Why governments will have to consider the costs of long COVID when easing pandemic restrictions


Richard Meade, Auckland University of TechnologyWith governments worldwide under pressure to ease pandemic restrictions as vaccination rates rise and impatience with border restrictions grows, new threats become clearer.

One of the costliest, it is now feared, could be a tsunami of “long COVID” cases.

Long COVID is a serious ongoing illness that follows an acute episode of the disease. It is characterised by extreme fatigue, muscle weakness, post-exertional malaise and an inability to concentrate (“brain fog”), among many other symptoms.

The focus, therefore, needs to shift towards protecting quality of life as much as saving lives in the first place.

In the UK it is reported two million people have experienced long COVID. Around 385,000 having suffered symptoms for a year or more.

The nation’s so-called “Freedom Day” on July 19 went ahead despite expert warnings of soaring infections, especially among younger and unvaccinated people. A further 500,000 long COVID cases have been predicted during the current wave of infection.

These numbers far outstrip the already staggering 150,000 deaths attributed to the virus in the UK — and the associated costs will be significant.

Putting a price on long COVID

The social costs of long COVID should not be underestimated. For example, suppose an elderly person contracts COVID-19 and dies, when they might otherwise have lived in full health another five years. A health economist would say their early death has cost society five “quality-adjusted life years” (QALYs).

This is usually expressed as a monetary amount that can then be weighed against the cost of saving that person’s life when deciding on appropriate pandemic protections.

Contrast this with a young person contracting COVID-19 and not dying, but suffering long COVID for 10 years, with their estimated quality of life effectively halved while unwell.

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They too will have lost an estimated five QALYs — the same social cost as the elderly person who died.

This means if we ease pandemic restrictions on the basis that people are no longer dying, we might be facing equally serious social costs from long COVID.

If long COVID is chronic and much more common than death from COVID (as the current data strongly suggest), the costs rise further. If sufferers of long COVID also face shortened lives, having endured years of debilitation and misery, the costs rise again.

Rough first estimates suggest the overall economic cost of long COVID could be almost half the cost of COVID-related deaths in the UK.

For younger people, however, the social costs of long COVID are estimated to far outstrip those of dying, meaning they will carry a disproportionate burden of the pandemic’s long-term costs.

Comparison with chronic fatigue syndrome

Long COVID is often likened to chronic fatigue syndrome (CFS), which is sometimes called ME (for myalgic encephalomyelitis). Both are characterised as a form of “post-viral fatigue syndrome”, with CFS leaving sufferers seriously debilitated and unable to maintain normal lives — often for years, even decades.

While we have no long-term data to gauge how chronic or serious long COVID might be, we should be mindful that it could be as long-lived as CFS.

Furthermore, long COVID is also reported to affect multiple organs in measurable ways, including damage to major organs like the heart and lungs.

Consequently, long COVID could shorten lives, if not end them. This distinguishes it from CFS which – frustratingly, for sufferers wanting to be taken seriously – lacks recognised objective markers.

Read more:
The mystery of ‘long COVID’: up to 1 in 3 people who catch the virus suffer for months. Here’s what we know so far

Protecting quality of life

On a personal note, I suffered CFS for 11 years and recovered in 2004. It emerged after a flu-like illness in 1993, which evolved into a constellation of symptoms that defied explanation or treatment.

Recovery required years off work and, with the care and support of family and friends, patient and determined rebuilding of my ability to lead a normal life.

The condition involved huge personal, social and professional costs. I was unable to maintain a normal life, relationships and work commitments. Constant ill health, with no end in sight, was enormously frustrating and miserable.

Read more:
I went from regular TV commentator on COVID to long COVID sufferer in just a few months

It never helped that medical practitioners were either incredulous or believed I was unwell but had no real solutions to offer.

Like CFS, long COVID is a serious condition that cannot be taken lightly. Even if not fatal, it can still seriously affect the sufferer’s quality of life. Hence, policymakers need to consider the social costs of long COVID when deciding when and how to ease pandemic restrictions.

Our pandemic response will need to be as much about protecting quality of life as it has been about saving lives. We need to take serious steps to keep long COVID at bay.The Conversation

Richard Meade, Research Fellow in Economics, and in Social Sciences & Public Policy, Auckland University of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Vital Signs: rules are also signals, which is why easing social distancing is such a problem

Richard Holden, UNSW

Australia’s states and territories have begun relaxing the restrictions put in place to contain COVID-19.

From today, for instance, the most populous state, New South Wales, is allowing outdoor gatherings of ten people, the use of public pools and playground equipment, and home gatherings with up five visitors. Restaurants and cafes can also serve up to ten diners, so long as they follow the “four square metres rule” (meaning a premises will need a dining area of 40 square metres to seat ten patrons).

Many will welcome these developments. But they represent a difficult choice for governments.

Read more:
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Allowing the public greater freedoms will help boost both morale and economic activity. But it risks a second-wave outbreak of COVID-19 and a return to more stringent restrictions.

Easing off on social distancing rules while keeping COVID-19 under control with good but imperfect testing and contact tracing is a tough balancing act.

It’s made even tougher by the fact government rules do more than simply define what is permissible.

The rules also send a message to the public about the information authorities have, influencing personal perceptions and therefore behaviour, regardless of whether it is permitted.

Hearing the wrong story

So governments need to take into account not just the direct effect of rules but, crucially, the broader message absorbed by the public.

There’s a risk people will hear only part of the story, interpreting the easing of restrictions as a sign we’ve beaten the virus and are on our way back to normal.

This, in part, explains why New South Wales Premier Gladys Berejiklian urged continued vigilance when she announced relaxing of restrictions on May 10. “Just because we’re easing restrictions doesn’t mean the virus is less deadly or less of a threat,” she said. “All it means is we have done well to date.”

An extra layer of complexity

Trying to ensure the public doesn’t misinterpret government messages makes decisions on when and how to ease restrictions particularly complex.

The key risk, of course, is that people infer from relaxed restrictions that the government now thinks risks are minimal and everyone can go back to life as it was in January 2020.

This signalling effect means governments need to be more cautious about relaxing restrictions.

On the other hand, the longer they seek to impose rules, particularly if other jurisdictions are easing restrictions, the more they risk losing their authority.

This conundrum can be seen in Australia’s second-most-populous state, Victoria. It has regularly imposed rules going further than those recommended by the federal government.

ABC Q&A host Hamish MacDonald captured this nicely when he asked Victorian Premier Daniel Andrews this week:

Dan Andrews, you would have seen all of the images of people out in Victoria over the weekend, clearly going beyond what was formally allowed in terms of social distancing. Have some Victorians, do you think, seen this federal three-step plan, observed that you’re going to take somewhat longer to deliver on some of the steps, and just taken matters into their own hands?

It doesn’t help that the Victorian and federal governments differ despite both apparently acting on the advice of public health experts.

“Follow the medical advice” has been a powerful aphorism, but it is likely to weaken the further the response to COVID-19 moves from the “hammer” phase – using strict social distancing measures – to the “dance” phase – using more targeted measures such as contact tracing to contain the spread of the virus until there’s a vaccine.

Leading by example

One thing leaders can do to mitigate this problem is communicate to the public through their own behaviour.

Other countries have seen some some disturbingly mixed messages. Britain’s prime minister, Boris Johnson, for example, proudly talked about shaking hands with COVID-19 patients just weeks before he almost died from the virus. US President Donald Trump, among other things, has refused to wear a mask while Americans are being encouraged or required to.

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Australia’s politicians have generally done better. A notable example was federal Health Minister Greg Hunt admonishing mining magnate Andrew Forrest to maintain proper social distance at a press conference last month. That was a powerful reminder, as has been the sight of the prime minister, the chief medical officer and cabinet members standing appropriate distances apart.

The ‘horror-case scenario’

Perhaps what governments fear most is a breakdown in public compliance with social distancing that leads to large enough second-wave outbreaks to warrant a return to the conditions that applied in April.

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Politics with Michelle Grattan: Paul Kelly on the risk of a COVID-19 second-wave

This would be a huge blow, both to the economy and the national psyche – which is what will drive business and consumer confidence. Household spending accounts for nearly 60% of GDP, so confidence is crucial to recovery.

That confidence will depend not only on what rules governments put in place but what messages they send to the Australian public in coming months.The Conversation

Richard Holden, Professor of Economics, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Yes, we’re flattening the coronavirus curve but modelling needs to inform how we start easing restrictions


Tony Blakely, University of Melbourne

Australia is on track to flatten the curve of coronavirus cases, which will allow our health system to cope with increasing demand for intensive care unit (ICU) beds, recently released modelling confirms.

The modelling, produced by the Doherty Institute, was delivered to government in February but only released publicly yesterday.

Read more:
Coronavirus modelling shows the government is getting the balance right – if our aim is to flatten the curve

In a press conference before the release, Prime Minister Scott Morrison and Chief Medical Officer Brendan Murphy emphasised the modelling was theoretical and used international data.

International data is still useful – the public health advice on tobacco, for example, is derived mostly from non-Australian studies.

But the way an epidemic plays out is context-specific. The way Australians hang out together, for instance, is different from the way Chinese people socialise. This changes fundamental parameters, such as how many people someone with COVID-19 can be expected to infect.

So what does the modelling tell us and what are we yet to determine?

What scenarios were modelled?

The more applicable of the two papers released yesterday aimed to estimate how much ICU and hospital capacity would be exceeded (in both percentage terms, and number of days) for various scenarios of how the epidemic unfolds.

The three scenarios were:

  • unmitigated spread (just “let the epidemic rip”). Peak daily ICU demand would be 35,000 a day, greatly exceeding Australia’s expanded ICU capacity of 7,000 beds

  • quarantine and isolation of cases scenario. The number of ICU beds needed during the peak would be 17,000 a day, still exceeding Australia’s expanded capacity

  • a quarantine and isolation scenario, plus social distancing at two levels of intensity. Daily ICU bed demand would peak at below 5,000.

Australia was never going to allow unmitigated spread and has implemented quarantine and isolation of cases. And in terms of social distancing, Australia has already exceeded the measures in the paper’s more intense scenario.

What do we learn from the modelling?

As we’ve learnt over the past month from simpler models and back-of-the-envelope calculations, ICU capacity is under grave threat of overload for anything other than a carefully designed, tested and monitored package of case isolation, quarantine and physical distancing.

Physical distancing is essential to flatten the curve enough to avoid ICU overload if we elect to let this epidemic wash through society to achieve herd immunity.

Read more:
Coronavirus: can herd immunity really protect us?

The Conversation, CC BY-ND

Importantly, in all scenarios primary care and general hospital ward capacity were never (even remotely) threatened.

Accordingly, and correctly, the chief medical officer emphasised it’s important that people with existing chronic diseases (such as heart and respiratory disease) keep getting routine medical check-ups, so their conditions don’t deteriorate and require hospitalisation down the track.

If someone experiences sudden shortness of breath or chest pain, they still should be ringing 000 and getting assessed.

Life goes on, as do the vast array of other threats to our health that we can mitigate. And we have the capacity to keep doing this.

Read more:
If coronavirus cases don’t grow any faster, our health system will probably cope

What do we do next?

The bigger question is what comes next, and this wasn’t addressed in the modelling papers.

The prime minister and chief medical officer urged Australians not to relax their current social distancing actions.

But Morrison noted there was a financial and societal limit to endless mitigation. In other words, we need to get through this, but within sensible resource limits.

Read more:
Scott Morrison indicates ‘eliminating’ COVID-19 would come at too high a cost

The government wants to use this position of “relative calm” to make decisions about where to next. As Brendan Murphy said:

We are on a life raft. We now have to chart the course of where we take that life raft. The National Cabinet wants considered advice on all the directions. We don’t have those answers yet.

When will we be ready to ease social distancing restrictions?

How can modelling help us decide?

Essentially, we need different, better and more models than we saw yesterday. Some of this work for the government is underway and will be released in coming weeks. But we also need two things:

1. Agent-based modelling

This is modelling of individuals bouncing around society like balls in a pin ball machine.

Yesterday’s model used equations applied to groups of people. But it can’t easily model the impact of separate interventions, such as school closures versus reducing gathering sizes.

Agent-based models offer more options. If we know, for example, that citizen A reduces their social contacts with people from 15 contacts a day of more than five minutes duration within 1.5 metres, to two such contacts while working from home, then we can (and should) model that.

We need many different agent-based models from many different research groups. Australians aren’t going to stay in lockdown indefinitely so the more models and sources of information, the better.

Read more:
Coronavirus: there’s no one perfect model of the disease

2. To broaden the scope of modelling

We need models that include more than just the COVID-19 transmission dynamics. We need models that weigh up the consequences of both the epidemic, and our potential societal cures to the epidemic.

There is a real risk the societal cure we choose may do more harm. Lockdowns, for example, cause drops in GDP and increases in unemployment. That feeds back on to changes in suicide and heart disease. We need to quantify that, and weigh it up.

The Conversation, CC BY-ND

What are the options going forward?

My team and many others around the country are building simple but useful models to help Australia decide on the way forward. There are three main options:

  1. should we go all-in and aim for elimination (with the fall back of option 2 or 3 if this fails)?

  2. should we keep squashing the curve, as we are doing successfully now, and wait 18 months for a vaccine?

  3. should we meticulously plan for a relaxation of distancing measures (while protecting our elderly and those with chronic conditions), let the case numbers rise so our ICU can cope, and ride this flattened curve out to herd immunity within, say, the next six months?

This is what we need to work our way through.

Read more:
Now we’re in lockdown, how can we get out? 4 scenarios to prevent a second wave

The Conversation

Tony Blakely, Professor of Epidemiology, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australia: NSW – Bushfire Crisis Lessens

The link below is to an article that reports on the easing of the bushfire crisis in New South Wales.

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Chinese Christians Blocked from Attending Lausanne Congress

Police threaten or detain some 200 house church members who planned to attend.

DUBLIN, October 15 (CDN) — As organizers prepared for the opening of the Third Lausanne International Congress on World Evangelization tomorrow in Cape Town, South Africa, Chinese police threatened or detained some 200 delegates who had hoped to attend.

After receiving an invitation to attend the event, house church groups in China formed a selection committee and raised significant funds to pay the expenses of their chosen delegates, a source told Compass. Many delegates, however, were “interviewed” by authorities after they applied to attend the Congress, the source said.

When house church member Abraham Liu Guan and four other delegates attempted to leave China via Beijing airport on Sunday (Oct. 10), authorities refused to allow them through customs, reported the Chinese-language Ming Pao News. Officials detained one delegate and confiscated the passports of the other four until Oct. 25, the closing date of the conference.

China’s State Administration for Religious Affairs and the Ministry of Public Security had notified border control staff that the participation of Chinese Christians in the conference threatened state security and ordered them not to allow delegates to leave, Liu told U.S.-based National Public Radio (NPR).

Officials also prevented two house church Christians from Baotou City, Inner Mongolia, from leaving the country, and on Oct. 9 placed one of them in a 15-day detention, the China Aid Association (CAA) reported.

When Fan Yafeng, leader of the Chinese Christian Legal Defense Association and winner of the 2009 John Leland Religious Liberty Award, discussed the harassment with NPR on Tuesday (Oct. 12), officials assigned some 20 police officers to keep him under house arrest.

On Wednesday (Oct. 13), approximately 1,000 police officers were stationed at Beijing International Airport to restrain an estimated 100 house church members who planned to leave for the Congress via Beijing, according to CAA.

CAA also said authorities over the past few months had contacted every delegate, from Han Christians in Beijing to Uyghur Christians in Xinjiang, for questioning, and threatened some family members.

Normal church operations were also affected. The Rev. Xing Jingfu from Changsha in Hunan province told NPR that authorities cited the Lausanne Congress when they recently ordered his church to close.

China’s Foreign Ministry spokesman, Ma Zhaoxu, in a statement issued to NPR, accused the Lausanne Committee for World Evangelization of communicating secretively with members of illegal congregations and not issuing an official invitation to China’s state-controlled church.

According to the Ming Pao report, the Lausanne committee said members of the Three-Self Protestant Movement had asked if they could attend. Delegates, however, were required to sign a document expressing their commitment to evangelism, which members of official churches could not do due to regulations such as an upper limit on the number of people in each church, state certification for preachers, and the confinement of preaching to designated churches in designated areas. House church Christians faced no such limitations.

The first such conference was held in Lausanne, Switzerland in 1974, which produced the influential Lausanne Covenant. The second conference was held in 1989 in Manila. Some 4,000 delegates from 200 countries are expected to attend the third conference in Cape Town.


Progress or Repression?

China watchers said there has been a slight easing of restrictions in recent months, accompanied by a call on Sept. 28 from senior Chinese political advisor Du Qinglin for the government to allow the independent development of the official church. Du made the remarks at the 60th anniversary celebrations of the Three-Self Patriotic Movement, according to the government-allied Xinhua news agency.

The BBC in August produced a glowing series on the growth of Christianity in China after Chinese authorities gave it unprecedented access to state-sanctioned churches and religious institutions. Religious rights monitor Elizabeth Kendal, however, described this access as part of a propaganda campaign by the Chinese government to reduce criticism of religious freedom policies.

NPR also produced a five-part series on Chinese religions in July. The series attributed the growth of religious adherence to the “collapse of Communist ideology” and pointed out that growth continued despite the fact that evangelism was “still illegal in China today.”

The claims of progress were challenged by an open letter from Pastor Zhang Mingxuan, president of the Chinese Christian House Church Alliance, to Chinese President Hu Jintao on Oct. 1, China’s National Day.

In the letter, published by CAA on Oct. 5, Zhang claimed that Chinese house church Christians respected the law and were “model citizens,” and yet they had become “the target of a group of government bandits … [who] often arrest and beat innocent Christians and wronged citizens.” Further, he added, “House church Christians have been ill-treated simply because they are petitioners to crimes of the government.”

Zhang then listed several recent incidents in which Christians were arrested and sent to labor camps, detained and fined without cause, beaten, interrogated and otherwise abused. He also described the closure or demolition of house churches and the confiscation of personal and church property.

He closed with a mention of Uyghur Christian Alimjan Yimit, “who was sentenced to 15 years in prison because he evangelized among Uyghurs – his very own people.”

Report from Compass Direct News