As long as the number of Covid-19 infections continues to increase across the globe the numbers of those suffering long-term effects from the virus will continue to rise in New Zealand, the World Health Organization and local experts warn.
The WHO is calling the rapidly growing number of recovered cases experiencing long-term health issues a “highly significant” global “disease burden”, which they’re working with urgency to address.
It’s not a health crisis which New Zealand is immune to, despite currently having no community transmission of the virus.
Although New Zealand had a low number of Covid-19 cases during last year’s initial outbreak, there is a steady stream of positive cases among returnees arriving into the country every week.
Since January 1 this year, 325 cases have tested positive with Covid-19, with 42 of those being historical cases.
Those historical cases alongside returnees who previously had Covid-19 could be experiencing long-term effects from the virus.
“We're getting cases through the border every day and that's a mixture of people who are officially infected, but of course we're seeing a lot of people who've been infected in the past who were infected in the US, in the UK,” says Dr Michael Maze, an infectious disease and respiratory doctor from Christchurch.
“Although they're no longer infectious and they will no longer come up in our case numbers they could still have lingering health concerns and they would quite legitimately expect to be able to seek help for that in New Zealand.”
Often referred to as ‘Long Covid’, the lingering effects of the virus can be severe, with people experiencing lung and heart damage to less severe lingering symptoms such as fatigue and muscle aches.
These are symptoms Maze is all too familiar with, having spoken to around 100 people in Canterbury who suffered from Covid-19 and are still recovering from the virus.
“For some people it's breathlessness, chest pains, and that can relate to permanent damage to the heart and lungs.
“But for many people it's often just a profound sense of fatigue and being exhausted all the time.
“And for other people it can be a feeling of brain fog, feeling like they're not thinking straight or a wide range of other symptoms too.”
Maze says New Zealand doesn’t have enough data to know how common Long Covid is among the recovered cases because data isn’t being collected.
“We don't have any firm data about the proportion overall. But it's definitely here and definitely a large number of people are still noticing symptoms.
“Internationally there's reports that up to 10 or even 30 per cent of people will still be experiencing symptoms some months after they were infected. So that would suggest it's really common.”
Maze says he wouldn’t be “surprised” if New Zealand has similar numbers among its Covid survivors as seen overseas.
He also expects the number of cases to increase.
“As the number of people infected worldwide gets larger and larger you can expect the number of people with persistent or longhaul symptoms is going to increase as well. And of course, Kiwis infected overseas are just as likely to be getting longhaul Covid as well as anybody else.
“And if they come home of course they need to have a health system that can look after them and deal with them.”
Long Covid becoming a “highly significant” health burden for the world
Globally, researchers are working at pace to uncover why a large portion of Covid-19 cases classified as recovered are still suffering.
“We've got a whole new disease burden around the world,” Dr Margaret Harris from the WHO told 1 NEWS.
Harris says the long-term effects of Covid-19 will place a huge amount of stress on health care systems across the world.
“It is going to be a huge burden and if you look at the number of cases we've got around the world, and these are in many countries where the health system has just been shattered by acute Covid.
“But that doesn't mean the people who got through it should be left to somehow struggle with what's left behind.”
How serious a health issue this is becoming can be seen in the billions of dollars being spent in the UK and US on research into the virus and why it is causing long-term health issues.
The US announced it will be spending $1.5 billion on research, while the UK is investing nearly $35 million.
According to a recent policy brief released by the WHO as many as one in five of 71 million recovered cases experience “persisting ill heath” after they test negative for the virus.
This number is growing rapidly.
Despite studies being in the early stages, it’s possible “there will be considerable numbers of people with ongoing symptoms for several years at least”, the WHO policy brief reads.
The mains concerns emerging from initial research of Long Covid is the multisystem pathology of the disease making treatment more complex for those suffering the post-effects of the virus.
Initial research also shows that whether someone had a severe infection of the virus or didn’t have many symptoms during their initial infection doesn’t determine whether or not they will have long-term effects from the virus.
Harris says the WHO saw the urgency of acting quickly to try and prevent a potential health crisis from Long Covid very early in the pandemic.
“It's not unexpected - it's not something that you should be like 'how did that happen?'”
Harris says the initial assumption the virus was only an “old person’s” disease was a position they warned the world against taking when the pandemic first struck.
“We were saying as the WHO, don't take that position, you don't know what this virus does, you don't know even if people who don't have symptoms whether you've got other processes going on.
“And unfortunately, now we are seeing in quite a percentage of people, they have what we think is an inflammatory process … but that inflammatory response has continued and that's where the problem lies.”
Harris says Long Covid is “very” real condition and health issue that needs to be acknowledged here in New Zealand.
“Encourage those with symptoms to come forward, encourage your medical and health professions to recognise it and develop a referral system to the right people.”
Is New Zealand acting too slowly on Long Covid?
In June last year, Director-General of Health Dr Ashley Bloomfield said due to the low number of cases in New Zealand during the outbreak there wasn’t enough evidence to say New Zealanders were suffering from any long-term effects.
“I haven’t read any reports on ongoing symptoms here in New Zealand,” he said.
When asked at a press conference last week if he still stood beside his comments, Bloomfield said there was “emerging evidence” of long-term effects of Covid-19 but again stressed there was only a small number of New Zealanders that had Covid-19.
However, Dr Anna Brooks, an immunologist from the University of Auckland, says when the Ministry of Health is talking about the small number of cases in New Zealand it isn’t taking into consideration the thousands of returnees who have had or are bringing Covid-19 back into New Zealand.
With a raging pandemic across the globe, new variants threatening current vaccine efficacy and slow vaccine rollouts, cases of Covid-19 are expected to continue to arrive in the country.
This steady stream of imported cases is raising the number of people returning with long-term effects, says Brooks.
“We are missing every single person who is coming back into the country,” she says.
“We have zero intel of how many returnees have had Covid. No one's asking, no one's documenting. We have zero idea as to how many people are going to be suffering with Long Covid in this country.”
Brooks says the Ministry of Health is aware of Long Covid, but its response to the emerging public health issue is too slow.
“We’ve been slow. It’s not like we’re not acting, because the Ministry is aware of this.
“Yes, there's going to be a health burden, what size? Nobody knows because nobody is asking the questions.”
Brooks says information on the Ministry of Health’s website, Unite Against Covid-19’s website and given to GPs on Long Covid has been lacking.
“I guess the main problem is that nobody knows how to help because we still need to understand what that looks like, right?
“I guess long term there needs to be Ministry support and a national rollout of medical recommendations.
“The key problem is that our group of longhaulers or even people that have had Covid, it's going to keep getting bigger and bigger and how are they going to access health care if they don't have proof they've had Covid? So that again is a big thing nationally.”
Maze says he doesn’t know what action the Ministry of Health or each DHB is supplying to those suffering Long Covid in their regions but agrees the public health system needs to prepare for more people to appear in the system due to Long Covid.
“In New Zealand we've had roughly low numbers of Covid compared to many parts of the world so perhaps it isn't front of mind,” says Maze.
“But I think as time goes by and they get more and more people having been diagnosed with Covid in New Zealand and having come back from overseas that it's going to become increasingly obvious to us that we need to make sure we've got a system in place and so the earlier we can make that connection we can front foot it and be prepared better.
“It’s about not only seeing the issue for what it is now, but seeing what it could be in the future and making sure that it's well set up so that we're front footing it rather than reacting and waiting until we've got a problem and a lot of people in need.”
Brooks says many people with Long Covid in New Zealand feel helpless when seeking help from GPs, who often haven’t heard of the condition.
Medical Director of The Royal New Zealand College of General Practitioners Dr Bryan Betty says some information on Long Covid has been given by the Ministry of Health to GPs.
“But it’s very unclear what the approach is longer term,” he says.
“It really is emerging as an issue with a lot of unknowns, so an evolving situation. In view of the low numbers in New Zealand it isn’t something GPs would be seeing frequently.”
However, both Brooks and Maze say this won’t be the case and predict GPs will see an increase of patients presenting long-term effects from the virus.
“Certainly some of the discussions I've had with people who have had Long Covid have felt like that. They say that they've been in and they haven't necessarily had practitioners who knew much about it or had heard of it at times. And so again there's a huge amount of people to get their heads around in all parts of medicine.”
The Ministry of Health says it’s continuing to look into Long Covid and has begun to “collate the evidence that was emerging around rehabilitation post-Covid-19”.
“Our advice to anyone experiencing Long Covid symptoms is to work closely with their general practitioner on a programme of health measures that will address the various ongoing symptoms a person is experiencing.
“The Ministry will continue to share more information with the health sector as it learns more from this research.”
Research into Long Covid hasn’t begun in New Zealand yet, however the Ministry of Health announced a request for proposals for research late last year.
They say the formal process is getting underway now.