Denis Naughten (Roscommon-Galway, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Ceann Comhairle for giving me the opportunity to raise this important issue. Long Covid has been called a hidden iceberg of long-term illness, yet the HSE has been slow to acknowledge the condition or provide clear care pathways, which could have serious long-term implications for those with the condition, as well as for our health service more generally and for our economy. Various studies give different incidence rates of long Covid. A research paper produced by the Oireachtas Library and Research Service, at my request, estimates that the number of people in Ireland who have had Covid-19 and are experiencing or will experience long Covid is at a minimum of 114,500, and growing, with the continued rate of infection.

The World Health Organization definition of long Covid is where symptoms persist for more than three months from the onset of the initial Covid-19 infection, lasting for at least two months, when they cannot be explained by an alternative diagnosis. In general, those with the condition are impacted in their everyday functioning, with symptoms such as fatigue, shortness of breath and cognitive dysfunction. These effects appear to occur irrespective of the initial severity of the infection, but occur more frequently in women, the middle-aged, and those with more serious symptoms initially. I estimate that if all 114,500 people claim Covid illness benefit, and subsequently claim illness benefit for the minimum five-month duration as specified by the World Health Organization definition, this would cost the Department of Social Protection €925 million. This figure does not include health costs, nor does it take into account the reduction or loss of productivity and absenteeism, never mind the financial and personal impact it has on those with chronic conditions associated with long Covid.

Sadly, in-depth searches of the HSE website and a variety of HSE documents do not identify any sources quantifying or indicating the nature or scale of the impact of long Covid on our health service. This could be a sleeping crisis that may overwhelm the already horrendous waiting lists in our health service.

The HSE stated last September that it planned to establish specialist long Covid clinics. As of today, only a model of care for long Covid has been agreed, with the HSE now starting to implement it. The HSE has stated that a variety of disciplines will need to be recruited to support these clinics. As a result, they have no idea when long Covid clinics will become fully operational. Here is the sting in the tail. It is only after these become operational that pathways to and from general practitioners and community services will be established, even though the majority of people with long Covid will have to rely on their GP to access the service initially. This slow rate of action is in stark contrast to dealing with primary Covid infection.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

I thank Deputy Naughten for raising this important matter. Covid-19 is a new disease, so information on it, its features and its course are still emerging. The natural history, clinical course and consequences of Covid-19 are still not completely understood. It is recognised that most patients with Covid-19 return to baseline after acute infection, but a proportion of people report ongoing health issues. There is a lot of uncertainty in the international literature about how many people experience these prolonged symptoms, so it is extremely difficult to determine the scale of this.

People who have had Covid-19 and are in need of further care are currently being followed up by their GP or in hospital settings as clinically appropriate. Treatment is currently focused on the management of specific symptoms. Those in the community who are concerned about persistent Covid-19 symptoms should contact their GP in the first instance. Building on the services already in place to support people with post-acute and long Covid symptoms, I am pleased to be able to inform the Deputy that the HSE has developed an interim model of care for long Covid. A programme manager for long Covid has been appointed and clinical leads representing respiratory medicine, infectious diseases and neurology have also been appointed. This interim model of care outlines how services and supports for people with long Covid should be designed and delivered. I advise the Deputy that an implementation team has been established to oversee this work and its initial priority will be on the establishment of post-acute and long Covid clinics to treat patients as needed, while also working to better understand the demand for this service.

The HSE has advised the Department of plans for each hospital group to have access to both a post-acute and long Covid clinic. It is planned that long Covid clinics will be located at Cork University Hospital, St. James's Hospital, University Hospital Limerick, Galway University Hospital, Beaumont Hospital and St. Vincent's University Hospital. It is planned that post-acute clinics will be located at Cork University Hospital, St. James's Hospital, University Hospital Limerick, Galway University Hospital, Connolly Hospital, Blanchardstown, Letterkenny University Hospital and the Mater University Hospital. The HSE has indicated that long Covid clinics will manage people from 12 weeks post onset of symptoms. Post-acute clinics will be assessing and managing individuals with ongoing symptoms that are four to 12 weeks after initial onset of infection. This will include those that have been hospitalised, in addition to GP referrals for people with more moderate to severe symptoms.

I understand from the HSE that it will be setting up working groups for these clinics over the coming weeks. The objective of these working groups will be to standardise the pathways of care, including multi-disciplinary team supports and operating aspects of the services. This may need to adapt and change over time in response to lessons from the sites, the evolving situation with Covid and emerging evidence. I assure the Deputy that the Department of Health will continue to develop an understanding of the implications of long Covid to inform policy as appropriate.

Denis Naughten (Roscommon-Galway, Independent)
Link to this: Individually | In context | Oireachtas source

I thank the Minister of State for her reply. The difficulty with the reply is that I do not see the sense of urgency about this in the HSE. As the Minister of State says in her reply, the HSE is setting up working groups for clinics over the coming weeks. As I have pointed out, it is only when these clinics are operational that referral pathways will be put in place for GPs. The Minister of State is advising people to go to their GPs but the GPs are not being given the tools or the referral pathways for those particular patients. Today, 114,500 people are affected, and that number is increasing. This has to take on a greater level of urgency.

The emerging consensus in the literature in this area is the importance of those multidisciplinary rehabilitative teams for post-Covid patients, as the Minister of State has outlined. Post-Covid rehabilitation will assume increasing importance as the surge of patients is discharged from hospital, placing additional burdens on our health system. The rehabilitative needs of patients are varied and multifaceted. Clinics should offer these multidisciplinary assessments. The emerging literature emphasises the importance of the assessment of post-acute Covid patients after the discharge and of preparedness for the appropriate clinical rehabilitation pathways. Such initial multidisciplinary assessments for long Covid may play a role in reducing unnecessary chest X-rays and clinic appointments and help to focus the type of follow-up care that is needed.

Surely, with limited hospital appointment capacity, we must try to provide focused, targeted support to these patients.

Mary Butler (Waterford, Fianna Fail)
Link to this: Individually | In context | Oireachtas source

The number of people affected by longer term effects after acute Covid-19 remains unknown and estimates vary internationally. We are still learning about this condition and the supports that are needed to care for those affected by it in Ireland. The Department of Health, through the Health Research Board, HRB, continues to fund research into the clinical impacts of Covid-19 so that we can learn more.

To aid recognition and management of those affected the WHO, through a global consensus process, has proposed a working clinical case definition of post-Covid-19 syndrome which occurs "usually 3 months from the onset" of Covid-19, with symptoms that last for at least two months and cannot be explained by an alternative diagnosis. The common symptoms identified 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. However, the WHO notes that this definition may change as new evidence emerges and our understanding of the consequences of Covid-19 continues to evolve.

In Ireland those affected by long Covid will continue to be cared for through our health services. The HSE's planned service development will also adapt as we learn more about what is needed over the coming period to ensure that all the necessary supports are in place.