Review Long Covid in Aotearoa NZ: Risk assessment and preventive action urgently needed, 2024, Kvalsvig et al

Hutan

Hutan

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Staff member
https://www.phcc.org.nz/briefing/lo...essment-and-preventive-action-urgently-needed

On the Public Health Communication Centre Aotearoa
Amanda Kvalsvig, Anna E. S. Brooks, John D. Potter, Mona Jeffreys, Julie Bennett, David Davies-Payne, Jonathan Kennedy, Dianne Sika-Paotonu, Carmen Timu-Parata, Jenene Crossan, Celia Hume, Lynne Russell, Paula Lorgelly, Michael Baker

Summary
Covid-19 can cause longer-term changes in health, collectively known as Long Covid. With only four years of follow-up time to observe this evolving new virus we cannot yet see the full picture of Long Covid, but its impacts are already substantial and measurable in individuals, sectors, and societies. Evidence consistently shows that Long Covid is common, affects all ages, and frequently results in prolonged illness that can be disabling. It occurs with first infections and reinfections and follows all virus variants. There is currently no cure, making prevention critical.

Three urgent recommendations to the NZ Government are:
  1. Identify a proportionate response by conducting a comprehensive Long Covid risk assessment;
  2. Rapidly reduce infection and reinfection rates by ensuring that public settings are safer to access; and
  3. Expand Covid-19 vaccine eligibility and coverage (eg, to younger age groups) to benefit from the demonstrated ability of vaccines to reduce the risk of Long Covid.
 
Long Covid includes a full spectrum of severity from hidden effects (tissue damage that does not initially cause symptoms)17 45-47 through mild and transient symptoms to life-changing and life-limiting conditions such as heart attacks and strokes,48 49 diabetes,50 myalgic encephalomyelitis/chronic fatigue syndrome [ME/CFS]),51 52 and clinically significant neurocognitive events or dysfunction.53
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For the substantial sub-group meeting the criteria for ME/CFS, research on this condition has shown that recovery after 2-3 years is uncommon with ME/CFS and that most people have significant long-term disability.7 62 63
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Long Covid occurring in the form of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is debilitating and disabling, with long-term impacts on health and healthcare use.51 52 63 91 SARS-CoV-2 may rapidly supersede other pathogens as the leading cause of ME/CFS.
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Immunological studies describing Long Covid immune profiles and vascular inflammation biomarkers96-98 109 are a promising initial step towards definitive treatment. Repurposing existing medications may be helpful but definitive treatments may still be years away. The ‘syndromic’ type of Long Covid presentation that includes extreme fatigue, cognitive impairment (“brain fog”), and post-exertional malaise (PEM) has clinical and biological similarities with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS);51 52 101 research on treatment options may benefit both of these groups of patients.
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A breakthrough study recently published in Nature Communications revealed mitochondrial dysfunction as the pathophysiological cause of muscle damage associated with exercise intolerance.21 This recent discovery builds on previous research identifying immune and mitochondrial disturbances associated with post-infection syndromes which is critical for identifying pathogenesis and mechanisms of disease. The accumulating evidence16 110-114 also highlights the importance of clinically assessing for PEM in Long Covid and ME/CFS patients, and managing exertion appropriately, as Graded Exercise Therapy (GET) is contraindicated.115
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This report is a truly outstanding piece of work and could form the blueprint for ANY government willing to confront the enormous health & economic challenges presented by repeated Covid infections and the resulting impact of Long Covid.
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Nice feedback from that commentator.

The overwhelming feeling I get from reading that roll is that governments are going to continue to deny the problem. Tackling it is just too difficult. I mean - better ventilation in schools? There's not even enough money for school infrastructure without ventilation considerations. There's such a shortage of government funds everywhere - what government is going to scare and upset their population about this and run the risk of reducing economic activity and making their health workforce even more disgruntled than they already are ... (Yes, I know inaction will get them to the same places, but probably they think it won't be their problem should things get really bad.)

I thought the recommendation for ongoing vaccination protection was interesting. If I have some time I would like to look into that a bit more. It's a nice story, but I wonder how firm it really is that vaccination protects against Long Covid going forward. If it is really solid, that might be one thing that governments would be willing to pay for.
 
Hutan said:
The overwhelming feeling I get from reading that roll is that governments are going to continue to deny the problem. Tackling it is just too difficult.
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As the authors say here: https://www.nature.com/articles/s41577-023-00904-7

The oncoming burden of long COVID faced by patients, health-care providers, governments and economies is so large as to be unfathomable, which is possibly why minimal high-level planning is currently allocated to it.
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Hutan said:
Nice feedback from that commentator.

The overwhelming feeling I get from reading that roll is that governments are going to continue to deny the problem. Tackling it is just too difficult. I mean - better ventilation in schools? There's not even enough money for school infrastructure without ventilation considerations. There's such a shortage of government funds everywhere - what government is going to scare and upset their population about this and run the risk of reducing economic activity and making their health workforce even more disgruntled than they already are ... (Yes, I know inaction will get them to the same places, but probably they think it won't be their problem should things get really bad.)
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To be fair, if we did spend the money on that and other things, billionaires may have to do away with having to live on only 4 yachts, instead of 6, millionaires may have to see their wine cave almost half empty, and that's just clearly not a future worth living. Think of the crew of the other 2 yachts, having to work... other jobs. Mayhem, basically.
 
27th March: Reti seeks advice on long Covid (Waatea News) —

Dr Reti says he’s aware of the study.
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Health Minister Shane Reti says he has established an expert group to give advice on what should be done about long Covid.
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2nd April: Health Ministry apologises after providing incorrect advice to ministers (Newsroom)

The Ministry of Health has formally apologised to Health Minister Shane Reti and Finance Minister Nicola Willis for providing incorrect information in a briefing on the Government’s response to Long Covid.

Last week, the Public Health Communications Centre at the University of Otago Wellington published a paper recommending the Government do more to help those suffering from the condition.
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In response to the report, Reti and Willis pointed to the existence of a Long Covid Expert Advisory Group set up in 2022. However, it now appears that group finished its work that same year and has since been disestablished.
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Willis also said there was a programme of work at the ministry to support patients with Long Covid. The Ministry of Health webpage for the Long Covid programme doesn’t list any documents or advice released more recently than September 2022.
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Newsroom has sought clarification from the ministry on the status of this work programme and what work the Government is currently doing on Long Covid.

The report by the public health researchers found Long Covid is a “major threat to individual health, societal wellbeing and economic performance”.
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I was actually relieved because there was a risk any “new” expert advisory group could have included the self-proclaimed experts (BA) who are supporting the LP/Switch practitioners who are doing the GP conference rounds presenting their LC cure.
 
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