The World Health Organisation’s decision to remove covid-19 as a global health emergency is the right move, epidemiologist Professor Michael Baker says.

The organisation said the virus was now an established and ongoing health issue that no longer constituted a public health emergency of international concern.

Professor Baker said the global status change made sense at this stage, but it did not impact on whether covid-19 was still a pandemic.

Covid-19 was still New Zealand’s number one killer when it came to infectious disease and people should make sure they were vaccinated and take sensible precautions, he said.

“There might be some scaling down in the international reporting of cases, but really it doesn’t make a difference to somewhere like New Zealand.

“It makes no practical difference whatsoever to how countries manage this infection.”

1000 NZ deaths predicted this year
Professor Baker earlier said that this year covid-19 was on track to kill some 1000 people in New Zealand and hospitalise around 10,000.

The threat of long covid also loomed — with one recent study suggesting as many as one in five New Zealanders reported lingering symptoms after their first infection.

He emphasised the need for caution in easing our few remaining protections.

The latest vaccine was one of the best things people could do to guard against the disease, because it included protection against omicron — the current dominant variant circulating in the community.

“You have to always think why the World Health Organisation assigned it [a global health emergency originally] and it’s really related to these certain criteria.

“It is about how severe and how unexpected [the disease is], but it’s really about whether an international response is needed and whether there’s potential for international spread.”

This article is republished under a community partnership agreement with RNZ.

Article by AsiaPacificReport.nz

Late last month, New Zealand Health Minister Andrew Little stated what most who work in health already know.

Healthcare is all about people – the people being cared for and the people doing the caring.

Population growth, ageing and a pandemic mean there is no shortage of those needing care, but in New Zealand and globally, there is a chronic shortage of healthcare workers.

Little stopped short of calling it a crisis, but researchers and international agencies alike agree with a survey of New Zealand doctors that the health workforce is in crisis.

In 2016, the World Health Organisation (WHO) projected a global shortage of 18 million healthcare workers by 2030. That was before the covid-19 pandemic. Between 80,000 and 180,000 healthcare workers have died globally during the pandemic’s first 16 months, according to the WHO’s conservative estimate.

“Public statements from political leaders that there is ‘no crisis’ in the health system have seemed increasingly out of step with doctors’ experience over the past year” https://t.co/dXMhA38XIO

— Emma Espiner (@emmawehipeihana) July 11, 2022

Add to this the impact the pandemic has had on the mental health of frontline health staff, including reports of post-traumatic stress disorder (PTSD), and a healthcare workforce seven times more likely to have severe covid and now carrying the burden of long covid.

It’s clear healthcare is no longer the attractive sector it once was.

A highly mobile workforce and a global shortage
Like the cost-of-living crisis, the health workforce shortage is not unique to Aotearoa New Zealand.

This year’s budget included NZ$76 million for medical training and primary care specialists, but doctors who started training this year will not be specialists until 2034.

Meanwhile, Labour’s solution is to undertake an international recruitment drive. It is hailing New Zealand as one of the easiest places in the world for healthcare workers to come to. But are our newly opened borders attractive enough?

Overseas recruitment drive for nurses gains ‘good response’ https://t.co/RZrM4fW67L

— RNZ News (@rnz_news) July 13, 2022

In my health economics lectures I often use an anecdote about the Indian doctor who gets a job in the UK (colonial ties and a multicultural society), the British doctor who moves to Canada (less administration and more family friendly hours), the Canadian doctor who moves to the United States (specialists have much higher earning potential), and the US doctor who undertakes missionary work in India.

This highlights two issues: the health workforce is highly mobile and employment isn’t always about money. Aotearoa New Zealand is competing in a global health workforce market, and minister Little recently acknowledged the health sector as “fiercely competitive”.

But this isn’t a new phenomenon for New Zealand.

The health workforce in New Zealand has one of the largest shares of migrant workers, with 42 percent of doctors and almost 30 percent of nurses foreign-born (second only to Israel and Ireland, respectively). This is much higher than the aggregate estimates showing one in six doctors practicing in OECD countries studied overseas.

The OECD estimates the number of foreign-born doctors and nurses in OECD countries has increased by 20 percent, twice the growth rate of the overall increase across the workforce. This is what is most concerning.

The health workforce is not equally distributed. Migration of workers from low- and middle-income countries to high-income countries like Aotearoa New Zealand is a real threat to achieving universal health coverage and sustainable development goals.

New Zealand needs to be mindful that promoting our open borders is not at the expense of under-performing health systems with much greater need.

Losing healthcare workers to Australia
Outflow is also a problem in New Zealand, with New Zealand-trained doctors and nurses crossing the Tasman every year. Add to this the international recruits leaving New Zealand for Australia and there most definitely is a health workforce crisis.

As our nearest neighbour, Australia is aggressively recruiting staff. And like pavlova and Phar Lap they are happy to claim what is ours as theirs. An easier route to citizenship and voting rights will make Australia even more desirable.

How can New Zealand compete in this market? Minister Little refers to encouraging New Zealanders to return home, including lifting their pay. Research shows it’s not all about income. Location and professional development opportunities are important factors when choosing career moves.

The healthcare reforms helped tempt me back to New Zealand after 22 years away. Perhaps working in a system which has equity as its focus may encourage those who are clinically trained to return as well.

There is considerable research to inform policies around retention and recruitment. The New Zealand Ministry of Health may wish to look to the UK, which was historically dependent on EU health and care workers and now has a health workforce depleted by both Brexit and the pandemic.

In the recent LSE-Lancet Commission on the future of the NHS, British scholars argued a sustainable workforce needed integrated approaches to be developed alongside reforms to education and training that reflect changes in roles and the skill mix, and more multidisciplinary working.

The LSE-Lancet Commission authors flagged the need for better workforce planning. New Zealand’s approach to workforce forecasting has also been criticised previously.

Planning aside, a possible solution worthy of discussion is the required skill mix of the workforce, particularly with technological advancements and changing health needs. For example, the introduction of non-medical prescribers has improved job satisfaction, released clinical time and increased patient access.

New Zealand’s once-in-a-generation health reforms offer a logical time to undertake workforce reforms. We need to learn from our own historical mistakes and avoid disconnecting the workforce from the policy reforms.

If minister Little and the ministry are to solve this, he will first need to admit there is a health workforce crisis.

Aotearoa New Zealand is unfortunately not alone in its quest to adequately staff healthcare, but the transformation of the health sector to create a more equitable, accessible, cohesive and people-centred system means New Zealand is uniquely placed to put those people who deliver care at the centre.

Dr Paula Lorgelly is professor of health economics, University of Auckland. This article is republished from The Conversation under a Creative Commons licence. Read the original article.

Article by AsiaPacificReport.nz

It seems not a day goes by without learning someone in our inner circle of family, friends and colleagues has covid. When we ask how unwell our acquaintance is, the responses vary from “they’re really crook” to “you wouldn’t even know they had it”.

This is in line with studies that report moderate to severe illness in a minority of people (usually older with other risk factors) and that up to one in three positive people exhibit no symptoms.

Given the ubiquitous presence of this highly infectious coronavirus in our community and the high rate of asymptomatic illness, those who have not been diagnosed with covid might wonder, “how would I know if I had been infected?”

And, “does it matter if I have?”.

How covid is diagnosed
Most people know they’ve had covid because they had a fever or upper respiratory tract symptoms and/or were exposed to an infected person AND had a swab test (PCR or rapid antigen) that detected the covid virus (SARS-CoV-2) in the upper airway.

At the beginning of 2022, many people with consistent symptoms or high-risk exposures were not able to access PCRs or RATs to confirm their diagnosis, but instead presumed themselves positive and quarantined.

It is possible to diagnose past infection in those who never tested positive. A blood test can look for SARS-CoV-2 antibodies (also known as immunoglobulins). When we are infected with SARS-CoV-2, our immune system launches a precision counter strike by producing antibodies against viral targets, specifically the Spike (S) and Nucleocapsid (N) proteins.

Covid vaccination induces a similar immune response against the S protein only. The S antibody “neutralises” the invader by preventing the virus from attaching to human cells.

These antibodies can be detected within one to three weeks after infection and persist for at least six months — potentially much longer. A blood test that shows antibodies to S and N proteins indicates someone has been previously infected. Detection of antibodies to the S protein only indicates vaccination (but not infection).

The problem with antibody tests
Before you rush off to get a covid antibody test, there are a few notes of caution. There is still much to learn about the characteristics of the immune response to covid infection.

Not everyone mounts a detectable antibody response following infection and levels can decline to undetectable levels after several months in some people.

Because there are other circulating seasonal coronaviruses (such as those that cause the common cold), tests may also pick up antibodies to non-SARS-CoV-2 strains, leading to “false positive” results.

Commercial and public hospital pathology labs can perform SARS-CoV-2 antibody testing, but the interpretation of results should be undertaken carefully.

So, antibody testing should really only be done when there’s a good reason to: say, when confirming past infection or effectiveness of vaccination is important for the current care of an individual.

Diagnosing a post-infectious complication or eligibility for a specific treatment, for example. It could also be useful for contact tracing or for assessing the background population rate of infection.

Antibody testing a population
“Seroprevalence studies” test for the presence of SARS-CoV-2 antibodies in repositories of stored blood that are representative of the general population, such as from a blood bank. This data helps to understand the true extent of covid infection and vaccination status in the community (and informs our assessment of population susceptibility to future infection and reinfection). It’s more useful than daily reported case numbers, which are skewed towards symptomatic individuals and those with access to swab testing.

New research from the World Health Organisation, which is yet to be reviewed by other scientists, reported the results of a meta-analysis of over 800 seroprevalence studies performed around the world since 2020. They estimated that by July 2021, 45.2 percent of the global population had SARS-CoV-2 antibodies due to past infection or vaccination, eight times the estimate (5.5 percent) from a year earlier.

There are plans to conduct fresh seroprevalence studies in Australia in the coming year, which will update local data and help us understand to what extent the omicron wave has washed through the population.

Even after ‘mild’ cases, a new study by this @CurtinUni expert finds “long COVID” symptoms may persist. This includes “brain fog”, fatigue, and problems with concentration and memory. https://t.co/4lckYrks0Y

— The Conversation (@ConversationEDU) March 7, 2022

Does it matter if I have had covid and didn’t know?
For most people, knowing your covid infection status is unlikely to be more than a topic of dinnertime conversation.

While some studies have pointed to a less robust and durable antibody response following mild or asymptomatic infection compared with severe illness, it is not known how this influences protection from reinfection. Certainly, the knowledge we have antibodies from past infection should not deter us from being fully up-to-date with covid vaccination, which remains the best protection against severe illness.

There are reports of people with mild or asymptomatic covid infection developing ‘long covid’ — persistent or relapsing symptoms that last several months after initial infection. Symptoms can include shortness of breath, physical and mental fatigue, exercise intolerance, headaches, and muscle and joint pain.

However, the likelihood of developing this condition appears higher in those who suffer a heavier initial bout of covid illness. This might be linked with higher viral load at that time.

Bottom line
As we enter the third year of the covid pandemic and given that up to one in three infections may be asymptomatic, it is likely many of us have been infected without knowing it.

If you are experiencing lingering fatigue, brain fog or other symptoms that could be long covid, you should talk to your GP. Otherwise, knowing our covid infection status is unlikely to be of much practical benefit. Antibody testing should be reserved for specific medical or public health indications.

Being up-to-date with covid vaccination is still our best defence against severe illness moving forward.

Dr Ashwin Swaminathan is a senior lecturer at the Australian National University in Canberra. This article is republished from The Conversation under a Creative Commons licence. Read the original article.

Article by AsiaPacificReport.nz