Catherine Connolly (Galway West, Independent)
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There are four speakers to discuss the supports needed for those suffering with long Covid. Each Deputy will have one minute.

Paul Murphy (Dublin South West, RISE)
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I think Deputy Kenny is not here.

Catherine Connolly (Galway West, Independent)
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Then Deputies will have a little extra time.

Paul Murphy (Dublin South West, RISE)
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In the future, we look back at this moment and at how the governments of the world are treating Covid-19 and we will say it was a social crime. It is a decision to allow Covid to basically let rip, condemning millions of people to death but also tens of millions to a marginalised existence due to long Covid and how states are treating it. Hundreds of thousands of people in this country are affected by long Covid. This is an ongoing mass disabling event. We are not just talking about people being a little bit fatigued. We are talking about children who are not able to go to school, adults who are no longer able to work and people who are not able to breathe properly. This is a very serious issue. The problem is that the State has good words, and we unanimously passed a very good resolution in the Dáil almost a year ago, but that has not been acted on. The long Covid clinics are not functioning properly. They are barely open one day a week, and half a day a week in some cases. The Government has no approach towards stopping the continuous spread of Covid. It has not brought back in masking in healthcare settings. There is no awareness campaign for people. The Government is not taking it seriously and it needs to.

Marc Ó Cathasaigh (Waterford, Green Party)
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I thank Deputy Paul Murphy for his work in this area, for co-ordinating the briefing in the AV room and for co-ordinating this Topical Issue debate. People living with long Covid do not feel heard. They do not feel supported or believed. I have been open about the fact that I meet a person with long Covid every day as I live with one. These people look fine and healthy. When they report to their GP, there is no test they can take for long Covid so everything else is ruled out. People suggest that they are a little bit down in themselves and suggest it is this or that.

The provision of services is inadequate, as is awareness not only among the general population but among our GP cohort. In the region that the Minister of State, Deputy Butler, and I represent, no long Covid clinic is available. A clinic in Waterford city that provides health services for 600,000 people in the wider region has no long Covid clinic available. For those struggling with their energy the idea of travelling to Dublin, Cork, Limerick or Galway to access services is untenable.

We do not have a clear picture of what this issue actually looks like. The Minister of State at the Department of Health, Deputy Butler, in reply to a question I asked spoke about a follow-up after disease acquisition survey to be completed in the fourth quarter of this year but there is no correlation between acute Covid and long Covid. How will we access these people? How will we find out how many people in the general population are affected by this disease? I am not seeing an approach at Government level.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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I thank Deputies Murphy, O'Rourke and Ó Cathasaigh for raising this important issue. I hear loud and clear what they are saying about people not feeling supported. It is of great concern and I want to reflect this. I advise the Deputies that the HSE has developed an interim model of care for long Covid that aims to build on existing service provision in addition to establishing new services in GP, community and acute hospital settings. The HSE identified early in the pandemic the need for this service and set up a multispeciality, multidisciplinary team to develop the interim model of care, under the auspices of the chief clinical officer.

The priority is to ensure there are long Covid and post-acute Covid clinics operating in each hospital group - and I note the point made by Deputy Ó Cathasaigh - to ensure a national service as close to home as possible for those suffering from long Covid. To ensure this national service can be put in place, the Minister allocated funding that facilitated an overall investment of €6.6 million for long Covid service development in 2023, a trebling of the allocation for 2022.

At present, six long Covid clinics and seven post-acute Covid clinics operate nationally. The long Covid clinics operational under the model of care include St. Vincent’s University Hospital and Beaumont Hospital. The post-acute Covid clinics operational under the new model of care include the Mater hospital and Connolly Hospital Blanchardstown. In addition, Tallaght University Hospital, St. James’s Hospital, Cork University Hospital, University Hospital Galway and University Hospital Limerick are operating combined post-acute and long Covid clinics. The HSE has also advised that there is a tertiary neurocognitive clinic in St. James's Hospital, led by a consultant neurologist with a background in neurocognitive disorders. This clinic is accepting referrals from long Covid and post-acute clinics around the country. Recruitment, which includes consultants in a number of disciplines and administration, is under way. To date, 65.9 whole-time equivalent posts have been sanctioned across all of the post-acute and long Covid clinics. As of 8 September 2023, 46.1 of these posts have been recruited.

The HSE also commissioned a HIQA review of international evidence to further inform the development of the service, the results of which were published in December 2022. The review examined 24 guidelines and two models of care and found that approaches and recommendations in the interim model of care are broadly consistent with those identified in this international literature review. An online epidemiological survey, FADA, is under way, which will provide insight into the prevalence of long Covid in the Irish population and the risk factors for developing long Covid. The FADA study will determine the prevalence of long Covid for individuals diagnosed with Covid-19 between March 2020 and 31 Jan 2022 by PCR testing. The results of the survey are due later this year.

Most children with Covid-19 infection have asymptomatic or mild disease. Fortunately, the incidence of severe disease and hospitalisation of children with Covid-19 is low. At present, the diagnosis and care for children and young people suspected of having long Covid is provided by GPs and existing referral pathways within paediatric services. The evolving evidence regarding the impact of long Covid in children is being monitored by the HSE to ensure service delivery is adapted as needed.

I thank the Deputies again for raising this issue. I will bring back their responses to the Minister, Deputy Donnelly. I note the very serious concerns they have raised.

Paul Murphy (Dublin South West, RISE)
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I thank the Minister of State. What people with long Covid say is that the current model of care is simply not working and action is needed to change it. The first thing to be done to try to stop more people having long Covid is to stop people getting Covid infections or reducing the number. We need to have education campaigns, an emphasis on ventilation and clean air, vaccination and masking in healthcare settings. Those suffering are also calling for an awareness campaign to let people know this is a danger of getting Covid. There needs to be a proper review of the non-Covid clinics. They are not working. There are not enough of them and they do not operate enough. There are not enough referrals from GPs. There also needs to be financial support for people affected by long Covid.

Marc Ó Cathasaigh (Waterford, Green Party)
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I will pick up where Deputy Murphy left off. If our health provision for long Covid is hit and miss, then it is substantially more miss than hit. The actual services provided in the long Covid clinics that exist are uneven at best. There absolutely needs to be an underpinning in terms of social protection for those people suffering in the long term. The reliance on PCR diagnosis misses the large number of people who are diagnosed through a red line on an antigen test. There is no register of people who are suffering from long Covid.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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I thank the Deputies and I take the points made on public awareness, ventilation and clean air. There is a winter vaccination programme and I encourage people to avail of the vaccine over the coming weeks and months. The Government continues to support the roll-out of the national service for long Covid, with €2.2 million in funding for the implementation of the model of care approved for 2022, which trebled to €6.6 million for 2023.

The interim model of care was developed by a group of clinicians across a range of specialties and disciplines, including leadership and representation from primary care, older persons, respiratory medicine, chronic disease, infectious disease, mental health and neurology. As part of this, a number of long Covid and post-acute Covid clinics are operational and seeing patients. There are challenges and it is important to make tweaks and respond to the needs of people.

Estimates of the proportion of people who go on to experience long Covid-type symptoms vary considerably in the international literature. As this is a relatively new condition, there are still considerable unknowns relating to the prevalence and duration of symptoms and the impacts of factors such as virus variant type, vaccination status and the interplay of underlying medical and social conditions with post-Covid reported symptoms.

The development of effective therapeutic options for patients suffering from long Covid poses significant challenges. Many of the proposed interventions for people with long Covid symptoms do not yet have sufficient evidence to support them and overall, effective strategies that address the multifaceted nature of long Covid remain elusive. Future research investigating the effectiveness and safety of interventions is required, and a large number of trials are currently ongoing. A recent HIQA report advised that in the absence of strong evidence to support the effectiveness of interventions for long Covid, a holistic symptom management approach should be used to support those living with long Covid, including medical assessment and referral to the appropriate specialist. In the few seconds I have remaining, I encourage people to avail of the Covid vaccine. I will pass on the response to Deputies. I note the considerable concerns they have brought here today.