Cohort profile: Ngā Kawekawe o Mate Korona | Impacts of COVID-19 in Aotearoa – a prospective, national cohort study of people with COVID-19 in New Zealand

Abstract

PurposeThe COVID-19 pandemic has had significant health, social and economic impacts around the world. We established a national, population-based longitudinal cohort to investigate the immediate and longer-term physical, psychological and economic impacts of COVID-19 on affected people in Aotearoa New Zealand (Aotearoa), with the resulting evidence to assist in designing appropriate health and well-being services for people with COVID-19.ParticipantsAll people residing in Aotearoa aged 16 years or over, who had a confirmed or probable diagnosis of COVID-19 prior to December 2021, were invited to participate. Those living in dementia units were excluded. Participation involved taking part in one or more of four online surveys and/or in-depth interviews. The first wave of data collection took place from February to June 2022.Findings to dateBy 30 November 2021, of 8735 people in Aotearoa aged 16+ who had COVID-19, 8712 were eligible for the study and 8012 had valid addresses so were able to be contacted to take part. A total of 990 people, including 161 Tāngata Whenua (Māori, Indigenous peoples of Aotearoa) completed one or more surveys; in addition, 62 took part in in-depth interviews. Two hundred and seventeen people (20%) reported symptoms consistent with long COVID. Key areas of adverse impacts were experiences of stigma, mental distress, poor experiences of health services and barriers to healthcare, each being significantly more pronounced among disabled people and/or those with long COVID.Future plansFurther data collection is planned to follow-up cohort participants. This cohort will be supplemented by the inclusion of a cohort of people with long COVID following Omicron infection. Future follow-ups will assess longitudinal changes to health and well-being impacts, including mental health, social, workplace/education and economic impacts of COVID-19.

The long-term impacts of COVID-19 on confirmed cases at least 12 months post-infection in Wellington, New Zealand: an observational, cross-sectional study

“…This is similar to the pooled prevalence found at least at 12 months of 23% (95% CI: 12-34) for depression and 26.2% (95% CI: 15-29) for anxiety, 8 and the prevalence of approximately one third for symptoms of anxiety and depression in the New Zealand cross-sectional study. 20 One third of our participants also reported experiencing fatigue, which is similar to the pooled prevalence of 28% (95% CI: 18-39) at least at 12 months, 8 but less than the prevalence of 60-77% seen in the New Zealand studies. 19,20 The reported prevalence for depression and fatigue using the WHO Symptom Questionnaire was higher than that of the PHQ-9 and FSS, respectively.…”

“…20 One third of our participants also reported experiencing fatigue, which is similar to the pooled prevalence of 28% (95% CI: 18-39) at least at 12 months, 8 but less than the prevalence of 60-77% seen in the New Zealand studies. 19,20 The reported prevalence for depression and fatigue using the WHO Symptom Questionnaire was higher than that of the PHQ-9 and FSS, respectively. We believe the prevalence identified through the latter two questionnaires are likely to be closer to the true estimate, as these questionnaires are screening questionnaires designed to explore different presentations of the same problem.…”

“…A New Zealand case control study 19 that included largely non-hospitalised cases who tested positive in March-June 2020 showed that dyspnoea persisted in 27% of cases compared to 6% in controls (p<0.001), at a mean of 306 days post COVID-19 testing. Another New Zealand crosssectional study 20 surveyed 990 participants who had tested positive for COVID-19 or were a probable case between 2020 and 30 Nov 2021 (which includes the Delta wave and participants who were only 7 months post positive test/ probable case). Of the 405 participants who answered the survey on long COVID, they found that over 50% of tāngata whenua and tāngata Tiriti experienced shortness of breath, which is in keeping with our findings where 57.1% reported having some degree of breathlessness using the mMRC Dyspnoea Scale and 50% using the WHO Symptom Questionnaire.…”

Continued mitigation needed to minimise the high health burden from COVID-19 in Aotearoa New Zealand

“…7 • It is common to experience new health problems following a COVID-19 infection, 8,9 and the high baseline of infections and reinfections during 2022-2023 has led to the emergence of long COVID, particularly among population groups with high infection rates. 10,11 • New Zealand managed to sustain relatively low excess mortality during widespread Omicron infections, 12 and cumulative excess mortality in New Zealand from January 2020 to June 2023 remains close to zero (Figure 7, Appendix 1).…”

“…There are some measurement aspects (e.g., the timing and questionnaire) in the above estimate that may under-count long COVID. 11 This study had a 12% response rate and recruited participants who tested positive before December 2021, so these results reflect pre-Omicron variants and, in some cases, pre-vaccination infections.…”