary care. We've said that most people, we believe, will recover, with supportive care… There is probably a role for these clinics regarding a small proportion of people.[174]

6.207As discussed in the section ‘Drawbacks of long COVID clinics’, there are often long wait lists for patients to access these services. Triaging long COVID patients so that only those with more severe or complex needs are referred to long COVID clinics is one way to improve wait lists. Another option would be to open additional long COVID clinics or increase funding for existing clinics to enable additional staffing (see ‘Public hospital funding’ section later in this chapter for further discussion).

6.208Different views were heard on the number of long COVID clinics that should be established across Australia. Some advocated for additional long COVID clinics, potentially including in regional areas.[175]

6.209The Australian Medical Association similarly called for additional long COVID clinics, but warned that careful consideration and planning needs to be undertaken regarding the impact this would have on the workforce. It advised:

More dedicated Long COVID clinics will also assist with the management of these conditions, however these must be planned with the whole health system in mind. Too often we have seen new services established which have required significant staff. These staff have come from other services, at times leaving the existing services unable to manage. Australia has a total health workforce shortage right now, and we must sensibly manage our limited resources.[176]

6.210From the perspective of an existing specialist service, the long COVID clinic at St Vincent’s Hospital recommended ‘Specialist long COVID clinics that operate in a small number of centres in each state.’[177]

Tiered model of care

6.211Extending calls for clearer referral pathways from primary care, some witnesses and submitters emphasised that a tiered model of care would be effective and efficient for supporting long COVID patients.[178] In general, proposals for a tiered model of call involved:

• self-management resources and tools initially
• then if required, GP management potentially including multidisciplinary care; and
• if further support was required, escalation to specialist care (potentially again including multidisciplinary care) via long COVID clinics or other means.
  212. One group recommending a tiered model of care was the NCET. It recommended endorsing and supporting:

… a model of care delivery that involves a tiered approach to providing clinical care. Most patients with long COVID will not require specialist care. Many of these patients will be able to self-manage their clinical care. However others, will require clinical care from a general practitioner, and others still will require more intensive multidisciplinary care involving the primary care team plus allied health and a variety of specialists….[179]

6.213The NCET specified that primary care should play a coordination role. It explained:

A tiered model of care (similar to that used for COVID-19) could be employed across the healthcare system, notably coordinated within primary care, to avoid unnecessary burden on the patient and health system and to guide patient-centred and appropriate clinical care.[180]

6.214Evidence outlining the benefits of a tiered model of care highlighted that this would be sensible and pragmatic in terms of both financial viability and health workforce limitations.

6.215Professor Anne Holland, Head of Post COVID Service and Head of Respiratory Research at Alfred Health and Professor of Physiotherapy at Monash University, noted that triaging only long COVID patients with higher needs to specialist long COVID clinics would reduce demand and thus make the clinics more affordable to run. She commented:

We've talked today about being able to make a diagnosis in primary care and people being confidently able to do that, then having self-management resources available that will help most people, along with the messaging about recovery, and then a pathway into a specialist service if you need it. If we know that only a small number of people are going to need that pathway, because there are other things available, that will make it easier for state health to keep those [long COVID clinics] open.[181]

6.216Professor Morgan pointed out that reducing the number of people with long COVID seeking to attend long COVID clinics would improve access for those patients who do require greater support. He said:

I don’t believe you could set up a system of long-COVID clinics that has equitable access for everybody. It would largely be an excessive resource for people with mild conditions, and therefore interfere with access by people with severe conditions.[182]

6.217Dr Gardiner echoed that triaging long COVID patients based on their needs is essential to manage costs, maintain efficiency, and work within existing health workforce constraints. He told the Committee:

We're certainly looking at an approach like the UK and providing particularly some virtual rehab, and we'd like the GPs to be the centre of that…

And then there could be a very targeted long COVID clinic side of things… I think the big target of that would be for those with multiple medical comorbidities and for those with a lot of impact in their daily life, so we'd triage them… If we don't do that, then we certainly wouldn't be able to manage demand. It'd be quite expensive and fairly inefficient. And, quite frankly, we'd never be able to get the allied health and other resources available to do any of this.[183]

6.218Western Sydney Local Health District’s Dr Ahlenstiel suggested that for a long COVID model of care to be ‘financially viable and sustainable’, it will need to involve telehealth and involvement from the primary health networks, since there are only a limited number of specialists around.[184]

6.219It was also mentioned that if long COVID clinics continue to be utilised, it is important that these conduct outreach with other health care settings, ‘so that everyone can benefit from the specialist knowledge that’s being developed through those.’[185]

Alternative proposals

6.220Over the course of the inquiry the Committee also heard various alternative suggestions to either strengthen existing models of care or create new models. Some of these are mentioned below.

6.221Dr Danielle Hitch told the Committee about a model of care for patients with long COVID developed by the Western Health COVID Recovery Collaboration and co-designed by people experiencing the condition. Dr Hitch described that:

…we've co-produced a model of care with people who have long COVID. It's called the discovery model. Our consumer partners were clear that they wanted access to care in their local communities; they didn't want to have to travel and they wanted something that was just around the corner, if possible. They also wanted options that met their individual needs. So, the model is founded on care coordination, rather than a new long COVID clinic. It's about linking people with existing local services and supports—healthcare supports as well as beyond health care, because long COVID impacts every part of daily life. So, as part of the model we also have things like education, cultural participation and employment relationships—all of those sorts of things.[186]

6.222The Western Health COVID Recovery Collaboration’s submission noted that this model of care includes an online self-management component, which is currently being developed.[187]

6.223Queensland Health also advocated for a model of care including greater community allied health services, ‘to which GPs could refer patients for symptom management (rather than a dedicated Long COVID-19 service).’[188]

Australian Government funding for long COVID care

6.224This section considers Australian Government funding particularly relevant for long COVID health care. Broader funding for Australia’s healthcare system is not within the scope of this inquiry.

Public hospital funding

6.225Given long COVID clinics were a major point of discussion throughout the inquiry, it follows that the Committee also received evidence regarding funding arrangements for these clinics.

6.226The Committee heard that as long COVID clinics were generally set up by individual hospitals and local health networks, the funding arrangements for these clinics vary.

6.227For example, Associate Professor Irving, Respiratory Physician at the Royal Melbourne Hospital’s Post-Covid Clinic, told the Committee that initially the hospital’s respiratory outpatient service expanded to cover the long COVID clinic. Associate Professor Irving described how the clinic’s funding arrangements had evolved since it first started:

…more recently it's a Medicare clinic, and we're billing item numbers. The

integrated allied health service is being funded by the hospital for 12 months and then being reviewed. It's only in the credit to the hospital to do it. To be fair, quite a few of the early patients were our own staff and that was our incentive.[189]

6.228The long COVID clinic at The Royal Children’s Hospital in Melbourne also utilises a mixture of core hospital funding and Medicare bulkbilling.[190]

6.229The long COVID clinic at St Vincent’s Hospital reported that its respiratory physician and rehabilitation physician are funded in kind only, and its psychologist is also funded in kind provided by the Department of Pain Medicine within the hospital.[191]

6.230Despite variations in funding, the Committee heard repeatedly that a key challenge for the long COVID clinics was unstable, short-term funding. Dr Brendan McMullan, a Paediatric Infectious Diseases Specialist with Sydney Children’s Hospitals Network, noted that sufficient resourcing to support children with long COVID is a challenge:

… particularly in terms of coordination of support for post-COVID conditions and the lack of dedicated funding. The work that the group of clinicians have managed to achieve over the past almost three years has been almost entirely as a sort of coalition of the willing. People have been going above and beyond to do this work, obviously recognising the importance of it and being very happy to contribute, but with a lack of dedicated funding. There is a real sustainability issue there. There are other places around the world that have invested in coordinating long COVID care, like in the United Kingdom, which has included dedicated funding for paediatrics as well.[192]

6.231Acknowledging the current funding instability, multiple submitters and witnesses called for greater funding for long COVID clinics.[193]

6.232Some of these calls came from health practitioners working at long COVID clinics. For instance, Dr Gerhardy who works at the Nepean and Blue Mountains Local Health District’s long COVID clinic, mentioned at a public hearing in December 2022 that:

We have issues with ongoing funding. For example, at the moment our clinic is funded only until the end of this year, meaning we'll lose at least two physicians, as well as our essential administrative staff, as we head into 2023, and I'm sure our clinic is not the only one in this position.[194]

6.233The Department’s submission explained the responsibilities of the Australian Government and state and territory governments in relation to public hospitals, out of which most long COVID clinics are based. The Department noted that:

State and territory governments are responsible for the public health system, including public hospitals and community clinics. They continue to have a role supporting people who have long COVID by providing access to outpatient services, including multidisciplinary long COVID clinics. Some private hospitals have also established long COVID clinics.

The Government is working with state and territory governments to better understand the services provided by multidisciplinary long COVID clinics, including whether demand is being met and any additional demand for primary health care services arising from long COVID.[195]

6.234The Australian Government contributes funds to the states and territories for public health services under the 2020-25 National Health Reform Agreement (NHRA).[196] The Department explained that:

Under the National Health Reform Agreement (NHRA), the state and territory governments have committed to providing eligible patients with the choice to receive public hospital services free-of-charge, on the basis of clinical need and within a clinically appropriate period. Decisions regarding access to public hospital services and determining the appropriate treatment of individual patients rest with states and territories, individual hospitals and the doctors involved.

Public hospital services provided for the treatment of long COVID, including in an outpatient setting, attract a funding contribution from the Commonwealth under the NHRA.[197]

6.235Under the NHRA, the Australian Government’s total funding contribution to public health services is capped at 6.5 per cent a year.[198]

6.236The Victorian Department of Health proposed that the Australian Government provide ‘Additional funding of demand growth in public health services (unconstrained by the 6.5 per cent growth cap) to ensure adequate care for long COVID without negatively impacting other hospitalisation care needs.’[199]

Medicare

6.237Under Medicare, the Australian Government pays for some or all of the costs of various medical services, including those provided in public hospitals. The Medicare Benefits Schedule (MBS) lists professional services that the Australian Government subsidises, under specific items.

6.238Given Medicare is one of the Australian Government’s major levers to support public health in Australia, the Committee was interested to hear evidence regarding to what extent Medicare was supporting long COVID patients accessing care, and proposals for potential improvements to the system. This section discusses aspects of the Medicare system particularly relevant to long COVID: calls for one or more new MBS items specifically for long COVID, discussion regarding MBS Chronic disease GP Management Plans and Team Care Arrangements.

New Medicare item/s for long COVID

6.239The Committee heard some calls for a new MBS item – or items - specifically for long COVID. Dr Su Mon Kyaw-Myint, speaking in a personal capacity, suggested this and noted that from her perspective, it would be ‘easy’ to add a new Medicare item for long COVID.[200]

6.240The Victorian Department of Health recommended the creation of multiple new MBS items – that is ‘Specific MBS long COVID items to support access to primary care for patients including items for essential affordable allied health services.’[201]

6.241The Victorian Department of Health also separately advocated for changes to chronic disease management plans to enable greater access to allied health care for individuals with long COVID (this is discussed further below). It noted that in the event relevant changes to chronic disease management plans were not supported, Victoria would alternatively support the introduction of ‘a specific long COVID care plan MBS item.’[202]

6.242In its submission, Queensland Health stated that it saw a need for greater funding for long COVID patients to access allied health support. Queensland Health commented that the current MBS CDM plans (which are discussed below), would not be suitable for long COVID patients as they anticipate the person being sick for at least six months. Queensland Health cautioned against associating long COVID with chronic disease and suggested that an alternative funding arrangement facilitating access to allied health, potentially similar to the existing MBS CDM items, be established.[203]

6.243The Australian Government Department of Health and Aged Care affirmed that, like most health conditions, there are no specific MBS items for the treatment or care of individuals with long COVID. The Department noted that:

Individuals with long COVID can access existing MBS items for the treatment of their condition, including time tiered GP general attendance items. If clinically appropriate, GPs can also refer patients to relevant specialists for treatment. Specialist doctors also have access to a range of general consultation items.[204]

6.244Professor Morgan, representing the Royal Australian College of General Practitioners, argued that from a GP perspective amending the current MBS items would be a better solution rather than creating a new MBS item for long COVID. He explained:

The current system, with enhancements, would be better than a new Medicare item number for a single disease definition, because one problem you have then is how well that label fits the person in front of you that needs your help. You end up with the label being stretched to fit the needs of the person, or people missing out on care. I'd much rather see an enhancement through access to additional resources by tweaking the numbers that are currently available...[205]

6.245Proposals for a new long COVID-specific MBS item to aid in data collection are discussed in Chapter 3.

Chronic disease General Practitioner Management Plans

6.246Under the current Medicare system, people with long COVID may be eligible for MBS Chronic disease GP Management Plans (GPMP). The Department outlined the general eligibility requirements:

To be eligible for CDM [chronic disease management] items a person must have at least one medical condition that has been present (or is likely to be present) for at least six months or is terminal. The CDM items enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions. GPs may refer patients for up to five MBS subsidised allied health services per calendar year under a GP Management Plan and Team Care Arrangement. There is no list of eligible conditions. Whether an individual meets the eligibility requirement of having a chronic or terminal condition is a clinical judgement for their GP.[206]

6.247Multiple submitters and witnesses raised the potential for GPMPs to be used to support patients with long COVID. Dr Archana Sud, an Infectious Diseases Physician and Clinical Director of Medicine at the Nepean and Blue Mountains Local Health District, commented that ‘GP care plans [GPMPs] could be encouraged, and they might help them [patients] to access at least some allied health help.’[207]

6.248However, the Committee received evidence regarding various issues and/or deficits relating to the current GPMP MBS items.

Long COVID eligibility

6.249The Committee received evidence indicating that there is significant confusion among GPs over whether it is reasonable to create chronic disease GPMPs for patients suspected of having long COVID.[208]

6.250Professor Morgan indicated that issuing advice clarifying the situation could be a short-term fix that would improve long COVID patients’ access to care.[209]

6.251The core issue is that, as reflected in Chapter 2 of this report, the prognosis for long COVID patients, that is how long their illness will persist and the likelihood of recovery, is unclear. This presents an issue because the use of MBS chronic disease GPMP items requires the GP to forecast whether the patient’s condition is likely to last for at least six months.

6.252The Australian Healthcare and Hospitals Association outlined the ambiguity of the current situation:

Chronic disease GP Management Plans… and Team Care Arrangements… present a mechanism though which GPs are seeking to provide more coordinated joined up care for those experiencing long COVID. However, to be eligible for these MBS items patients must have a chronic medical condition which has been, or as the case is more likely to be, the condition must be present for at least six months. Together with nationally inconsistent definition of long COVID and a limited evidence base, health professionals face considerable difficulty determining if the experience of long COVID symptoms actually persist past 6 months. As such, many people are left to experience debilitating symptoms for 6 months before they are able to access subsidised coordinated support for long COVID.[210]

6.253The Royal Australian College of General Practitioners advised the Committee that it sought clarity in late 2021 regarding whether the MBS chronic disease GPMP items could be used for managing patients with long COVID, and was told that - “whether a patient is eligible for a [chronic disease management] service or services is essentially a matter for the GP to determine using clinical judgement”.[211]

6.254However, the South Australian Minister for Health and Wellbeing, the Hon Chris Picton MP, described the current situation as ‘ambiguous’ and recommended explicit confirmation be issued that long COVID is a condition eligible for MBS chronic disease GPMPs.[212]

Reducing the 6-month requirement

6.255As previously stated, to access MBS chronic disease GPMP items for long COVID, the patient must have had long COVID for at least six months or be likely to have long COVID for at least this period.

6.256Professor Michael Kidd AM, Deputy Chief Medical Officer of the Department, outlined the current functioning of the MBS chronic disease GPMP items for long COVID patients. He stated:

The chronic disease item numbers are not enacted until six months after someone has been diagnosed with a chronic condition. Of course, with the current definition that we have, that's three months after people may have been diagnosed with long COVID. That means that access to subsidised allied health, psychology and so forth, is not readily available to people. Those who can afford to pay for it can access it; those who can't afford to do so within that three-month period miss out, which obviously is inequitable.[213]

6.257The previous section highlighted that due to an absence of clear guidance and research regarding the prognosis for long COVID patients, some GPs are hesitant to utilise MBS GPMP items for long COVID patients that have not yet been sick for six months.

6.258Some submitters and witnesses advocated for amending the MBS GPMP items to allow for these to be used for patients with long COVID who have been sick for at least three months (rather than six).[214]

6.259Professor Lena Sanci, Head of the Department of General Practice and Primary Care at Melbourne Medical School at the University of Melbourne commented that allowing long COVID patients to access MBS GPMP items ‘even earlier’ than three months would be beneficial.[215]

6.260At a public hearing with the Department, the viability of amending the MBS chronic disease GPMP items to allow these to be utilised for long COVID patients who have been sick for three months (as opposed to six) was discussed. Professor Brendan Murphy AC, Secretary of the Department, informed the Committee that this proposal:

…would require a change of Medicare policy. It would require approval of government and it would require costing and finance assessment. It's certainly possible. It would be tricky to do it for just one condition because you'd then open the door to lots of other people who may have less than a six-month, debilitating condition. It would be a complex issue to deal with. It's certainly feasible.[216]

Increasing allied health sessions

6.261The current MBS chronic disease GPMP items allow for a maximum of five subsidised allied health sessions each calendar year.[217]

6.262A recurrent suggestion throughout the inquiry was to increase the number of subsidised allied health sessions available to long COVID patients per annum under a MBS chronic disease GPMP.[218]

6.263Allied Health Professions Australia argued that the current limit of five allied health visits each year ‘results in sub-optimal, fragmented care for long COVID patients.’ Allied Health Professions Australia further suggested that the limit of five sessions requires patients to ‘ration’ their allied health services and stated that increasing the number of subsidised allied health visits would grant health practitioners ‘more scope to improve the quality of multidisciplinary care.’[219]

6.264The Committee heard that the limit of five subsidised allied health visits per calendar year is particularly challenging for people with long COVID who:

• are experiencing severe symptoms[220]
• are experiencing multisystem symptoms (for instance, respiratory and cognitive symptoms), requiring support from different allied health providers[221]
• have existing chronic conditions and may have accordingly used up their subsidised allied health visits[222]
• are financially disadvantaged and unable to pay for additional, non-subsidised allied health sessions.[223]
  265. One GP from rural Victoria, quoted by the Royal Australian College of General Practitioners in its submission, articulated his challenge supporting some of the abovementioned long COVID patient cohorts to access allied health. The GP explained:

Most of my long COVID patients already have other chronic diseases and their five Medicare rebated allied health sessions have already been allocated or used. It’s vastly insufficient for someone who is simultaneously unable to earn an income because of their illness and requires expensive regular allied health input to maximise their recovery.[224]

6.266Noting these concerns, Allied Health Professions Australia advocated for allowing long COVID patients with MBS chronic disease GPMPs to access the initial five allied health sessions, then, subject to ongoing review by their GP to check efficacy, access up to 10 extra allied health visits.[225]

Team Care Arrangements

6.267In addition to chronic disease GPMPs, the MBS also includes items relating to Team Care Arrangements (TCAs). TCAs are for chronic health conditions that require a multidisciplinary team. For the purpose of a TCA, the multidisciplinary team includes the patient’s usual medical practitioner and at least two other collaborating health or care providers.[226]

6.268Allied Health Professions Australia commented that ‘Care coordination is highly valuable in assisting patients to navigate their healthcare, particularly for chronic and complex conditions such as long COVID.’[227] For this reason, a TCA may be useful for some individuals with long COVID.

6.269However, Allied Health Professions Australia identified that one issue with the current TCA arrangements is that the patient’s treating practitioner (GP) must invite other people providing multidisciplinary support to the patient (such as allied health providers) to participate in the case conference. Since many GPs have ‘stretched resources’, they may find this difficult to organise.[228]

6.270The Committee further heard from Professor Morgan that the MBS TCA items are ‘clunky and difficult’ because they require the patient’s multidisciplinary team members to be available at the same time.[229] Professor Morgan proposed that the utility of these MBS TCA items for supporting long COVID patients could be improved by allowing multiple one-on-one coordination meetings, in instances where convening all relevant parties at once is not possible.

6.271It was previously noted that there is a lack of clarity over whether patients with long COVID symptoms who have been sick for less than six months can be considered as having a ‘chronic condition’ for the purpose of accessing MBS chronic disease GPMPs. The Royal Australian College of General Practitioners informed the Committee that this same issue exists with the MBS TCA items.[230]

Health workforce: awareness, education and training

6.272The Committee heard a wide range of evidence regarding the level of awareness of long COVID, and relevant education and training, for Australia’s health workforce.

6.273The Committee also received evidence regarding the need to support individuals with long COVID by making available relevant information. This issue is discussed earlier in this chapter in the section titled ‘Self-management’.

Importance of long COVID awareness, knowledge and expertise

6.274As discussed throughout this report, long COVID is a relatively new condition. The Australian Medical Association cautioned that ‘we are still learning more about long COVID and new diagnostic criteria and treatment protocols are emerging for review every day.’[231]

6.275Consequently, it is unsurprising that many healthcare workers, from GPs to allied heath and the tertiary hospitals, have gaps in their knowledge regarding long COVID. Professor Crabb AC of the Burnet Institute observed that:

There are definitely gaps in the knowledge of clinicians… But that is just reflective of the community knowledge gap; it is a global problem. I don't think it's something to beat ourselves up about. We need to recognise just how significant it is. The full-frontal acknowledgement of the significance of long COVID, for example by this committee, starts a process by which those groups say, 'Right, we need to learn more.' Then they become receptive to what is on offer from an educational point of view.[232]

6.276Many individuals with long COVID reported a need to provide education and support for healthcare practitioners regarding long COVID.[233] Dr Nada Hamad, a physician, described her personal experience while seeking help for long COVID, which included not being heard, being dismissed, and receiving advice not based on available evidence from various health practitioners. Professor Hamad stated:

I am here to tell you that, while this is disappointing, it is not a doctor failure; it is a system failure. Doctors are not equipped to deal with this level of uncertainty and lack of education, and are just as susceptible to public narratives and societal pressures as anyone else. If we are told, 'COVID is just a cold, not exceptional and nothing to worry about,' they believe it. If you don't give them access to diagnostic tools and treatment options, they will not use them. They are prone to bias like everybody else.[234]

6.277The Australian Academy of Science and the Australian Academy of Health and Medical Sciences agreed that there are currently significant gaps, reporting that ‘Health professionals do not have enough information to fully understand the condition, how to identify it and how to manage or refer their patients.’[235]

6.278To rectify the situation and better support long COVID patients, many individuals and organisations called for greater awareness raising, education and training for primary care practitioners including GPs and allied health professionals, as well as medical specialists.[236]

6.279The Australian Healthcare and Hospitals Association specifically advocated for ‘nationally consistent’ advice, education and training for healthcare practitioners, ‘to upskill on long COVID diagnostic and treatment approaches and deliver care that better aligns with their values as healers’.[237]

6.280As discussed in the previous section titled ‘Settings and models of care’, a major theme raised by a majority of witnesses and submitters was the necessity for primary care to support and manage the majority of individuals with long COVID. The Committee heard repeatedly that if this is to occur, there needs to be a particular focus on greater awareness raising, education and training regarding long COVID targeted at primary care practitioners.[238]

6.281Dr Ahlenstiel, the Clinical Network Director at the Western Sydney Local Health District, reported that in his experience, GPs are ‘quite keen to manage their patients… But obviously, like anyone else, they need to first be trained in how to manage those patients. The last thing you want to do is put your patient into harm’s way.’[239]

6.282Dr Zinta Harrington, Head of the Department of Respiratory and Sleep Medicine at Liverpool Hospital, expressed a somewhat different view that there may be sufficient information available, but time for health practitioners to engage with it may be an obstacle. She commented:

I think there's terrific information available. I think as part of your submissions, you've had access to the New South Wales department of health resources. The Critical Intelligence Unit resources have regular updates. I think Coronacast is great. We have departmental meetings. The PHN [Primary Heath Network] organised a webinar for the GPs on long COVID in, I think, just the last three months. I think there is access. The availability is there. It's time that's probably the greatest barrier.[240]

Current communication, education and training

6.283The Committee received evidence regarding information sharing, and education and training specifically relevant to long COVID that is being offered to health practitioners across Australia. Given the large amount of work underway, it is not possible to mention this all here. As such, this section highlights only a few examples.

6.284However, the Committee acknowledges that various parts of Australia’s healthcare system including the Australian Government, state and territory governments, Primary Health Networks, Local Hospital Networks, long COVID clinics, and peak bodies representing health practitioners including college, are all actively working to build the health workforce’s awareness, knowledge and expertise regarding long COVID

6.285At the Commonwealth level, Professor Kidd AM, Deputy Chief Medical Officer, advised that the Department is actively and regularly engaging with peak bodies, primary health networks and other relevant stakeholders to disseminate messaging regarding long COVID to relevant parts of the health workforce.[241]

6.286The Committee heard that a vast range of activity is occurring within state and territory governments to build health practitioners’ understanding and management of long COVID.

6.287For instance, the South Australian Minister for Health and Wellbeing, the Hon Chris Picton MP, advised that the South Australian Department of Health and Wellbeing is working to support GPs by regularly sharing updates, producing a comprehensive Long COVID assessment guideline, conducting webinars, and producing long COVID clinical fact sheets. Minister Picton also noted that South Australia’s state-wide Long COVID Clinical Advisory Group has endorsed a long COVID definition for the state and developed a South Australian long COVID model of care, which will assist practitioners.[242]

6.288Queensland Health reported that it has summarised information and guidance about long COVID for clinicians on a webpage, which includes links to other recommended clinical guidance.[243]

6.289Meanwhile, the Committee heard that NSW Health’s Critical Intelligence Unit maintains an online living evidence table on long COVID, which ‘ensures that the most up to date information is available to clinicians.’[244]

6.290Dr Harrington informed the Committee that the Primary Health Networks are also playing an active role. She commented that as part of the Primary Healthcare Network’s Clinical Council, she has been:

… supporting and witnessing the PHNs [Primary Health Networks] development of a long COVID pathway… which helped decide which patients would benefit from specialist referral; and their peer education sessions, webinars to promote GP recognition of the management of long COVID.[245]

6.291Dr Archana Sud, an Infectious Diseases Physician and Clinical Director Medicine at the Nepean and Blue Mountains Local Health District, described how the long COVID clinic she works at was also supporting local GPs by holding education and question-and-answer sessions, as well as liaising closely with Primary Health Networks to develop guidance on how to make a diagnosis of long COVID, and when to refer patients to specialist services.[246]

6.292Many peak bodies representing health disciplines are also contributing to raising awareness, educating and training their members regarding long COVID. For instance, the Royal Australian College of General Practitioners has developed guidelines on ‘Caring for patients with post-COVID-19 conditions’.[247] However, it was acknowledged that embedding these guidelines within general practice is an ongoing challenge.[248]

6.293Multiple peak bodies have also contributed via the NCET. The NCET brings together 35 organisations representing various Australian healthcare professionals, ‘to identify and rapidly synthesise emerging research in order to provide national, evidence-based guidelines.’[249]

6.294Since the beginning of the COVID-19 pandemic in 2020, the NCET advised that it:

…has been gathering and synthesising data to inform best practices clinical care for the treatment of long COVID. Our approach involves daily searches for evidence, appraisal of this evidence and development of recommendations for clinical care…. The Guideline is approved by the NHMRC (National Health and Medical Research Council) and endorsed by 35 health care organisations across Australia.[250]

Proposals to improve awareness, knowledge and expertise

6.295Despite the current efforts to assist healthcare practitioners to provide efficient, effective and evidence-based care to people with long COVID, the vast majority of submitters and witnesses called for more to be done.

6.296Multiple suggestions were received for how the Australian Government could raise greater awareness and improve healthcare practitioners’ knowledge and expertise of long COVID. Some of these are discussed below.

6.297Professor Dore, an Epidemiologist with the Kirby Institute, outlined where he sees that more effort is needed, including education and training around how primary care engages with long COVID patients. Professor Dore stated:

I think education and training at the primary care level is essential. There's obviously been some done by the college of GPs and various other organisations. I think we need a big effort in trying to get primary care to better understand the requirements of long-COVID assessment; better understand what's potentially available on the management front; and develop… some standardised referrals pathways, who needs to be referred and so forth. To really put a concerted effort into that education and training at the primary care level, and engagement—as I said, a lot of patients come to me and they've been somewhat dismissed. I think that's an exposure issue for people at the primary care level—with some education and training and making them part of the solution.[251]

6.298Regarding training, some witnesses suggested that supporting long COVID specific continuing professional development (CPD)[252] training for clinicians like GPs would be one way to encourage uptake, since undertaking regular CPD is a requirement for many health professions.

6.299Professor Julie Leask suggested that a practical option may be ‘to ask the college to prioritise CME-awarded [continuing medical education, similar to CPD] educational sessions around long COVID…’.[253]

6.300Professor Morgan also proposed encouraging CPD training on long COVID. He suggested that:

It would be very good value for the taxpayer to… fund the production of CPD products that are high quality, and then make them available at no cost. Unlike other clinicians within hospital systems, GPs fund their own CPD and have to fund the time they take away from their practices. That could be addressed. It would be fantastic if the training and the self-maintenance of GPs' knowledge was valued in the system and by the system as a public necessity.[254]

6.301The Australian Long Covid Community Facebook Group echoed calls for targeted CPD but went one step further and suggested ‘…mandated professional development regarding the validity of Long Covid as a formal diagnosis and access to treatment pathways and guidelines in keeping with current research and best practice from around the world.’[255]

6.302Professor Lena Sanci proposed that Primary Health Networks should conduct training on long COVID since they receive funding to educate primary care practitioners in their area, and noted that there is need for state-level public health units to coordinate training with Primary Health Networks.[256]

6.303The Victorian Department of Health advocated for the Australian Government to ‘Lead the development of nationally consistent training and support of GPs and other healthcare workers in primary care to optimally diagnose, treat and mange people with long COVID.’[257]

6.304Additionally, Victoria’s Department of Health recommended that the Australian Government:

• Implement a national GP advice line to support best practice diagnosis and care
• Promote resources including agreed referral criteria to specialist care via PHNs [Primary Health Networks] and professional groups[258]
  305. Perhaps the most recurrent specific proposal to improve health workforce awareness, knowledge and expertise of long COVID was that up to date, evidence-based guidelines to support healthcare practitioners working with long COVID patients should be developed and maintained.[259]
  306. The NCET made the case for why clinicians require centralised and evidence-based guidance for long COVID. The NCET noted that it is challenging to develop and maintain up to date guidance given the ‘rapidly evolving and complex’ evidence regarding long COVID. The NCET elaborated:

We currently know little about long COVID, however, research is emerging which will add to the growing body of evidence and help us to understand more about the condition and how it may be best managed. Studies researching long COVID tend to be complex, and interpretation of the results requires high level appraisal and synthesis skills. Furthermore, understanding how individual study results contribute to the whole evidence-base requires broad knowledge of the topic. New research is likely to continue to emerge for the foreseeable future, and mechanisms need to be in place to support clinicians to ensure they are able to provide consistent, evidence-based practice.[260]

6.307Professor Morgan observed that Australian Government funding for the NCET was not renewed, and expressed disappointment since the NCET is ‘world’s best practice in evidence generation’, and the ‘research, the care-delivery systems and the evidence-based guidelines [that NCET develops] won’t just be benefiting long COVID but also other post-viral syndromes and chronic fatigue states that cause so much distress in the community.’[261]

6.308The NCET recommended that the Australian Government continue to fund it ‘to identify, assess, and synthesise up-to-date evidence and convene clinical expertise to develop and sustain recommendations for the clinical care of long COVID in adult and paediatric populations in Australia.’[262]

6.309Dr Kyaw-Myint, an individual with long COVID, emphasised that for any guidelines regarding long COVID ‘It is crucial to have consumer input’ to reflect patient voice. Dr Kyaw-Myint further indicated that patients may be able to meaningfully contribute to guidelines, since many individuals with long COVID have ‘read all the resources, all the articles. We have been keeping track of all the treatments: what works, what doesn’t work.’[263]

Committee comment

6.310As noted in Chapter 1, the Committee reiterates that its purpose for this inquiry is to make public policy recommendations regarding long COVID. The Committee is not a technical health advisory committee, and as such it is not appropriate for it to issue health advice regarding the diagnosis and/or treatment of long COVID, propose a detailed model of care, or undertake other such actions. However, the Committee has carefully considered evidence received and through this report makes a number of recommendations that it believes will support a better Australian healthcare response to long COVID.

6.311The Committee recognises that there is currently a limited understanding of long COVID. It is unknown 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. The Committee acknowledges how challenging these circumstances are for individuals with long COVID and their loved ones.

6.312The Committee also recognises that this situation is challenging for healthcare practitioners, who often do not have answers to their patients’ questions.

6.313Although there is not yet a clear picture regarding the prevalence of long COVID in Australia and the likely prognosis for those individuals that develop it, the Committee is encouraged by indications that the majority of long COVID cases will involve milder symptoms that do not require specialist care. At the same time, the Committee accepts that some individuals will be more severely impacted by long COVID. Long term severe impacts do not seem to be the norm, with most patients recovering albeit over different periods of time. Regardless, all individuals with long COVID deserve appropriate support and care.

6.314In relation to current settings of care and models of care, it is evident that there are significant inconsistencies across Australia in who manages long COVID patients, and the care they receive.

6.315The Committee considers that given it is likely only a minority of long COVID cases will require specialist care, most individuals with long COVID should be supported via primary care. The Committee sees that there is a role for specialist, multidisciplinary long COVID clinics in supporting individuals with severe symptoms and/or complex needs.

6.316However, the Committee notes that long COVID clinics that are hospital-based are not scalable and will create more bottlenecks. Consequently, the Committee considers that these long COVID clinics should be limited in number, to provide care (via telehealth or in person) to triaged patients, while minimising the impacts of these clinics on the broader health workforce. The Committee additionally proposes that specialist long COVID clinics should be seen as centres of excellence and engage in research regarding long COVID and conduct education outreach activities with other healthcare settings to disseminate their knowledge and expertise.

6.317The Committee considers that there is great heterogeneity in managing long COVID with pros and cons to all models. A one size fits all approach may not work for some jurisdictions because of geography, workforce, demands on the system etc.

6.318In general, the Committee sees benefit in a tiered model of care approach, which could allow individuals with long COVID to access appropriate care proportionate to their needs.

6.319The Committee believes that there may be a role for the Department of Health and Aged Care to convene a working group including states and territories to assist with developing guidelines and models of care.

6.320The Committee sees that community-based care is in most instances ideal provided it is supported with education, timely specialist input, adequate remuneration, connectivity, self-management tools and guidelines.

6.321The Committee also sees a need to provide greater support to healthcare practitioners supporting long COVID patients, in particular primary care. The Committee considers that this should be achieved via:

• Support and education for GPs and other primary healthcare providers to diagnose long COVID and manage patients
• Development of living guidelines codesigned with patients
• Support for multidisciplinary long COVID clinics across Australia, as a tertiary referral pathway
• Support for the establishment of outreach long COVID clinics for rural and regional areas
• Provision of mental health support for people with long COVID
• Leveraging of telehealth and digital health resources to help people with long COVID self-manage and access primary care.
  322. The Committee notes that this inquiry received some evidence suggesting that broader problems with Australia’s healthcare system, such as health workforce issues, pose challenges for effectively responding to long COVID.[264] While it is beyond the scope of this inquiry to explore Australia’s overall healthcare system, or make recommendations regarding the broader system, the Committee encourages the Department of Health and Aged Care to consider issues raised during this inquiry in the context of ongoing reforms to the healthcare system.[265]
  323. The Committees also observed that throughout the inquiry many submitters and witnesses raised a host of issues and various questions regarding Australia’s response to the COVID-19 pandemic broadly. In many instances, these broader issues or questions were only tangentially related to long COVID. The Committee recognises the importance of a comprehensive look at the COVID-19 pandemic and Australia’s response, and that this could inform future responses. However, the Committee considers that given this inquiry’s targeted focus upon long COVID, a broader mechanism is needed to conduct this work.

Footnotes

[1]Professor Michael Kidd AM, Deputy Chief Medical Officer, Department of Health and Aged Care, Committee Hansard, Canberra, 17February 2023, p. 13.

[2]Australia Long Covid Community Facebook Group, Submission 309, p. 8.

[3]Australian Academy of Science and the Australian Academy of Health and Medical Sciences, Submission165, pages 7–8.

[4]See, for example: Professor Greg Dore, Epidemiologist, Kirby Institute, Committee Hansard, Canberra, 12October 2022, p. 34; Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, The Royal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 12; Dr Golo Ahlenstiel, Clinical Network Director, Specialty Medicine, Western Sydney Local Health District, Committee Hansard, Liverpool, 5December 2022, p. 11; DrBenjamin Gerhardy, Respiratory Physician, Nepean and Blue Mountains Local Health District, CommitteeHansard, Liverpool, 5December 2022, p. 2; DrJen Kok, Medical Virologist, Australian Society of Microbiology; Institute of Clinical Pathology and Medical Research; and NSW Health Pathology, Committee Hansard, Canberra, 17 February 2023, p. 42; BurnetInstitute, Submission 149, p. 14; Queensland Health, Submission 150, p. 5, citations omitted; Department of Health and Aged Care, Submission 196, p. 21; Royal Australasian College of Physicians, Submission 249, p. 6; NSW Health, Submission 272, p. 6.

[5]NSW Health, Submission 272, p. 6.

[6]Burnet Institute, Submission 149, p. 14.

[7]Dr Benjamin Gerhardy, Respiratory Physician, Nepean and Blue Mountains Local Health District, CommitteeHansard, Liverpool, 5December 2022, p. 3.

[8]National Clinical Evidence Taskforce (Monash University), Submission 232, p. 19.

[9]Royal Australian College of General Practitioners, Submission 168, p. 4.

[10]Royal Australasian College of Physicians, Submission 249, p. 6.

[11]See, for example: Associate Professor Lou Irving, private capacity, Committee Hansard, Canberra, 17February 2023, p. 45; Professor Steve Wesselingh, President of the Australian Academy of Health and Medical Sciences, CommitteeHansard, Canberra, 17 February 2023, p. 45.

[12]Australia Long Covid Community Facebook Group, Submission 309, p. 9.

[13]Professor Steve Wesselingh, President of the Australian Academy of Health and Medical Sciences, Committee Hansard, Canberra, 17 February 2023, p. 45.

[14]Australian Healthcare and Hospitals Association, Submission 285, p. 5.

[15]Professor Michael Kidd AM, Deputy Chief Medical Officer, Department of Health and Aged Care, Committee Hansard, Canberra, 17February 2023, p. 13.

[16]Associate Professor Nada Hamad, private capacity, Committee Hansard, Canberra, 17 February 2023, p. 23.

[17]Professor Greg Dore, Epidemiologist, Kirby Institute, Committee Hansard, Canberra, 12 October 2022, p. 34.

[18]Professor Steve Wesselingh, President of the Australian Academy of Health and Medical Sciences, Committee Hansard, Canberra, 17 February 2023, p. 45.

[19]Professor Brendan Crabb AC, Chief Executive Officer and Director, Burnet Institute, Committee Hansard, Malvern, 20 February 2023, p. 3.

[20]See, for example: Professor Greg Dore, Epidemiologist, Kirby Institute, Committee Hansard, Canberra, 12 October 2022, p. 34; DrJen Kok, Medical Virologist, Australian Society of Microbiology; Institute of Clinical Pathology and Medical Research; and NSW Health Pathology, Committee Hansard, Canberra, 17 February 2023, p. 42; ProfessorBrendan Crabb AC, Chief Executive Officer and Director, Burnet Institute, Committee Hansard, Malvern, 20February 2023, p. 3.

[21]Professor Jeremy Nicholson, Director, Australian National Phenome Centre, Committee Hansard, Malvern, 20 February 2023, p. 31.

[22]Professor Brendan Crabb, Chief Executive Officer and Director, Burnet Institute, Committee Hansard, Malvern, 20 February 2023, p. 3.

[23]Burnet Institute, Submission 149, p. 14.

[24]Dr Jen Kok, Medical Virologist, Australian Society of Microbiology; Institute of Clinical Pathology and Medical Research; and NSW Health Pathology, Committee Hansard, Canberra, 17 February 2023, p. 42.

[25]Australian Academy of Science and the Australian Academy of Health and Medical Sciences, Submission165, p. 8.

[26]Royal Australasian College of Physicians, Submission 249, p. 6.

[27]See, for example: Associate Professor Alex Holmes, Fellow, Royal Australian and New Zealand College of Psychiatrists; Department of Health (Victoria), Submission 87, p. 3; Minister for Health and Wellbeing, SA, Submission 200, p. 7; Royal Melbourne Hospital; University of Melbourne, Committee Hansard, Canberra, 17February 2023, p. 50; Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, The Royal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 9.

[28]Professor Brendan Crabb AC, Chief Executive Officer and Director, Burnet Institute, Committee Hansard, Malvern, 20 February 2023, p. 1.

[29]Dr Colin McQueen, Submission 308, p. 1; Lisa Brereton, Submission 442, pages 3–4; Name withheld, Submission 9, p. 1; Ms Rose Stuart-Smith, Submission 193, p. 3; Australian Traditional Medicine Society (ATMS), Submission 271, pages 2, 6, 10–11; Ms Penelope McMillan, Spokesperson, ME/CFS Australia, Committee Hansard, Canberra, 17 February 2023, p. 51.

[30]Australia Long Covid Community Facebook Group, Submission 309.3, pages 1, 4.

[31]Australia Long Covid Community Facebook Group, Submission 309.3, pages 1–2.

[32]Professor Greg Dore, Epidemiologist, Kirby Institute, Committee Hansard, Canberra, 12 October 2022, p. 35.

[33]See, for example: Department of Health and Aged Care, Submission 196, p. 20; Pfizer Australia, Submission225.1, p. 6; Therapeutic Goods Administration, Paxlovid, www.tga.gov.au/resources/auspmd/paxlovid, accessed 24 March 2023; Therapeutic Goods Administration, Lagevrio, www.tga.gov.au/resources/auspmd/lagevrio, viewed 24 March 2023.

[34]See, for example: Name withheld, Submission 147, p. 4; Name withheld, Submission 221, p. 4; Namewithheld, Submission 298, p. 1; Name withheld, Submission 488, p. 4.

[35]Name withheld, Submission 311, p. 24.

[36]Pfizer Australia, Submission 225.1, pages 5–6.

[37]Public Health Association of Australia, Submission 351, p. 8.

[38]Burnet Institute, Submission 149, p. 16.

[39]Australian Patients Association, Submission 256, p. 6; OzSAGE, Submission 299, p. 9.

[40]Royal Australian College of General Practitioners, Submission 168, p. 10.

[41]National Clinical Evidence Taskforce, Australian guidelines for the clinical care of people with COVID-19, app.magicapp.org/#/guideline/L4Q5An/section/jN222G, viewed 24 March 2023.

[42]National Clinical Evidence Taskforce, Australian guidelines for the clinical care of people with COVID-19, app.magicapp.org/#/guideline/L4Q5An/section/jN222G, viewed 24 March 2023.

[43]Healthdirect, Medications for treating COVID-19, www.healthdirect.gov.au/covid-19/medications#not-approved, viewed 24 March 2023.

[44]Associate Professor Alex Holmes, Fellow, Royal Australian and New Zealand College of Psychiatrists; Royal Melbourne Hospital; University of Melbourne, Committee Hansard, Canberra, 17 February 2023, p. 50.

[45]See, for example: DrBrett Gardiner, Clinical Network Director, Subacute and Ambulatory Medicine, Western Sydney Health District, Committee Hansard, Liverpool, 5 December 2022, p. 12; Dr Benjamin Gerhardy, Respiratory Physician, Nepean and Blue Mountains Local Health District, CommitteeHansard, Liverpool, 5December 2022, p. 2; Royal Melbourne Hospital, Submission 164, p. 2.

[46]Burnet Institute, Submission 149, p. 15.

[47]National Clinical Evidence Taskforce, Australian guidelines for the clinical care of people with COVID-19, app.magicapp.org/#/guideline/L4Q5An/section/jN222G, viewed 24 March 2023.

[48]Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, The Royal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 8.

[49]Associate Professor Lou Irving, private capacity, Committee Hansard, Canberra, 12 October 2022, p. 4.

[50]Associate Professor Lou Irving, private capacity, Committee Hansard, Canberra, 12 October 2022, p. 4; Professor Lena Sanci, Head, Department of General Practice and Primary Care, Melbourne Medical School, The University of Melbourne, Committee Hansard, Canberra, 17 February 2023, p. 50.

[51]National Clinical Evidence Taskforce (Monash University), Submission 232, p. 7.

[52]Royal Melbourne Hospital, Submission 164, p. 2.

[53]Royal Melbourne Hospital, Submission 164, p. 2.

[54]Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, TheRoyal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 9.

[55]Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ), Submission 283,p. 5.

[56]Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ), Submission 283, p. 5, citationsomitted.

[57]National Clinical Evidence Taskforce, Australian guidelines for the clinical care of people with COVID-19, app.magicapp.org/#/guideline/L4Q5An/section/jN222G, viewed 24 March 2023.

[58]Department of Health and Aged Care, Getting help for Long COVID, www.health.gov.au/sites/default/files/documents/2022/11/getting-help-for-long-covid_0.pdf, viewed 24 March 2023.

[59]Long Covid Clinic St Vincent’s Hospital Sydney, Submission 287, p. 4.

[60]Dr Benjamin Gerhardy, Respiratory Physician, Nepean and Blue Mountains Local Health District, CommitteeHansard, Liverpool, 5 December 2022, p. 7.

[61]Associate Professor Alex Holmes, Fellow, Royal Australian and New Zealand College of Psychiatrists; Royal Melbourne Hospital; University of Melbourne, Committee Hansard, Canberra, 17 February 2023, p. 50.

[62]See, for example: Emerge Australia, Submission 67, p. 17; Sian Webster, Submission 279, p. 4; CFS Patient Advocates, Submission 470, p. 10; Name withheld, Submission 229, p. 1; Robin Austin, Submission 499.1, p. 4.

[63]Professor Anne Holland, Head of Post COVID Service, Head of Respiratory Research, Alfred Health, Professor of Physiotherapy, Monash University, Committee Hansard, Canberra, 17 February 2023, p. 49.

[64]National Clinical Evidence Taskforce, Australian guidelines for the clinical care of people with COVID-19, app.magicapp.org/#/guideline/L4Q5An/section/jN222G, viewed 24 March 2023, citations omitted.

[65]Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ), Submission 283, p. 12.

[66]See, for example: Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ), Submission283, p. 11; Western Health COVID Recovery Collaboration (WHCOVRE), Submission 493, p.16; Australian Physiotherapy Association, Submission 126, pages 12-14; Burnet Institute, Submission 149, p. 15; Dr Irani Thevarajan, Infectious Diseases Physician, Peter Doherty Institute for Infection and Immunity, Committee Hansard, Canberra, 12 October 2022, p. 18.

[67]Royal Melbourne Hospital, Submission 164, p. 3.

[68]Ms Carly McConnell, ReCOV Team Leader, Royal Melbourne Hospital, Committee Hansard, Canberra, 12October2022, p. 2.

[69]Long Covid Clinic St Vincent’s Hospital Sydney, Submission 287, p. 4.

[70]Department of Health and Aged Care, Submission 196, p. 20.

[71]National Clinical Evidence Taskforce (Monash University), Submission 232, p. 20.

[72]Royal Melbourne Hospital, Submission 164,p. 3.

[73]Professor Margaret Hellard, Deputy Director of Programs, Burnet Institute, Committee Hansard, Canberra, 12October2022, p. 22.

[74]See, for example: Royal Melbourne Hospital, Submission 164, p. 3; Victorian Post acute Covid-19 sequelae research group (VPACS), Submission 290, p. 7.

[75]Western Health COVID Recovery Collaboration (WHCOVRE), Submission 493, p. 15, citations omitted.

[76]See, for example: Department of Health (Victoria), Submission 87, p. 12; Exercise & Sports Science Australia, Submission 169, p. 7; Murdoch Children’s Research Institute, Submission178, p. 10. Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ), Submission283,p. 9; Associate Professor Philip Britton, private capacity, Committee Hansard, Canberra, 17February 2023, p. 47; Professor Lena Sanci, Head, Department of General Practice and Primary Care, Melbourne Medical School, The University of Melbourne, Committee Hansard, Canberra, 17 February 2023, p.50; Professor Anne Holland, Head of Post COVID Service, Head of Respiratory Research, Alfred Health, Professor of Physiotherapy, Monash University, Committee Hansard, Canberra, 17 February 2023, p. 56; DrBrett Gardiner, Clinical Network Director, Subacute and Ambulatory Medicine, Western Sydney Health District, Committee Hansard, Liverpool, 5 December 2022, p. 12; Dr Tuan-Anh Nguyen, Head of Department, Senior Staff Specialist, Rehabilitation Medicine, Campbelltown Hospital, Committee Hansard, Liverpool, 5December 2022, p. 35; Ms Carly McConnell, ReCOV Team Leader, Royal Melbourne Hospital, Committee Hansard, Canberra, 12October2022, p. 4.

[77]Dr Danielle Hitch, Senior Lecturer in Occupational Therapy, Deakin University, Committee Hansard, Canberra, 12 October 2022, p. 28.

[78]National Clinical Evidence Taskforce, Australian guidelines for the clinical care of people with COVID-19, app.magicapp.org/#/guideline/L4Q5An/section/jN222G, viewed 24 March 2023.

[79]Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, The Royal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 8.

[80]Dr Tuan-Anh Nguyen, Head of Department, Senior Staff Specialist, Rehabilitation Medicine, Campbelltown Hospital, Committee Hansard, Liverpool, 5December 2022, p. 35.

[81]Dr Tuan-Anh Nguyen, Head of Department, Senior Staff Specialist, Rehabilitation Medicine, Campbelltown Hospital, Committee Hansard, Liverpool, 5December 2022, p. 34.

[82]Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ), Submission 283,p. 11; Dr Tuan-Anh Nguyen, Head of Department, Senior Staff Specialist, Rehabilitation Medicine, Campbelltown Hospital, Committee Hansard, Liverpool, 5December 2022, p. 34.

[83]Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ), Submission 283,p. 11.

[84]Associate Professor Alex Holmes, Fellow, Royal Australian and New Zealand College of Psychiatrists; Royal Melbourne Hospital; University of Melbourne, Committee Hansard, Canberra, 17 February 2023, p. 50.

[85]See, for example: Australian Academy of Science and the Australian Academy of Health and Medical Sciences, Submission 165, p. 8; Victorian Post acute Covid-19 sequelae research group (VPACS), Submission 290, p. 20.

[86]Dr Brett Gardiner, Clinical Network Director, Subacute and Ambulatory Medicine, Western Sydney Health District, Committee Hansard, Liverpool, 5 December 2022, p. 12.

[87]Ms Carly McConnell, ReCOV Team Leader, Royal Melbourne Hospital, Committee Hansard, Canberra, 12October2022, p. 4.

[88]Department of Health and Aged Care, 3 November 2022, Getting help for Long COVID, www.health.gov.au/sites/default/files/documents/2022/11/getting-help-for-long-covid_0.pdf, p. 19, viewed 24 March 2023.

[89]National Clinical Evidence Taskforce (Monash University), Submission 232, pages 19–20.

[90]Australian Medical Association, Submission 328, p. 1.

[91]Minister for Health and Wellbeing, SA, Submission 200, p. 6.

[92]Queensland Health, Submission 150, p. 7.

[93]Allied Health Professions Australia, Submission 269, p. 18.

[94]Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p. 13.

[95]Professor Catherine Bennett, Chair in Epidemiology, Deakin University, Committee Hansard, Canberra, 12October 2022, p. 32.

[96]Royal Australian College of General Practitioners, Submission 168, pages 8–9.

[97]Minister for Health and Wellbeing, SA, Submission 200, p. 6, citations omitted.

[98]Dr Kenneth McCroary, Director, Macarthur General Practice, Committee Hansard, Liverpool, 5December 2022, p.46.

[99]Burnet Institute, Submission 149, p. 15.

[100]Dr Brett Gardiner, Clinical Network Director, Subacute and Ambulatory Medicine, Western Sydney Health District, Committee Hansard, Liverpool, 5 December 2022, p. 14.

[101]See, for example: Department of Health and Aged Care, Getting help for Long COVID, www.health.gov.au/sites/default/files/documents/2022/11/getting-help-for-long-covid_0.pdf, p. 19, viewed 24 March 2023; Dr Tuan-Anh Nguyen, Head of Department, Senior Staff Specialist, Rehabilitation Medicine, Campbelltown Hospital, Committee Hansard, Liverpool, 5December 2022, p. 35; Queensland Health, Submission 150, p. 7; Minister for Health and Wellbeing, SA, Submission 200, p. 5; Dr Kenneth McCroary, Director, Macarthur General Practice, Committee Hansard, Liverpool, 5December 2022, p.48.

[102]Dr Archana Sud, Director, Infectious Diseases Physician, Clinical Director Medicine, Nepean and Blue Mountains Local Health District, Committee Hansard, Liverpool, 5December 2022, p.7.

[103]Dr Kenneth McCroary, Director, Macarthur General Practice, Committee Hansard, Liverpool, 5December2022, p.47.

[104]See, for example: Rural Doctors Association of Australia, Submission 362, p. 2.

[105]Dr Danielle Hitch, Senior Lecturer in Occupational Therapy, Deakin University, Committee Hansard, Canberra, 12 October 2022, p. 33.

[106]Dr Su Mon Kyaw-Myint, personal capacity, Committee Hansard, Canberra, 17 February 2023, p. 26.

[107]Ms Karren Hill, Administrator, Australia Long Covid Community Facebook Support Group, CommitteeHansard, Canberra, 17 February 2023, p. 27.

[108]Mr Robin Austin, Member, Australia Long Covid Community Facebook Support Group, Committee Hansard, Canberra, 17 February 2023, p. 27.

[109]Australian Patients Association, Submission 256, p. 2.

[110]See: ACT Government, Post-COVID Recovery Clinic, www.canberrahealthservices.act.gov.au/services-and-clinics/services/post-covid-recovery-clinic, viewed 27 March 2023; NSW Health, Submission 272, p. 10; Queensland Health, Submission 150, p. 7; Minister for Health and Wellbeing, SA, Submission 200, p. 2; Department of Health (Victoria), Submission 87, p. 7; Department of Health (Western Australia), Submission273, p. 4.

[111]It appears that Tasmania does not have any long COVID clinic, although the Tasmanian Department of Health has launched a Post COVID-19 Navigation Service. See: Department of Health (Tasmania), Post COVID-19 Navigation Service, www.health.tas.gov.au/post-covid-19-navigation-service, viewed 27 March 2023.

[112]Department of Health (Northern Territory), Submission 253, p. 3.

[113]Department of Health (Northern Territory), Submission 253, p. 5.

[114]Department of Health and Aged Care, Submission 196, pages 19, 35; Pfizer Australia, Submission 225.1, p.4.

[115]See, for example: Department of Health (Western Australia), Submission 273, p. 4; Long Covid Clinic StVincent’s Hospital Sydney, Submission 287, p. 4.

[116]Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, The Royal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 9.

[117]Ms Carly McConnell, ReCOV Team Leader, Royal Melbourne Hospital, Committee Hansard, Canberra, 12October 2022, p. 5.

[118]Department of Health (Western Australia), Submission 273, p. 4.

[119]Ms Carly McConnell, ReCOV Team Leader, Royal Melbourne Hospital, Committee Hansard, Canberra, 12October 2022, p. 5.

[120]Long Covid Clinic St Vincent’s Hospital Sydney, Submission 287, p. 4.

[121]Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, The Royal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 8.

[122]Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, The Royal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 12.

[123]Minister for Health and Wellbeing, SA, Submission 200, p. 5.

[124]Dr Golo Ahlenstiel, Clinical Network Director, Specialty Medicine, Western Sydney Local Health District, Committee Hansard, Liverpool, 5December 2022, p. 12.

[125]Dr Danielle Hitch, Senior Lecturer in Occupational Therapy, Deakin University, Committee Hansard, Canberra, 12 October 2022, p. 27.

[126]Ms Carly McConnell, ReCOV Team Leader, Royal Melbourne Hospital, Committee Hansard, Canberra, 12October2022, p. 4; Department of Health (Western Australia), Submission 273, p. 4.

[127]Long Covid Clinic St Vincent’s Hospital Sydney, Submission 287, p. 3.

[128]Ms Carly McConnell, ReCOV Team Leader, Royal Melbourne Hospital, Committee Hansard, Canberra, 12October2022, p. 2.

[129]Long Covid Clinic St Vincent’s Hospital Sydney, Submission 287, p. 3.

[130]Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, The Royal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 12.

[131]Brimbank Community-Led Covid Group, Submission 527, p. 2.

[132]Long Covid Clinic St Vincent’s Hospital Sydney, Submission 287, p. 6.

[133]Allied Health Professions Australia, Submission 269, p. 4.

[134]Dr Irani Thevarajan, Infectious Diseases Physician at the Peter Doherty Institute for Infection and Immunity, Committee Hansard, Canberra, 12 October 2022, p. 16.

[135]Ms Karren Hill, Administrator, Australia Long Covid Community Facebook Support Group, Committee Hansard, Canberra, 17 February 2023, p. 27; Dr Su Mon Kyaw-Myint, personal capacity, Committee Hansard, Canberra, 17 February 2023, p. 26.

[136]Ms Karren Hill, Administrator, Australia Long Covid Community Facebook Support Group, Committee Hansard, Canberra, 17 February 2023, p. 27.

[137]Australia Long Covid Community Facebook Group, Submission 309, p. 10.

[138]See, for example: Australian Healthcare and Hospital Association, Submission 285, p. 5; Brimbank Community-Led Covid Group, Submission 527, p. 1; Name withheld, Submission 348, p.1; MrsMelindaBorder, Submission 184, p. 2; Name withheld, Submission 347, p. 1; Madeline Cooper, Submission 371, p.1.

[139]See, for example: Minister for Health and Wellbeing, SA, Submission 200, p. 7; Ms Carly McConnell, ReCOV Team Leader, Royal Melbourne Hospital, Committee Hansard, Canberra, 12October2022, p. 4.

[140]Long Covid Clinic St Vincent’s Hospital Sydney, Submission 287, p. 8.

[141]Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, The Royal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 11.

[142]Dr Zinta Harrington, Head, Department of Respiratory and Sleep Medicine, Liverpool Hospital, Committee Hansard, Liverpool, 5December 2022, p. 31.

[143]Dr Zinta Harrington, Head, Department of Respiratory and Sleep Medicine, Liverpool Hospital, Committee Hansard, Liverpool, 5December 2022, p. 31.

[144]UNSW Fatigue Clinic and Research Program, Submission 289, p. 2.

[145]Associate Professor Nada Hamad, private capacity, Committee Hansard, Canberra, 17 February 2023, p. 22.

[146]Dr Jason Agostino, Senior Medical Adviser, National Aboriginal Community Controlled Health Organisation, Committee Hansard, Canberra, 17 February 2023, p. 1.

[147]Dr Danielle Hitch, Senior Lecturer in Occupational Therapy, Deakin University, Committee Hansard, Canberra, 12 October 2022, p. 27.

[148]Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, The Royal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 11.

[149]Ms Carly McConnell, ReCOV Team Leader, Royal Melbourne Hospital, Committee Hansard, Canberra, 12October2022, p. 4.

[150]Dr Benjamin Gerhardy, Respiratory Physician, Nepean and Blue Mountains Local Health District, CommitteeHansard, Liverpool, 5 December 2022, p. 6.

[151]Australian Academy of Science and the Australian Academy of Health and Medical Sciences, Submission165, p. 7, citations omitted; Australian Healthcare and Hospital Association, Submission 285, p.5.

[152]See, for example: Minister for Health and Wellbeing, SA, Submission 200, p. 5; Ms Carly McConnell, ReCOV Team Leader, Royal Melbourne Hospital, Committee Hansard, Canberra, 12October2022, p. 5.

[153]Victorian Post acute Covid-19 sequelae research group (VPACS), Submission 290, p. 3.

[154]Minister for Health and Wellbeing, SA, Submission 200, p. 5.

[155]NSW Health, Submission 272, pages 9–10.

[156]Department of Health (Victoria), Submission 87, p. 7.

[157]Department of Health (Western Australia), Submission 273;Queensland Health, Submission 150.

[158]Queensland Health, Submission 150, pages 3, 8.

[159]Department of Health (Northern Territory), Submission 253, pages 2, 5.

[160]Australian Academy of Science and the Australian Academy of Health and Medical Sciences, Submission165, p. 2.

[161]National Clinical Evidence Taskforce (Monash University), Submission 232, p. 9.

[162]A biopsychosocial approach ‘systematically considers biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery.’ See: The University of Rochester Medical Center, The Biopsychosocial Approach, www.urmc.rochester.edu/medialibraries/urmcmedia/education/md/documents/biopsychosocial-model-approach.pdf, viewed 29 March 2023.

[163]National Clinical Evidence Taskforce (Monash University), Submission 232, p. 20.

[164]Dr Zinta Harrington, Head, Department of Respiratory and Sleep Medicine, Liverpool Hospital, CommitteeHansard, Liverpool, 5December 2022, p. 31.

[165]Professor Greg Dore, Epidemiologist, Kirby Institute, Committee Hansard, Canberra, 12 October 2022, p. 41.

[166]Dr Brett Gardiner, Clinical Network Director, Subacute and Ambulatory Medicine, Western Sydney Health District, Committee Hansard, Liverpool, 5 December 2022, p. 12.

[167]Department of Health (Victoria), Submission 87, p. 6.

[168]Australian Healthcare and Hospitals Association, Submission 285, p. 4, citations omitted.

[169]Name withheld, Submission 190, p. 1.

[170]Dr Tuan-Anh Nguyen, Head of Department, Senior Staff Specialist, Rehabilitation Medicine, Campbelltown Hospital, Committee Hansard, Liverpool, 5December 2022, p. 34.

[171]Professor Catherine Bennett, Chair in Epidemiology, Deakin University, Committee Hansard, Canberra, 12October 2022, p. 33.

[172]Royal Australasian College of Physicians, Submission 249, p. 6.

[173]Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p. 16.

[174]Professor Brendan Murphy AC, Secretary, Department of Health and Aged Care, Committee Hansard, Canberra, 17 February 2023, p. 13.

[175]See, for example: Royal Australasian College of Physicians, Submission 249, p. 4; Rural Doctors Association of Australia, Submission 362, p. 4.

[176]Australian Medical Association, Submission 328, p. 5.

[177]Long Covid Clinic St Vincent’s Hospital Sydney, Submission 287, p. 2.

[178]See, for example: Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ), Submission283, p. 11.

[179]National Clinical Evidence Taskforce (Monash University), Submission 232, p. 9.

[180]National Clinical Evidence Taskforce (Monash University), Submission 232, p. 20.

[181]Professor Anne Holland, Head of Post COVID Service, Head of Respiratory Research, Alfred Health, Professor of Physiotherapy, Monash University, Committee Hansard, Canberra, 17 February 2023, p. 62.

[182]Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p. 16.

[183]Dr Brett Gardiner, Clinical Network Director, Subacute and Ambulatory Medicine, Western Sydney Health District, Committee Hansard, Liverpool, 5 December 2022, p. 18.

[184]Dr Golo Ahlenstiel, Clinical Network Director, Specialty Medicine, Western Sydney Local Health District, Committee Hansard, Liverpool, 5December 2022, p. 12.

[185]Dr Danielle Hitch, Senior Lecturer in Occupational Therapy, Deakin University, Committee Hansard, Canberra, 12 October 2022, p. 27.

[186]Dr Danielle Hitch, Senior Lecturer in Occupational Therapy, Deakin University, Committee Hansard, Canberra, 12 October 2022, p. 27.

[187]Western Health COVID Recovery Collaboration (WHCOVRE), Submission 493, p. 15.

[188]Queensland Health, Submission 150, p. 7.

[189]Associate Professor Lou Irving, private capacity, Committee Hansard, Canberra, 12 October 2022, p. 5.

[190]Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, TheRoyal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 11.

[191]Long Covid Clinic St Vincent’s Hospital Sydney, Submission 287, p. 3.

[192]Dr Brendan McMullan, Paediatric Infectious Diseases Specialist, Sydney Children’s Hospitals Network, Committee Hansard, Liverpool, 5 December 2022, p. 23.

[193]See, for example: Royal Australasian College of Physicians, Submission 249, p. 67; Australian Healthcare and Hospitals Association, Submission 285, p. 6; Long Covid Clinic St Vincent’s Hospital Sydney, Submission 287, p. 3; Australian Medical Association, Submission 328, p. 5; Australian Federation of Disability Organisations, Submission 486, pages 13-14; Associate Professor Shidan Tosif, Consultant, General Medicine, and Clinical Lead, Post-COVID Clinic, The Royal Children’s Hospital, Committee Hansard, Canberra, 12 October 2022, p. 9.

[194]Dr Benjamin Gerhardy, Respiratory Physician, Nepean and Blue Mountains Local Health District, CommitteeHansard, Liverpool, 5 December 2022, p. 1.

[195]Department of Health and Aged Care, Submission 196, p. 20.

[196]Department of Health and Aged Care, 9 February 2022, 2020–25 National Health Reform Agreement (NHRA), www.health.gov.au/our-work/2020-25-national-health-reform-agreement-nhra, viewed 29 March 2023.

[197]Department of Health and Aged Care, Submission 196, p. 20.

[198]Department of Health and Aged Care, 9 February 2022, 2020–25 National Health Reform Agreement (NHRA), www.health.gov.au/our-work/2020-25-national-health-reform-agreement-nhra, viewed 29 March 2023.

[199]Department of Health (Victoria), Submission 87, p. 2.

[200]Dr Su Mon Kyaw-Myint, personal capacity, Committee Hansard, Canberra, 17 February 2023, p. 29.

[201]Department of Health (Victoria), Submission 87, p. 2.

[202]Department of Health (Victoria), Submission 87, p. 7.

[203]Queensland Health, Submission 150, p. 7.

[204]Department of Health and Aged Care, Submission 196, p. 19.

[205]Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p. 14.

[206]Department of Health and Aged Care, Submission 196, p. 19.

[207]Dr Archana Sud, Infectious Diseases Physician, Clinical Director Medicine, Nepean and Blue Mountains Local Health District, Committee Hansard, Liverpool, 5 December 2022, p. 7.

[208]Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p. 15; Australian Medical Association, Submission 328, p.15; Royal Australian College of General Practitioners, Submission 168, p. 9.

[209]Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p. 15.

[210]Australian Healthcare and Hospitals Association, Submission 285, p. 4, citations omitted.

[211]Royal Australian College of General Practitioners, Submission 168, p. 9.

[212]Minister for Health and Wellbeing, SA, Submission 200, p. 2.

[213]Professor Michael Kidd AM, Deputy Chief Medical Officer, Department of Health and Aged Care, Committee Hansard, Canberra, 17February 2023, p. 13.

[214]Department of Health (Victoria), Submission 87, p. 13; Allied Health Professions Australia, Submission 269, p. 20; Professor Andrew Lloyd, private capacity, Committee Hansard, Canberra, 17 February 2023, p. 46; Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p. 16.

[215]Professor Lena Sanci, Head, Department of General Practice and Primary Care, Melbourne Medical School, The University of Melbourne, Committee Hansard, Canberra, 17 February 2023, p. 47.

[216]Professor Brendan Murphy AC, Secretary, Department of Health and Aged Care, Committee Hansard, Canberra, 17 February 2023, p. 13.

[217]Services Australia, 6 December 2022, Chronic disease GP Management Plans and Team Care Arrangements, www.servicesaustralia.gov.au/chronic-disease-gp-management-plans-and-team-care-arrangements?context=20, viewed 29 March 2023.

[218]Department of Health (Victoria), Submission 87, p. 13; Royal Australian College of General Practitioners, Submission 168, p. 9; Minister for Health and Wellbeing, SA, Submission 200, p. 2; Allied Health Professions Australia, Submission 269, pages 16–23; Australian Healthcare and Hospitals Association, Submission 285, p.4; Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, CommitteeHansard, Malvern, 20 February 2023, p. 14.

[219]Allied Health Professions Australia, Submission 269, pages 16, 19, 21.

[220]Allied Health Professions Australia, Submission 269, p. 21.

[221]Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p. 14.

[222]Department of Health (Victoria), Submission 87, p. 13; Minister for Health and Wellbeing, SA, Submission200, p. 2; Royal Australian College of General Practitioners, Submission 168, p. 9.

[223]Minister for Health and Wellbeing, SA, Submission 200, p. 2.

[224]Royal Australian College of General Practitioners, Submission 168, p. 9.

[225]Allied Health Professions Australia, Submission 269, p. 22.

[226]Services Australia, Chronic disease GP Management Plans and Team Care Arrangements, www.servicesaustralia.gov.au/chronic-disease-gp-management-plans-and-team-care-arrangements?context=20, viewed 29 March 2023.

[227]Allied Health Professions Australia, Submission 269, p. 21.

[228]Allied Health Professions Australia, Submission 269, p. 21.

[229]Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, CommitteeHansard, Malvern, 20 February 2023, p. 16.

[230]Royal Australian College of General Practitioners, Submission 168, p. 9.

[231]Australian Medical Association, Submission 328, p. 10.

[232]Professor Brendan Crabb AC, Chief Executive Officer and Director, Burnet Institute, Committee Hansard, Malvern, 20 February 2023, p. 6.

[233]Australia Long Covid Community Facebook Group, Submission 309, p. 15.

[234]Associate Professor Nada Hamad, private capacity, Committee Hansard, Canberra, 17 February 2023, p. 21.

[235]Australian Academy of Science and the Australian Academy of Health and Medical Sciences, Submission165, p. 5, citations omitted.

[236]See, for example: Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ), Submission283, p. 9; Australian Academy of Science and the Australian Academy of Health and Medical Sciences, Submission 165, p.8.

[237]Australian Healthcare and Hospitals Association, Submission 285, p. 5, citations omitted.

[238]See, for example: Department of Health (Victoria), Submission 87, p. 6; Associate Professor Anthony Byrne, respiratory physician, St Vincent’s Hospital, Submission 155, p. 2; Australian Academy of Science and the Australian Academy of Health and Medical Sciences, Submission 165, p. 8; Allied Health Professions Australia, Submission 269, p. 17; Professor Greg Dore, Epidemiologist, Kirby Institute, Committee Hansard, Canberra, 12 October 2022, pages 34, 41–42.

[239]Dr Golo Ahlenstiel, Clinical Network Director, Specialty Medicine, Western Sydney Local Health District, Committee Hansard, Liverpool, 5December 2022, p. 16.

[240]Dr Zinta Harrington, Head, Department of Respiratory and Sleep Medicine, Liverpool Hospital, Committee Hansard, Liverpool, 5December 2022, pages 31–32.

[241]Professor Michael Kidd AM, Deputy Chief Medical Officer, Department of Health and Aged Care, Committee Hansard, Canberra, 17February 2023, p. 12.

[242]Minister for Health and Wellbeing, SA, Submission 200, p. 4.

[243]Queensland Health, Submission 150, p. 10.

[244]NSW Health, Submission 272, p. 9, citations omitted.

[245]Dr Zinta Harrington, Head, Department of Respiratory and Sleep Medicine, Liverpool Hospital, Committee Hansard, Liverpool, 5December 2022, p. 28.

[246]Dr Archana Sud, Director, Infectious Diseases Physician, Clinical Director Medicine, Nepean and Blue Mountains Local Health District, Committee Hansard, Liverpool, 5December 2022, pages6–7.

[247]Royal Australian College of General Practitioners, Caring for patients with post-COVID-19 conditions, www.racgp.org.au/clinical-resources/covid-19-resources/clinical-care/caring-for-patients-with-post-covid-19-conditions/introduction, viewed 30 March 2023.

[248]Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p. 14.

[249]National Clinical Evidence Taskforce, About the taskforce, clinicalevidence.net.au/about-the-taskforce, viewed 30 March 2023.

[250]National Clinical Evidence Taskforce (Monash University), Submission 232, p. 19, citations omitted.

[251]Professor Greg Dore, Epidemiologist, Kirby Institute, Committee Hansard, Canberra, 12 October 2022, p. 42.

[252]The Royal Australasian College of Physicians defines Continuing Professional Development (CPD) in a healthcare context as consisting of a range of activities undertaken to maintain clinical skills and knowledge, as well as competence in the delivery of patient-centred care. Royal Australasian College of Physicians, Continuing Professional Development, www.racp.edu.au/fellows/continuing-professional-development, viewed 19 April 2023.

[253]Professor Julie Leask, private capacity, Committee Hansard, Canberra, 17 February 2023, p. 63.

[254]Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p. 15.

[255]Australia Long Covid Community Facebook Group, Submission 309, p. 10.

[256]Professor Lena Sanci, Head, Department of General Practice and Primary Care, Melbourne Medical School, The University of Melbourne, Committee Hansard, Canberra, 17 February 2023, p. 63.

[257]Department of Health (Victoria), Submission 87, p. 12.

[258]Department of Health (Victoria), Submission 87, p. 12.

[259]See, for example: Department of Health (Victoria), Submission 87, p. 12; Royal Australian College of General Practitioners, Submission 168, p. 5; Australia Long Covid Community Facebook Group, Submission 309, p.17; Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p. 15.

[260]National Clinical Evidence Taskforce (Monash University), Submission 232, pages 4, 6.

[261]Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p. 13.

[262]National Clinical Evidence Taskforce (Monash University), Submission 232, p. 2.

[263]Dr Su Mon Kyaw-Myint, personal capacity, Committee Hansard, Canberra, 17 February 2023, p. 26.

[264]See, for example: Australian Medical Association, Submission 328, p.7; Dr Benjamin Gerhardy, Respiratory Physician, Nepean and Blue Mountains Local Health District, Committee Hansard, Liverpool, 5 December 2022, pages 2–3; Dr Zinta Harrington, Head, Department of Respiratory and Sleep Medicine, Liverpool Hospital, Committee Hansard, Liverpool, 5December 2022, p. 31; Dr Kenneth McCroary, Director, Macarthur General Practice, Committee Hansard, Liverpool, 5 December 2022, pages 47–48; Dr Jason Agostino, Senior Medical Advisor, National Aboriginal Community Controlled Health Organisation, Committee Hansard, Canberra, 17 February 2023, pages 1–2; Professor Lena Sanci, Head, Department of General Practice and Primary Care, Melbourne Medical School, The University of Melbourne, Committee Hansard, Canberra, 17 February 2023, p. 50; Professor Martin Hensher, private capacity, Committee Hansard, Canberra, 17 February 2023, p. 50; Professor Andrew Baillie, Professor of Allied Health, University of Sydney, Committee Hansard, Canberra, 17 February 2023, p.62; Professor Mark Morgan, Chair, Royal Australian College of General Practitioners’ Expert Committee for Quality Care, & Co-chair, National Clinical Evidence Taskforce’s Primary and Chronic Care Panel, Committee Hansard, Malvern, 20 February 2023, p.15.

[265]See, for example: Department of Health and Aged Care, Strengthening Medicare Taskforce, www.health.gov.au/committees-and-groups/strengthening-medicare-taskforce, viewed 3 April 2023.