COVID-19: impacts on health and the Australian health system

Rebecca Storen, Social Policy

Key issue

The COVID-19 pandemic continues to have direct and indirect health impacts for people, as well as the health system (and its workforce). More than 2 years into the pandemic, Australia has high levels of vaccination among the population but continues to see significant numbers of cases and deaths. Attention is also turning to the longer-term impacts of COVID-19, as evidence emerges that anywhere from 10% of people who have had SARS-CoV-2 infection may experience ‘long COVID’ (post COVID-19 condition) in the weeks to years following acute infection.

A snapshot in time

As at 27 June 2022, Australia had:

Info graphic - An estimated 259597 active SARS-CoV-2 cases. 8612 SASRS-CoV-2 related deaths. 2570 people in hospital. An estimated 7341978 SARS-CoV-2 cases to date. 20071312 people had recieved at least one COVID-19 vaccine dose. 13717904 people had received 3+ COVID-19 vaccine doses.

Source: Department of Health, Coronavirus (COVID-19) case numbers and statistics and COVID-19 vaccine rollout update – 26 June 2022, 27 June 2022.

More than 2 years into the COVID-19 pandemic, the number of SARS-CoV-2 infections (the virus that causes COVID-19) continues to climb, with 2022 already seeing the highest number of COVID-19 related deaths in Australia. A range of measures have been introduced by the Australian, state and territory governments to try and minimise transmission, ration health services and equipment and to save lives. This article focuses on a select few areas including hospital funding, Medicare and vaccines. Some of the direct and indirect health implications of COVID-19 are briefly considered, with an emphasis on the newly classified ‘post COVID-19 condition’ (also known as long COVID) and the suggested impacts of this condition. This article does not address mental health or the health workforce, but these topics are discussed elsewhere in the Briefing book.

Cases and deaths

Australia reported its first cases of COVID-19 on 25 January 2020, its first death on 1 March 2020 and the first recorded case of community transmission was reported the following day. Figure 1 provides the number of cases and deaths reported daily between January 2020 and June 2022.

Figure 1 Daily Coronavirus cases and deaths in Australia

Note: the chart provides the daily numbers by date they were reported to the World Health Organization (WHO). As such, some of the large spikes in the dataset are artificial and due to reporting patterns rather than exact cases identified on any one day.

Source: World Health Organization (WHO), ‘Daily cases and deaths ’, COVID-19 Dashboard (Geneva: WHO, 2 June 2022).

As discussed in the 'Australia in numbers' Briefing book article, recent estimates from the Department of Health suggest COVID-19 may become a leading cause of death in Australia in 2022.

Cases and deaths in residential aged care and NDIS services

As at 24 June 2022, there have been 2,562 COVID-19 outbreaks in residential aged care (an outbreak is defined as one or more positive residents, or 2 or more positive staff cases). There have been:

almost 57,000 resident cases
more than 2,800 deaths (the majority occurring in 2022)
more than 43,000 staff cases (p. 1).

As at 24 June 2022, of people receiving aged care services in their home 205 have tested positive to COVID-19 and 13 have died.

As at 23 June 2022, for the National Disability Insurance Scheme (NDIS), as reported to the NDIS Commission and the National Disability Insurance Agency, there have been:

over 23,600 cases among NDIS participants (active and recovered)
79 deaths of NDIS participants
more than 32,000 staff cases across NDIS services (active and recovered).

Health system

Hospitals and the National partnership on COVID-19 response

The National Health Reform Agreement (NHRA) sets out high-level health system responsibilities and reform objectives, and is the mechanism through which the Australian Government funds public hospital services. In May 2020, the Australian, state and territory governments entered into a new agreement through an addendum to the NHRA (2020–2025). Under the new agreement, ‘the Morrison Government has provided a funding guarantee to all states and territories to ensure no jurisdiction is left worse off as a result of the COVID-19 pandemic’.

On 6 March 2020 the Prime Minister announced the National partnership on COVID-19 response (National Partnership), between the Australian and state and territory governments. Under this agreement, from 21 January 2020, the federal government pays 50% of costs incurred by state and territory health systems for the diagnosis and treatment of people with, or suspected of having, COVID-19, and activities to prevent the virus from spreading. The National Partnership is in place ‘for the period of the activation of the Australian Health Sector Emergency Response Plan for Novel Coronavirus 2019 (COVID-19 plan) as declared by the Australian Health Protection Principal Committee (AHPPC), and then for sufficient additional time to allow for the final reconciliation of any payments made under the Agreement’ unless terminated or extended as agreed by all parties (Clauses 10 and 11). The 2022–23 Budget extends funding for the National Partnership until 30 September 2022 (p. 2).

The National Partnership also provides for states and territories to enter into agreements with private hospitals to ensure the public system has sufficient hospital services capacity, the cost of which will be equally shared between the Australian and relevant state or territory government. The Australian Government will also contribute 100% of funding to the states to guarantee the financial viability of private hospitals (Schedule B).

Primary care

Early in the COVID-19 pandemic a series of measures were announced for primary health care to diagnose and manage potential and confirmed SARS-CoV-2 cases, and to minimise transmission. These measures also covered the provision of care and support for people’s ongoing health needs (for example, prenatal care and managing chronic disease).

Temporary Medicare Benefit Schedule (MBS) items

A key introduced measure has been temporary MBS items for telehealth (video and/or telephone) consultations, with some of these items subsequently transitioned to permanent arrangements from January 2022. The Australian Institute of Health and Welfare (AIHW) provides a summary of the COVID-19 temporary MBS services and benefits processed quarterly (Figure 2). Between 1 April 2020 and 30 September 2021 there were 302,125,508 services processed and approximately $16.6 billion in benefits paid for COVID-19 related MBS items.

Figure 2 Medicare services and benefits processed for COVID-19 related MBS items by quarter

Graph - Medicare services and benefits for COVID-19 related items by quarter.
Source: Australian Institute of Health and Welfare (AIHW), Impacts of COVID-19 on Medicare Benefits Scheme [sic] and Pharmaceutical Benefits Scheme: Quarterly Data – Impact on MBS Service Utilisation (Canberra: AIHW, 18 February 2022).

The Australian National Audit Office (ANAO) is currently undertaking a performance audit of the Department of Health’s management of the expansion of telehealth services in response to COVID-19. Its report is due in December 2022.

Schedule A of the National Partnership states that the Australian Government, under a separate agreement, is responsible for 100% of funding for private pathology testing for COVID-19 (p.15). In addition, the Australian Government agreed to supplement 50% of the costs of COVID-19 testing undertaken at public health testing facilities (p. 22). In the 2022–23 Budget, the Government announced it would extend SARS-CoV-2 pathology MBS items until 30 September 2022 (p.89). It is currently unclear what funding arrangements will be in place from 1 October 2022 onwards.

Medicines

In response to the COVID-19 pandemic, the Australian Government, in conjunction with state and territory governments, implemented several changes to medicines regulation, including:

extending and expanding the continued dispensing arrangements, allowing an approved pharmacist to supply an eligible medicine where the person has immediate need and it is not practicable to obtain a Pharmaceutical Benefits Scheme prescription
enabling pharmacists to substitute some medicines in short supply without prior approval from the prescriber if the specified medicine is unavailable
limiting sales and dispensing of some medicines
enabling image-based prescriptions, allowing a prescriber to create a digital image of a paper prescription following a Medicare-subsidised telehealth consultation.

In addition, electronic prescriptions became more widely available from mid-2020 following legislative changes and technical upgrades.

Vaccinations

Evaluation and regulation

The Therapeutic Goods Administration (TGA) is responsible for evaluating and regulating therapeutic goods (which includes vaccines) to ensure they are high quality, safe to use and work as intended. The TGA has several options available to fast-track the approval of therapeutic goods to enable faster access. One of these is the provisional approval pathway, which grants temporary registration where the need for early access outweighs risks. This process has been used for COVID-19 vaccines. Figure 3 provides an overview of the COVID-19 vaccines that have provisional registration (as at May 2022).

Figure 3 COVID-19 vaccines with provisional registration in Australia

Effective date	Sponsor	Name	Type
a. 19 January 2022 b. 09 June 2022	a. Biocelect Pty Ltd on behalf of Novavax Inc b. Booster dose for individuals aged 18 years and over	NUVAXOVID (NVX-CoV2373) For individuals aged 18 years and over	Protein vaccine
a. 9 August 2021 b. 3 September 2021 c. 7 December 2021 d. 17 February 2022	Moderna Australia Pty Ltd	SPIKEVAX (elasomeran) a. For individuals aged 18 years and over b. For individuals aged 12 years and over c. Booster dose for individuals aged 18 years and over d. For individuals aged 6 years and over	mRNA
25 June 2021	Janssen-Cilag Pty Ltd	COVID-19 Vaccine Janssen For individuals aged 18 years and over	Viral vector
a. 15 February 2021 b. 8 February 2022	AstraZeneca Pty Ltd	VAXZEVRIA (previously COVID-19 Vaccine AstraZeneca) a. For individuals aged 18 years and over b. Booster dose for individuals aged 18 years and over	Viral vector
a. 25 January 2021 b. 22 July 2021 c. 26 October 2021 d. 3 December 2021 e. 27 January 2022 f. 7 April 2022	Pfizer Australia Pty Ltd	COMIRNATY (tozinameran) a. For individuals aged 16 years and over b. For individuals aged 12 years and over c. Booster dose for individuals aged 18 years and over d. For individuals aged 5 years and over e. Booster dose for individuals aged 16-17 years old f. Booster dose for individuals aged 12-15 years old	mRNA

Source: Therapeutic Goods Administration (TGA), COVID-19 vaccine: provisional registrations (Canberra: TGA, 2 May 2022).

COVID-19 vaccine program

The Australian Government has entered into supply agreements for several COVID-19 vaccines. On 7 September 2020, the Government announced it had signed the first agreement with AstraZeneca for production and supply of its University of Oxford COVID-19 vaccine, if the trials proved successful. This was followed by agreements with Novavax and Pfizer in 2020 and Moderna in 2021.

Due to commercial sensitivities, information on the full financial implications of the COVID-19 vaccine program is limited. However, according to Government estimates at the time of the 2022–23 Budget, total expenditure on the vaccine program (including rollout) has been more than $17 billion (p. 164).

The National Partnership sets out the Australian Government’s commitment, with the state and territory governments, to support the COVID-19 vaccine rollout including:

an upfront payment of $100 million, shared across jurisdictions based on population
a 50% contribution to the agreed price per vaccination dose delivered by the states
from 21 April 2021, a 50% contribution to additional costs incurred by states to set up additional COVID-19 vaccination sites (Schedule C).

The ANAO is undertaking a performance audit of the planning and implementation of the COVID-19 vaccine rollout. The report is due to be tabled in July 2022.

Health implications of the COVID-19 pandemic

Elective surgeries

In an effort to ration health resources, on 25 March 2020 the National Cabinet announced all non-urgent elective surgeries in the public and private system would be suspended. Since then, various jurisdictions have implemented restrictions on elective surgeries in response to subsequent outbreaks (for example, in Greater Sydney in July 2021 and in parts of Victoria in January 2022).

It is difficult to measure the full impact of the COVID-19 related delays to surgery, especially given delays in public specialist appointments and access to surgery were already issues of concern prior to the pandemic. However, what is known is that delays to clinically necessary surgery have social and financial cost implications. Delayed surgery affects people’s quality of life and may result in reduced or no capacity to work and reliance on medication to manage pain and other symptoms, which in turn can lead to poorer health outcomes and financial stress (p.13).

According to the AIHW, the proportion of people waiting more than one year for elective surgery increased from 2.8% in 2019–20 to 7.6% in 2020–21. The median waiting time for admission for elective surgery also rose from within 39 days in 2019–20 to 48 days in 2020–21 – this was higher for Aboriginal and Torres Strait Islander peoples, at 57 days.

Long COVID (post COVID-19 condition)

Clinical case definition and standardised data collection

In September 2020, the WHO created International Classification of Diseases (ICD) codes for post COVID-19 condition. The ICD is the international system for classifying diseases, injuries, symptoms, procedures and cause of death, and enables comparable morbidity and mortality statistics. This coding enables Australia and the international community to collect and compare data on people who have a history of SARS-CoV-2 infection, which is particularly important as the long-term health implications of an infection and the disease associated with it (that is, COVID-19) is currently poorly understood.

Early in the pandemic it became apparent that some people who had, or were suspected of having had, a SARS-CoV-2 infection were experiencing symptoms weeks after the infection that could not be explained by an alternative diagnosis. Different terms have been proposed to describe this condition, including long COVID. To standardise clinical case definitions and nomenclature to better support clinical care, epidemiological reporting, research and policy making, the WHO undertook work to define a clinical case definition of ‘post-COVID-19 condition’, through a Delphi process (which identifies a consensus view from an expert group). The description of post COVID-19 condition is a condition that:

… occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction but also others and generally have an impact on everyday functioning. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time.

More than 200 symptoms have been reported for post COVID-19 condition. Figure 4 provides a snapshot of common symptoms.

Figure 4 Common symptoms of post COVID-19 condition

Source: Researching COVID to Enhance Recovery (RECOVER), What is long COVID?, (US, RECOVER, 2022).

Incidence and prevalence of post COVID-19 condition

The incidence of post COVID-19 condition is unclear, but research to date suggests that the long-term impacts and burden of symptoms may be high.

One of the few studies currently available that has measured the health outcomes for people 2 years after hospitalisation from acute infection, shows:

people experiencing at least one post COVID-19 symptom decreased from 68% at 6 months to 55% at 2 years, with fatigue or muscle weakness the most commonly reported symptoms
most people (89%) improved enough to return to their original work within the 2-year period
participants reported decreases in anxiety or depression over time from 23% at 6 months to 12% at 2 years
participants still had more symptoms and lower health-related quality of life at 2 years than the control group.

Other research on post COVID-19 condition indicates that there is a difference between the experience of people who have had severe COVID-19 (and been hospitalised) and those who have had less severe symptoms. Estimates have suggested that 10–35% of people who did not require hospitalisation may experience at least one long COVID symptom, while for people who were admitted to hospital, this may be as high as 85%.

The Office for National Statistics in the UK provides regular population estimates of prevalence of ongoing symptoms following infection based on self-reported symptoms and activity limitations. Key points from the 1 June 2022 report include:

an estimated 2 million people (over 3% of the population) living in private households experienced long COVID as of 1 May 2022
71% of these people (approximately 1.4 million) reported symptoms that adversely affected their day-to-day activities and 20% (approximately 400,000 people) reported that their ability to undertake day-to-day activities was ‘limited a lot’
fatigue was the most common symptom reported, (55% of people), followed by shortness of breath, a cough and muscle aches
the prevalence of self-reported symptoms was highest for:

people aged 35–69 years
females
people living in ‘more deprived’ areas (as measured by indices of deprivation, which has 7 domains including income, employment and crime)
people working in social care (such as aged care), teaching and education, and health care
people with another activity-limiting health condition or disability.

Association with COVID-19 vaccines

Research is emerging on the association between long COVID symptoms and COVID-19 vaccines, although uncertainties remain.

Research suggests that adults who were vaccinated before they had a SARS-CoV-2 infection were less likely to develop long COVID symptoms, measured at 4 weeks to 6 months post-infection. One study found that fully vaccinated people were 50% less likely to experience long COVID symptoms 28 days or more after infection. Other studies have suggested that the protection from long COVID symptoms offered by vaccines may be lower, with results indicating that vaccination may reduce the likelihood of long COVID by approximately 15%.

There is also mixed evidence that suggests unvaccinated people with long COVID who were subsequently vaccinated may experience fewer long COVID symptoms than people who remained unvaccinated (p. 14). This is supported by a more recent UK study of more than 28,000 participants, which found that vaccination after SARS-CoV-2 infection appeared to be associated with reduced symptoms of long COVID for at least a few months following vaccination. The authors note the need for long-term follow up, especially in relation to the Omicron variant of the virus.

Future considerations

Domestic and international attention is turning to the lessons from COVID-19 and future pandemic prevention and preparedness. This work considers issues such as supporting prevention activities, the importance of early warning systems and the need for up-to-date systems that enable robust data collection and use as well as the importance of data sharing. In Australia, the Australian Labor Party has committed to establishing a Centre for Disease Control, which would be responsible for leading the federal response to future communicable disease outbreaks. Evaluating Australia’s prevention and preparedness for future health emergencies may include a focus on institutional and legal arrangements to enhance ways to minimise the health, social and economic impacts of a future outbreaks and may include reviewing the emergency powers under the Biosecurity Act 2015 and National Cabinet arrangements.

The ongoing pandemic continues to present challenges for the Australian health system and the health workforce (also see the article in this Briefing book on Health workforce), with most temporary response measures due to expire in coming months. Long COVID clinics are opening around Australia seeking to address the chronic health issues that are likely to emerge, especially as cumulative case numbers continue to rise. In response to long COVID and the potential persistent and long-term health outcomes people experience, some countries have started to consider classifying long COVID as a disability (for example, see information from the US). The long-term impacts of SARS-CoV-2 infection and the COVID-19 pandemic on people and the Australian community are unknown but evidence suggests that for some people, post COVID-19 condition may continue to impact their quality of life for years to come.

Further reading

Emma Vines, COVID-19 Vaccines: a Quick Guide, Research paper series, 2021–22, (Canberra: Parliamentary Library, 2021).
Parliamentary Library’s COVID-19 publications.
Parliamentary Library, Pandemics and Attempts to Reform the WHO, FlagPost (blog), (Parliamentary Library, 19 May 2022).
Australian Institute of Health and Welfare COVID-19 publications and data.

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