Australia Outback doctors warn COVID-19 Delta strain cases would devastate remote communities

05:19  27 july  2021
05:19  27 july  2021 Source:   abc.net.au

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'Julie' — a doctor in a remote outback town — is worried about her patients.

She cannot be identified because she fears she would lose her public hospital job if her bosses found out she had spoken to the media.

There are only four respirators in her hospital but she does not believe they would be of much use in the event of a COVID-19 outbreak, especially the Delta strain.

"With the Delta strain, with the rate of [its] transmissibility, we are potentially looking at catastrophic situations in remote parts of Australia if [that variant] gets established," she said.

"You can't just suddenly set up a row of ventilators … you need the staff to be able to run them."

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She said an outbreak would quickly see the hospital's already small staff reduced, either because they would contract the virus or be told to stay home because they had visited exposure sites, as recently happened in the Victorian town of Mildura.

Balancing act, with lives at risk

Because there was no bigger hospital "just down the road", Julie said anyone who got critically ill with COVID would have to be evacuated, by air, to a major city.

But, she said, those services already operated on a "finely balanced" supply-and-demand basis and argued the system would be "rapidly overwhelmed" by a significant outbreak.

Had she been asked back in December when Australia could open up, Julie said she would have replied when the nation reached an 80 per cent vaccination rate.

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However, she said, the Delta variant had changed the game, describing it as a "Pandemic 2.0".

She said she believed Indigenous children must be vaccinated before Australia was opened up.

"I can tell you, as somebody who's looked after Indigenous children, that those Aboriginal children will be at extremely high risk of severe outcomes," she said.

Julie said she believed an outbreak in an Indigenous community would see Aboriginal children die.

'Way of life'

The National Aboriginal Community Controlled Health Organisation's (NACCHO) medical adviser, Jason Agostino, agreed that Aboriginal children would be more vulnerable to the disease but played down the likelihood of deaths.

"I don't think [deaths are] likely, but I think there is a much higher risk of death than there is for other children because these are quite serious conditions that affect the heart and lungs," he said.

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Dr Agostino — a Canberra-based GP who works in the Yarrabah Aboriginal Community in Far North Queensland — said talk of abandoning any attempt to control COVID-19 was dangerous.

"I think it's important to acknowledge that, while the UK is letting it rip, it has 25,000 cases as its [latest] seven-day average, and the only reason that their deaths aren't higher is because they have a highly vaccinated population," he said.

"In remote Australia and across all of Aboriginal and Torres Strait Islander Australia, we only have around 22 per cent of people [who] have received a first dose of any vaccine, and that's much lower than in the non-Indigenous population.

"If we were to let it rip, we know that COVID-19 causes more serious disease in people with chronic conditions, [such as] diabetes and heart disease and [that] it spreads easily among crowded houses.

"Unfortunately, many Aboriginal and Torres Strait Islander people have these chronic diseases from younger ages and also live in crowded houses.

"So that combination, with low vaccination coverage, is a recipe for disaster."

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Dr Agostino agreed it was important for Australia to find vaccines that were safe for Indigenous children and said that, until a much higher rate of vaccination had been achieved, "lockdowns are going to be a way of life".

Opening up 'not an option'

Professor David Atkinson — who trains medical students and GPs in Western Australia's Kimberley region — said the broader Australian community needed to be persuaded that lifting current lockdown restrictions was "not an option".

"I have great sympathy for those in lockdown, but opening up any time soon [would be a] disaster," he said.

"It's a very risky environment for rural areas if there are cases coming in."

Julie said lockdowns represented a failure of public policy and people in Australia's major cities were "right to be annoyed" by them.

She said Australia's COVID-19 contagion strategy needed to go beyond vaccinations and lockdowns and include the introduction of HEPA (high-efficiency particulate absorbing) filters in schools and hospitals to prevent airborne transmission of the virus.

"Trying to fix [COVID-19] without fixing the air we breathe, is like trying to fix cholera without fixing the sewage system," she said.

Telehealth cutbacks bite

Dr Agostino said he was frustrated the federal government had recently cut back on telehealth subsidies, given the ongoing pressure the pandemic was putting on people's mental health.

He said long consultations could now only be claimed if they were done via video, not telephone, which was "beyond" hard in remote areas.

"Accessing video is just really hard because of costs or connectivity," he said.

"We need long consults. We need to be able to do things like mental health care plans for new patients."

Dr Agostino said the government recently reintroduced a small concession for people speaking by phone to their GPs, but only in COVID-19 hotspots.

In a statement, the federal Health Department said the changes to telehealth were "informed by Medicare data and expert advice".

However, it argued, "certain" mental health treatment services — including longer consultations delivered by telephone — had been retained.

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This is interesting!