Michelle Ananda-Rajah (Higgins, Australian Labor Party) Share this | Hansard source

Long COVID has emerged as a significant health and economic challenge. It has cast a long shadow over all our lives. No-one is untouched by this illness. It has affected young people and older people. It has disproportionately affected people in their working lives. Every single sector of our society and our community has been affected by it.

The committee that I was part of—the parliamentary health committee—has put out a significant body of work in response to this challenge.

I will speak about it, but I will also take this opportunity to cast back to my maiden speech. When I first came to this parliament it was actually through a pathway of medical activism in response to the COVID pandemic and how it was affecting healthcare professionals. This is what I said in my maiden speech:

Watch out for the tail. It has a sting. For COVID, it will be chronic disease and mass illness disrupting lives and constraining our productivity for years to come. This is not inevitable but depends on what we do next.

I will spend a bit of time talking about what we have done since coming to government.

Now, we know that COVID itself is a multisystem disease. It is not the flu. It is an infectious disease, a respiratory virus, but it has multisystem effects. Long COVID is not dissimilar. This is a disease characterised by persistent and chronic inflammation that affects every single organ in the body. We know that somewhere between five per cent to 10 per cent of patients develop long COVID. That may well be an underestimate. Some studies, one recently published in Nature, put the number as high as 10 per cent to 30 per cent. It is affecting people disproportionately with mild illness as well, and that's the majority of patients who now develop COVID in the Australian population, which is generally vaccinated.

What we've also found is that people in the prime of their working lives are being cut down, essentially, with this chronic disease, and it is highly gendered, disproportionately affecting women. It is distinct from a separate condition called post-COVID complications. Post-COVID complications refer to complications that arise as a result of COVID. They can be the new onset of diabetes, heart attacks, strokes and other acute illnesses. They are not the same as long COVID. Long COVID has a plethora of symptoms which range from fatigue to brain fog, inattention and problems with cognition. This is what makes it so debilitating; on the outside, people look completely normal, but they are absolutely struggling to fire on all cylinders internally.

What are the causes? What we know about long COVID, we could certainly fill a book with. What we don't know, we could fill a library with. We do know that there are certain things that may be contributing to this persistent and chronic inflammation in the body. One is a persistent reservoir of virus or antigen, a fragment of the virus, that is remaining in the body in various sanctuary sites. The gut is one such place. We know that immune disregulation—an immune system that has gone haywire and has not settled down—is another feature of long COVID. We believe that long COVID can lead to the reactivation of other viruses that lie dormant within our bodies, and the herpes family of viruses are one.

It may also be associated with microclots. COVID in itself is a vascular tropic virus—that means that it is a virus that likes blood vessels, and where are blood vessels? Blood vessels are throughout our body. As a result, getting sick with acute COVID and ending up, for example, in hospital can lead to blood clots all over the body, strokes or pulmonary emboli, which are clots in the lung. But the problem of long COVID, this persistent inflammation, can lead to microclots—clots that are so small that we can't actually see them with the resolution of our current imaging, but they are certainly there and causing impairment to organs and impaired blood blow and oxygenation.

We also think that there may be dysfunctional signalling between the brain, particularly the brain stem, and the rest of the body. The microbiome, which is the bacterial load inside our bodies, particularly in our gut, is also disregulated as a result of long COVID. So there are a lot of things going on in the body contributing to this persistent state of inflammation, and we have a power of work to do in terms of unpacking that.

So the long COVID inquiry was done at speed. It was launched in around September of last year and concluded in April with a report handed to the health minister. We sought out opinion from everyone in Australia, including peak bodies and patients with lived experience, many of whom have encountered a testimonial injustice where they have not been believed or have not felt like they've been heard, particularly by my colleagues in the medical profession.

We sought out top researchers from throughout the country. We brought forth health departments to share with us what they have been doing in terms of mitigating and managing patients who have long COVID. We also heard from some industry experts.

I'd like to go through some of the key recommendations that we put forward. One was that the committee recommended that we establish firstly a single database in order to acquire better quality data. We simply don't know. This is like blind men feeling an elephant—we have all sides of it, but we need to see the whole. We need better information on the number of infections and the complications, those from both long COVID and post-COVID complications and hospitalisations. We'd like a little bit of granularity around this in terms of the high-risk populations—the elderly, First Nations, minority groups and patients with disability—and we would also like to know what comorbid conditions they have that may be predisposing them to COVID.

Vaccination history is a really important variable to collect. We know that vaccination actually reduces your risk of long COVID, and so it's incredibly important that Australians do not become complacent about their vaccination status. Many of us will now be on to our fourth or fifth dose of vaccine. This is going to become an annual thing. COVID is not going anywhere. It started off as a pandemic, and it will now become endemic. This is a rapidly mutating virus that is rapidly changing and pulling away from vaccine efficacy. However, the vaccines still do have some efficacy. They're just not as good as they used to be. The primary goal of now getting vaccinated is to reduce your risk of long COVID. It is like a game of Russian roulette. If you get this virus, you may be the one who ends up with long COVID, and, if you're a young person, you do not want that. It could really hamper your productivity.

We have also suggested that we'll explore the use of innovative tools, such as artificial intelligence, to help scrape medical records, particularly electronic medical records, in order to identify those patients who may be developing symptoms but have not yet been flagged as actually having long COVID or, indeed, some of those post-COVID complications. We suggested that the health department use the World Health Organization definition of long COVID, which is, essentially, persistent symptoms up to three months after the primary illness, and there is a desperate need for evidence based living guidelines. This field is rapidly evolving. We cannot have guidelines that are set in stone. They must be continuously updated in order to keep up with the research. The second thing that's important is that guidelines alone are not enough. They must actually be implemented so that the GP in Cloncurry or in the Torres Strait can immediately jump online and find out what that GP needs in order to treat the patient sitting in front of them. That requires an investment in implementation science, which is something that I am passionate about.

One of the recommendations that I'm perhaps most proud of is the need for better indoor air quality standards. This is an area that I have been championing since coming to parliament. I'm pleased to say that I chaired the Clean Air Forum, which brought together a multidisciplinary group of experts from the built environment industry, aerosol science and people with lived experience to basically deal with this vexed problem of indoor air quality standards. This is not going to be our last pandemic. There will be another one. And we certainly do not want to go through what we have just come from. It's really, really important now to understand that 90 per cent of our time as a species is actually spent indoors. We evolved from roaming the plains of Africa to now spending most of our time indoors, so we need better indoor air quality standards in order to mitigate the response going forward. There's a lot of work to do, but we are committed to delivering on this.

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