Report – House of Representatives Standing Committee on Health, Aged Care and Sport, 19 April 2023
Report of the Inquiry into Long COVID and Repeated COVID Infections
Following a referral in September 2022 from the Federal Health and Aged Care Minister, Mark Butler, the House Standing Committee on Health, Aged Care and Sport inquired into and reported on long COVID and repeated COVID infections.
Following their inquiry, the Committee makes nine recommendations aimed at strengthening the Australian government’s management of long COVID, including regarding:
A definition of long COVID for use in Australia
Evidence-based living guidelines for long COVID, co-designed with patients with lived experience
A nationally coordinated research program for long COVID and COVID-19
7.1 The Committee recommends that the Australian Government establishes and funds a single COVID-19 database to be administered by the soon-to-be developed Centre for Disease Control to capture data on:
COVID-19 infections, complications, hospitalisations, and deaths as well as recurrent COVID infections
This should incorporate COVID-19 infections in high-risk populations including: hospital-acquired infections (distinguishing this from community acquisition if possible), infections in aged care and other institutions, and infections in Aboriginal and Torres Strait Islander peoples and the immunosuppressed
This should also include the collection of data regarding select comorbid conditions and ancestry to identify infections in Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse communities and the immunosuppressed
Long COVID diagnoses including post COVID complications
COVID-19 vaccination rates, vaccination side effects and post vaccination deaths
7.2 The Committee additionally recommends that the Australian Government explore the use of innovative tools (e.g. artificial intelligence and self-managed care platforms) and data linkage within and between states and territories, to collect this data.
7.3 The Committee recommends that at the present time the World Health Organization definition of long COVID be used clinically, but that the Australian Government Department of Health and Aged Care work with the states and territories to review this definition as more research and information becomes available.
7.4 The Committee additionally recommends developing evidence-based living guidelines for diagnosis and treatment incorporating tiered care including referral pathways, co-designed with patients with lived experience.
7.5 The Committee recommends that the Australian Government establish a nationally coordinated research program, led by the Department of Health and Aged Care (preferably the Centre for Disease Control), to coordinate and fund COVID-19 and longCOVID research.
7.6 This funding should be longer term and be nationally coordinated. The funding should aim to better integrate research by fostering greater collaboration rather than fragmentation.
7.7 The Committee also recommends that this research have adequate representation from Aboriginal and Torres Strait Islander peoples and the culturally and linguistically diverse population and be adequately funded to achieve these aims. Other vulnerable groups including the elderly, children, people with disability and the immunosuppressed should be represented.
7.8 Research programs should span basic science, clinical trials, models of care, health promotion and implementation science.
7.9 The Committee recommends that the Department of Health and Aged Care updates, focusses, and improves its COVID-19 vaccination communication strategy including by:
Emphasising the benefit of COVID-19 vaccines in both reducing transmission and illness severity for acute COVID-19 infections and reducing the risk of developing long COVID
Encouraging greater COVID-19 vaccination across the Australian population especially among children, young people and people of working age
Encouraging immunisation in high-risk groups in particular as the virus becomes endemic
Working with the states and territories to develop this health promotion program.
7.10 The Committee recommends that the Pharmaceutical Benefits Advisory Committee regularly review the benefits of antiviral treatments for COVID-19 in accordance with emerging research with a view to expanding the list of groups eligible to access these treatments through the Pharmaceutical Benefits Scheme (PBS).
7.11 The Committee also recommends that antiviral treatments for COVID-19 be approached as a pharmacist-initiated medication to participants eligible under the PBS.
7.12 The Committee additionally recommends that the Australian Government review its framework for access to antiviral treatments for COVID-19 to include non-mortality and non-hospitalisation outcomes such as productivity gains, time to illness resolution, return to work and number of health encounters.
7.13 The aim of the Committee is to ensure people get the support they need, most of which will occur via the primary care network. Accordingly, the Committee makes the following recommendations regarding management:
Support and education should be provided to general practitioners (GPs) as well as other primary healthcare providers to diagnose long COVID and to help manage those suffering from it. Education for GPs should be coordinated and eligible for Continuing Professional Development (CPD). The Medicare Benefits Schedule (MBS) chronic disease management item number should be reviewed
Clinical care should be linked to nationally coordinated research and data collection
Funding be provided in partnership with state health departments for selected public hospitals to develop multidisciplinary long COVID clinics linked to nationally consistent referral guidelines for screening patients with challenging long COVID complications
Mental health support for those with long COVID must be provided in an affordable, timely and equitable manner, and regular review of mental health issues should be part of GP management noting that the extent of related mental health impacts is still unknown
Telehealth and digital health resources be leveraged to make self-management and access to primary care easier
Funding be provided so that outreach long COVID clinics can be developed for rural and regional areas, accessible either face to face or via telehealth, as a GP resource.
7.14 The Committee recommends the Australian Government establish and fund a multidisciplinary advisory body including ventilation experts, architects, aerosol scientists, industry, building code regulators and public health experts to:
Oversee an assessment of the impact of poor indoor air quality and ventilation on the economy with particular consideration given to high-risk settings such as hospitals, aged care facilities, childcare and educational settings
Lead the development of national indoor air quality standards for use in Australia.
7.15 The Committee recommends funding be made available for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) research and patient support and that this funding should be allocated in consultation with peak bodies for ME/CFS and with note of the recommendations of the ME/CFS Advisory Committee’s 2019 report to the National Health and Medical Research Council.
7.16 The Committee recommends, given the multiple questions that have arisen during our Inquiry, that the Australian Government con ider a comprehensive summit into the COVID-19 pandemic and Australia’s past and current response, including by governments at all levels, with particular consideration to the role of the future Centre for Disease Control.
Media release – Therapeutic Goods Administration (TGA), 3 May 2022
Removal of prescribing restrictions on ivermectin
From 1 June 2023, prescribing of oral ivermectin for ‘off-label’ uses will no longer be limited to specialists such as dermatologists, gastroenterologists and infectious diseases specialists.
In its final decision published today, the Therapeutic Goods Administration (TGA) has removed the restriction through its scheduling in the Poisons Standard because there is sufficient evidence that the safety risks to individuals and public health is low when prescribed by a general practitioner in the current health climate.
This considers the evidence and awareness of medical practitioners about the risks and benefits of ivermectin, and the low potential for any shortages of ivermectin for its approved uses. Also, given the high rates of vaccination and hybrid immunity against COVID-19 in Australia, use of ivermectin by some individuals is unlikely to now compromise public health.
However, the TGA does not endorse off-label prescribing of ivermectin for the treatment or prevention of COVID-19.
A large number of clinical studies have demonstrated ivermectin does not improve outcomes in patients with COVID-19. The National Covid Evidence Taskforce (NCET) and many similar bodies around the world, including the World Health Organization, strongly advises against the use of ivermectin for the prevention or treatment of COVID-19.
Ivermectin for oral use is a Prescription Only (Schedule 4) medicine in the Poisons Standard. It is only approved by the TGA for the treatment of river blindness (onchocerciasis), threadworm of the intestines (intestinal strongyloidiasis), and scabies.
The restriction on ivermectin was introduced in September 2021 because of concerns about the safety of consumers using ivermectin without health advice to treat COVID-19, widespread use of ivermectin instead of approved vaccines and treatments for COVID-19, and potential shortages of the medicine for approved uses.
The final decision follows an application to remove the restrictions and has been made according to the process required under the Therapeutic Goods Act 1989. It takes into account advice from the independent Advisory Committee on Medicines Scheduling (ACMS) and two rounds of public consultation.
