The failure of government agencies to examine the potential impacts of Long Covid makes it impossible to make informed decisions on public health policy, Marc Daalder writes
Comment: Long Covid is shaping up to be the defining health legacy of the pandemic.
After milder variants (not guaranteed) or new sterilising vaccines (still in development) or infection-induced herd immunity (years away if ever) reduce the threat of acute infections, we’ll still be left with tens of millions of people worldwide who were disabled by the virus.
Even the impacts now, just three years into the pandemic, are gargantuan.
In Australia, experts estimated an annual cost to the economy of close to AU$5 billion, based on 31,000 people with Long Covid calling off sick from work each day in June.
In the United Kingdom, one in every 30 people reported Long Covid symptoms in November. Three-quarters of them say the illness has adversely affected their daily lives. Half a million Brits have left the workforce for long-term illness since 2019 – a massive 25 percent increase.
In the United States, 24 million people have Long Covid and just under 20 million of them have trouble carrying out regular activities. Of them, four million are out of work, costing the economy at least US$170 billion in lost wages, let alone healthcare and benefit costs.
Growing numbers of long Covid cases in UK
What about New Zealand?
We know very little about the impact of Long Covid in New Zealand, largely because no one is looking into it.
Official Information Act requests to the Treasury, the Department of Prime Minister and Cabinet, the Ministry for Social Development and the Ministry of Business, Innovation and Employment on work done to discern the potential impacts of the illness all came up blank. More specific requests to the health and education ministries seeking any information about the impact of Long Covid on the health and education workforces, also returned nothing.
Astoundingly, while the rest of the world has woken up to this pandemic legacy, New Zealand is still flying blind.
This is an abdication of the basic duty of the public service to prepare New Zealand for future challenges and to contribute to informed decision-making by ministers. It both leaves the country vulnerable to a future wave of disability and workforce shortages and means Covid-19 policy-making lacks crucial considerations about the impact of virus spread.
As one of the few journalists still writing about Covid-19 in New Zealand, I regularly receive emails from our essential workers - nurses, teachers and other professions we celebrated during lockdown - who are out of work due to Long Covid.
Here's an excerpt of one of them, from a primary school teacher who caught Covid-19 in April and who still hadn't recovered when he contacted me in September.
"I have had more time off work this year than I have had altogether in my working life. The second [doctor] commented that I had been to see a [doctor] twice in the past five years, until this year. I wake up every day feeling like I have been poisoned," he wrote.
"This week I feel like I have totally relapsed and I feel like I am recovering from Covid again. There appears to be no support. I am working with the goodwill of my principal but I am fast running out of sick days, I’ve had close to seven weeks off work this year, I would usually average one or two days a year. I love my job and want to keep working but if I keep relapsing I may not be able to and I’m now worried that I will have a heart attack or stroke while in class. I also have two young children who I am having to have less time with as most weekends I’m bed-bound."
These are serious personal impacts, overshadowed by media commentators and even government ministers who promise most patients a mild bout of illness.
They also point to a larger issue. At a time of record labour workforce tightness, shouldn't we be investigating the contribution of a new wave of disability to these shortages?
If workers like nurses and teachers are expected to be exposed to Covid-19 regularly, we should also expect some of them to come down with Long Covid. Why aren't ministries planning for this?
More broadly, Long Covid is poised to place significant demand on the welfare and healthcare system through increased demand, on the economy through lost wages and labour shortages and on society through the sudden spike of disability. Responsible agencies would be preparing to manage these impacts, not plunging their heads in the sand and pretending they don't exist.
The lack of work to understand the extent of Long Covid in New Zealand has another knock-on effect on public health decision-making too. I've read through dozens of public health assessments of the necessity, efficacy and justification for a range of health protections, from mask mandates to isolation periods to vaccination. Almost none of these ever mention Long Covid.
How can ministers make an informed decision when the Treasury is advising them of the economic benefits of slashing isolation periods while providing no information on the costs to the economy of further Covid-19 infections and Long Covid cases?
Fortunately, this latter trend may be starting to change. For the first time ever, I stumbled across a reference to Long Covid in a Covid-19 policy document this week.
In October, public health officials advised Cabinet to retain existing isolation and mask settings (which they did) because the virus "continues to pose a substantial public health risk, which is different from other respiratory and communicable diseases".
One example of that difference, beyond higher hospitalisation and death rates, was "Post-infection sequelae: This includes Long Covid, and increased risk factors for a range of other conditions (for example, cardiovascular disease, neurologic and psychiatric disorders, changes in brain structure, and diabetes). The data on Long Covid is developing but there are still many unknowns and we need to continue to monitor the risk."
Later in the same briefing, officials said masks in healthcare settings were needed to prevent hospital-acquired Covid-19.
"There is still significant value in trying to prevent infections where possible, as each new infection (or reinfection) effectively ‘rolls the dice’ for one or more post-acute sequelae that are known to occur such as Long Covid, and increased risk of long-term (up to one year) cardiovascular complications compared to individuals without Covid-19. Long Covid and other post-acute sequelae have personal costs, but also broader impacts on society, in terms of outcomes such as increased disability, increased welfare and health costs, and reduced workforce participation."
The only citation on the final claim was the United Kingdom's survey of Long Covid, highlighting the gap on New Zealand-specific analysis and data.
Officials finally recommended that a proposed work programme on reducing the adverse impacts of Covid-19 on vulnerable communities like Māori, Pasifika and disabled people "also encompass the effects of Long Covid".
That's a crucial step, but only a small one. Long Covid will have effects beyond individual health and needs a multi-agency approach.
The Government spent most of 2020 and 2021 saying the best economic response is a good health response. It's been a while since we heard that refrain, but it's still true.
As long as Long Covid is excluded from consideration, the Covid-19 programme will be both a poor economic and health response.