Institute for Health Transformation, Faculty of Health, Deakin University, 221 Burwood highway, Burwood, Victoria, 3125, Australia.
Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, 221 Burwood highway, Burwood, Victoria, 3125, Australia.
BMC Public Health. 2022 Apr 14;22(1):757. doi: 10.1186/s12889-022-13169-x.
Concerns have grown that post-acute sequelae of COVID-19 may affect significant numbers of survivors. However, the analyses used to guide policy-making for Australia's national and state re-opening plans have not incorporated non-acute illness in their modelling. We, therefore, develop a model by which to estimate the potential acute and post-acute COVID-19 burden using disability-adjusted life years (DALYs) associated with the re-opening of Australian borders and the easing of other public health measures, with particular attention to longer-term, post-acute consequences and the potential impact of permanent functional impairment following COVID-19.
A model was developed based on the European Burden of Disease Network protocol guideline and consensus model to estimate the burden of COVID-19 using DALYs. Data inputs were based on publicly available sources. COVID-19 infection and different scenarios were drawn from the Doherty Institute's modelling report to estimate the likely DALY losses under the Australian national re-opening plan. Long COVID prevalence, post-intensive care syndrome (PICS) and potential permanent functional impairment incidences were drawn from the literature. DALYs were calculated for the following health states: the symptomatic phase, Long COVID, PICS and potential permanent functional impairment (e.g., diabetes, Parkinson's disease, dementia, anxiety disorders, ischemic stroke). Uncertainty and sensitivity analysis were performed to examine the robustness of the results.
Mortality was responsible for 72-74% of the total base case COVID-19 burden. Long COVID and post-intensive care syndrome accounted for at least 19 and 3% of the total base case DALYs respectively. When included in the analysis, potential permanent impairment could contribute to 51-55% of total DALYs lost.
The impact of Long COVID and potential long-term post-COVID disabilities could contribute substantially to the COVID-19 burden in Australia's post-vaccination setting. As vaccination coverage increases, the share of COVID-19 burden driven by longer-term morbidity rises relative to mortality. As Australia re-opens, better estimates of the COVID-19 burden can assist with decision-making on pandemic control measures and planning for the healthcare needs of COVID-19 survivors. Our estimates highlight the importance of valuing the morbidity of post-COVID-19 sequelae, above and beyond simple mortality and case statistics.
人们越来越担心，COVID-19 的急性后期后遗症可能会影响大量幸存者。然而，用于为澳大利亚国家和州重新开放计划提供决策指导的分析并未将非急性疾病纳入其模型。因此，我们开发了一种模型，通过使用残疾调整生命年 (DALY) 来估计与澳大利亚边境重新开放以及放宽其他公共卫生措施相关的潜在急性和后期 COVID-19 负担，特别关注长期、后期后果以及 COVID-19 后永久性功能障碍的潜在影响。
根据欧洲疾病负担网络协议指南和共识模型，我们开发了一种模型，通过 DALY 来估计 COVID-19 的负担。数据输入基于公开来源。COVID-19 感染和不同情况是根据多尔蒂研究所的建模报告得出的，以估计澳大利亚国家重新开放计划下可能的 DALY 损失。长期 COVID 流行率、重症监护后综合征 (PICS) 和潜在永久性功能障碍发生率是从文献中得出的。DALY 计算了以下健康状况：症状期、长期 COVID、PICS 和潜在永久性功能障碍（例如，糖尿病、帕金森病、痴呆症、焦虑症、缺血性中风）。进行了不确定性和敏感性分析，以检查结果的稳健性。
死亡率占 COVID-19 总基本病例负担的 72-74%。长期 COVID 和重症监护后综合征分别占总基本病例 DALY 的至少 19%和 3%。当纳入分析时，潜在的永久性损伤可能导致 51-55%的总 DALY 损失。
长期 COVID 和潜在的长期 COVID 后残疾的影响可能会对澳大利亚接种疫苗后的 COVID-19 负担产生重大影响。随着疫苗接种覆盖率的提高，由长期发病引起的 COVID-19 负担在死亡率中的比例相对于死亡率上升。随着澳大利亚重新开放，更好地估计 COVID-19 负担可以帮助制定大流行控制措施的决策，并为 COVID-19 幸存者的医疗保健需求做出规划。我们的估计强调了重视 COVID-19 后遗症发病率的重要性，超过了简单的死亡率和病例统计数据。
