Managing the long term health consequences of COVID-19 in Australia

To date, Australia is one of a group of countries who have succeeded in limiting and largely controlling the spread of COVID-19 within their borders. As a result of these effective control measures, Australia has suffered a much lower burden of COVID-19 disease than most other countries; with rates of infections and deaths being an order of magnitude lower than those seen in most other high-income nations.

However, in those countries which have suffered more severely than Australia, concerns about the long-term consequences of the pandemic are increasingly focused on the long-term clinical sequelae being seen in survivors of COVID-19, including Long COVID and a wide range of other conditions.

Although Long COVID is not yet fully understood, health policy makers, including those in Australia, should be preparing to address it.

This policy challenge is exacerbated precisely because COVID-19 cases in Australia have been low. As of April 2021, the estimated likely case numbers for Long COVID lie between 2,867 and 5,413 cases. Therefore, the Australian response to Long COVID needs to be proportionate - suitable for dealing with today’s relatively small numbers, yet capable of rapid scaling-up if circumstances required it.

An outcome focused, value-based health care approach that reflects contemporary governance and funding arrangements, and that can achieve effective management of Long COVID, provides a useful template for a national strategy for managing the long- term sequelae of COVID-19. This should consider 1) a nationally unified and regionally controlled health system that puts patients at the centre, 2) performance information and reporting that is fit for purpose, 3) an integrated health workforce that exists to serve and meet population health needs, and 4) funding that is sustainable and appropriate to support a high-quality health system.

Against this framework, governments will need to consider the potential clinical evolution of patients who may have suffered organ damage and impairment due to COVID-19, while balancing the competing risks of inaction and overdiagnosis; in addition to preparing proportionately for the possible emergence of other as yet unknown, post-COVID sequelae, especially neurological conditions, such as those seen after other viral pandemics.

Recommendations are also provided to support:

• the establishment of a national post-COVID Centre of Excellence and state- based care coordination centres;

• a nationwide COVID-19 data registry that combines patient-level data on COVID-19 and subsequent health and healthcare utilisation history;