Patrick Costello (Dublin South Central, Green Party)
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652. To ask the Minister for Health if he will extend the availability of the antiviral drug called paxlovid and-or other antivirals and monoclonal antibodies to patients diagnosed with long Covid beyond those with an immunodeficiency to cover patients who are affected with long Covid and are having symptoms (details supplied); and if he will make a statement on the matter. [27334/22]

Stephen Donnelly (Wicklow, Fianna Fail)
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As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

Patrick Costello (Dublin South Central, Green Party)
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653. To ask the Minister for Health when access to diagnostic testing fluorescence microscopy to identify fibrin micro clots in long Covid patients will be introduced in Ireland so patients can be prescribed anticoagulants safely; and if he will make a statement on the matter. [27335/22]

Stephen Donnelly (Wicklow, Fianna Fail)
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As this is a service matter, I have asked the Health Service Executive to reply to the Deputy directly.

Patrick Costello (Dublin South Central, Green Party)
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654. To ask the Minister for Health the support that his Department has made available for research into treatments for long Covid, including research into the application of treatments currently available for patients with acute Covid such as paxlovid; and if he will make a statement on the matter. [27336/22]

Stephen Donnelly (Wicklow, Fianna Fail)
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COVID-19 is a new disease so information on its features, incidence and course are still emerging. My Department, and the HSE, continue to review new evidence, research and data on all aspects of COVID-19, including long-COVID, as it emerges to ensure care is in place for all who need it.

My Department plays a leading role in public health and medical research in Ireland. The Department supports research in these areas through the Health Research Board (HRB), a statutory body which operates under the aegis of the Department and a lead agency in Ireland supporting and funding health research. The HRB supports the conduct of clinical research and clinical trials (in addition to health services research, population health research, and managing several national health information systems) on behalf of the Department. The Health Research Board is also actively involved in the European Commission’s health research response to the COVID-19 pandemic through the EU Framework Programmes.

As the global COVID-19 pandemic has progressed, evidence has emerged that some patients who survive the virus are experiencing prolonged symptoms and complications beyond the initial period of acute infection and illness. Termed long-COVID, it can present with clusters of symptoms that are often overlapping and fluctuating. Symptoms include breathlessness, headaches, cough, fatigue and cognitive impairment or ‘brain fog’, while there is also emerging evidence that some people experience organ damage. As yet, there are no clear indicators in research to suggest why one person may develop prolonged issues and another would not. Therefore, greater focus is now being placed on assessing this and the possible causes, in order that treatments and supports can be developed and to better understand any long-term consequences.

Recent long-Covid studies include the following:

Alimentary Pharmabotic Centre (APC) Microbiome Ireland in UCC conducted a study which has shown that the levels of multiple biomarkers are altered in serum from patients with long-Covid, even nine months after the initial infection with SARS-CoV-2. Over 1,000 molecules were measured in patient serum, and a subset of these molecules were shown to be at different levels in patients compared to healthy volunteers. These differences indicate an ongoing activation of the immune system, which were coupled with differences in molecules generated during metabolism, giving some hints at what might be underpinning long-term symptoms such as fatigue and brain fog. Overall, the study findings identify novel mechanistic and potential diagnostic markers as well as potential therapeutic targets in long-Covid patients. 

Another study, led by researchers from the Centre for Vascular Biology in the RCSI School of Pharmacy and Biomolecular Sciences published evidence showing that patients with long-Covid continue to have higher measures of blood clotting, which may help explain their persistent symptoms, such as reduced physical fitness and fatigue. Clotting markers were significantly elevated in the blood of patients with long-Covid syndrome compared with healthy controls and these clotting markers were higher in patients who required hospitalisation with their initial COVID-19 infection. Even those patients that were able to manage their illness at home still had persistently high clotting markers. The researchers observed that higher clotting was directly related to other symptoms of long-Covid syndrome, such as reduced physical fitness and fatigue. Even though markers of inflammation had all returned to normal levels, this increased clotting potential was still present in long-Covid patients. This work was funded through the Wellcome Trust-Health Research Board Irish Clinical Academic Training (ICAT) programme as well through an HRB-funded Irish COVID-19 Vasculopathy Study.

Please also note the following information regarding other initiatives/trials:

The international peer-review process is at an advanced stage for the HRB’s largest project scheme, the 2022 Investigator Led Projects Scheme and this includes a number of grant applications focusing on long-Covid. The outcomes of this call will be available in June 2022.

Ireland, with the support of the DoH and HRB, continues to participate in the WHO Solidarity PLUS trial. This is a platform trial that represents the largest global collaboration among WHO member states. It involves thousands of researchers in over 600 hospitals in 52 countries, including sites across Ireland. This allows the trial to assess multiple treatments at the same time using a single protocol, recruiting thousands of patients to generate robust estimates on the effect a drug may have on mortality-even moderate effects. It also allows new treatments to be added and ineffective treatments to be dropped throughout the course of the trial. Previously, four drugs were evaluated by the trial. The results showed that remdesivir, hydroxychloroquine, lopinavir and interferon had little or no effect on hospitalized patients with COVID-19. Three further therapies were introduced in late 2021- artesunate, imatinib and infliximab – with the aim of reducing the risk of death in hospitalized COVID-19 patients.

Ireland is also participating in EU SolidAct, a randomised, multifactorial, adaptive platform trial for COVID-19 and emerging infectious diseases and pandemics. The purpose of this study is to evaluate the effect of a range of interventions to improve outcome of (i) hospitalized patients with moderate disease, and (ii) hospitalized patients with severe and critical disease.

Once the underlying mechanisms and causes of long-Covid become clearer, Ireland will be well placed, through the above platform trials, to engage in international trials assessing the effectiveness of treatments for long-Covid.

The HSE has developed and is implementing an interim Model of Care to provide long-COVID services nationally. This builds on existing service provision to further develop the necessary services across a number of health care settings including GP, community services and acute hospitals.

A phased implementation is underway with a focus on establishing, Post-Acute and long-COVID clinics nationally within each Hospital Group as initial priority. This involves expanding resources at existing clinics where required and development of new clinics in line with the Model of Care. 

I hope this clarifies the matter.