Inquiry report sheds light on emerging and complex health priority: Experts comment

Pharma News:The House of Representative’s Standing Committee has released its report following an inquiry into long COVID and repeated COVID infections. Medical and scientific experts comment on the Committee’s nine unanimous recommendations aimed at strengthening the government’s management of long COVID, including having a definition of long COVID, evidence-based living guidelines and a nationally coordinated research program for long COVID and COVID-19.

Professor Jeremy Nicholson, Director of the Australian National Phenome Centre and one of the submitters and reporters to the House of Representatives Standing Committee Inquiry into long COVID and Repeated COVID-19 Infections, said “There is a most important conclusion that the Long COVID ‘population experience’ would be best managed by the creation of a new Australian Centre for Disease Control (CDC) to help the collection and coordination of patient data at a national level and the formulation of a plan for funding for trials and studies relating to long COVID for the nation.

“Currently, trials and most research are scattered, statistically underpowered and not connected either between states or even within them. Obviously, the development of a CDC is going to take some time, but this would be an important development for Australia for future major disease monitoring and management.

“The report states that there are 200 diverse and non-specific symptoms for Long COVID – this clearly creates a challenge for the classification, diagnosis and stratification of the disease as well as its treatment. If there is a weakness in the report, it is in relation to the emphasis on symptomatic manifestations of Long COVID, rather than creating a pathway to the objective molecular classification of the disease using validated digital metrics which are now available. Obviously, symptomatic treatment is what the patients actually require but that needs mechanistic and biomarker knowledge and the interventions need to be focussed on the underlying chemical and metabolic abnormalities that are caused by the disease.

“Many of the Long COVID complications are due to the triggering of multiple inflammatory conditions or the acceleration of pre-existing conditions, including heart disease, diabetes and neurological disorders, for each of which there are numerous existing treatments. So there needs to be more emphasis on advancing chemical diagnostics for Long COVID (blood and urine tests) for assessing individual patient problems and then applying those at population scale.”

The report also mentions new outreach funding for improved healthcare access to Long COVID patients in remote regions and the needs of affected First Nations people. This will require further future development of ruggedised diagnostics that can be applied away from high-technology medical centres, which in itself is a major task.

Professor Kevin Barnham, Head of Neurotherapeutics Laboratory at The Florey Institute of Neuroscience & Mental Health, commented “There is a pressing need to fully understand the impacts of this condition on the brain. We have concerns around the neurological symptoms being presented, including loss of smell and memory complaints.

“Approximately 80% of those infected with COVID-19 report neurological dysfunction, and 30% have persistent symptoms. The long-term implications of these neurological symptoms require careful consideration as many of them are known to be associated with increased risk of neurodegeneration or recognised as part of the early symptoms for disorders such as Parkinson’s disease and Alzheimer’s disease.”

The RACGP President called for immediate support for long COVID patients. Dr Nicole Higgins said “It’s disappointing the report doesn’t recommend immediate support for people suffering distress and disability from long COVID. Patients’ Medicare rebates don’t adequately support people with long COVID. It’s a complex chronic condition and it requires more of a GPs’ time, but the current patient rebates penalise GPs for spending longer with patients.”

Over the course of the inquiry, the Committee held four public hearings and received almost 600 submissions from individuals, organisations and government bodies.

The Chair of the Committee, Dr Mike Freelander MP said “It is clear that the emergence of long COVID has created challenges for patients and healthcare professionals alike. People with long COVID suffer from a lack of information and treatment options. Health care professionals, who worked tirelessly over the acute phase of the pandemic, are now in a difficult situation trying to support patients with this new and poorly understood condition.”

The Deputy Chair of the Committee, Mrs Melissa McIntosh MP, stated “Throughout the inquiry, the Committee heard from hundreds of Australians about what it is like to live with long COVID and how the condition impacts their daily lives. The Committee was particularly concerned to hear that long COVID is associated with poor mental health. The Committee heard that many individuals with long COVID feel isolated, disbelieved, anxious or depressed.”

The announcement from Mark Butler MP, Minister for Health and Aged Care, of a further $50 million to support long COVID research and related programs is also welcome, but falls short of the current and future research needs across such a broad swathe of medicine. It is also a small sum in relation to the healthcare burden imposed by COVID-19 and Long COVID that is even now starting to have effects.

Medical and scientific experts hope that the new $50 million represents a first step towards investigating and ultimately mitigating Long COVD which is one of the most complex healthcare challenges of our time.

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