Today, OzSAGE, a multi-disciplinary network of Australian experts, releases its advice paper for protecting Australia’s Regional, Rural and Remote communities (“regional Australia”) and health system from Covid-19. The full advice may be found below.
In safer opening up of Australia, the strain on regional Australia from outbreaks of Covid-19 must be considered. Regional health services do not have neighbouring hospitals ‘just down the road’ where they can direct patients, and rely on being able to send severely ill patients to city hospitals. This needs specialised transport such as air ambulance, which are in short supply. Some communities are near state borders, with the closest hospital interstate. Border towns have faced difficulties accessing care for COVID and non-COVID conditions.
If people from big cities travel to regional Australia after relaxation of public health measures, they may bring COVID-19 with them and cause an outbreak. Vaccination levels vary and have generally been lower than big cities to date. Some populations in regional Australia, including elderly, socially disadvantaged, Indigenous and remote populations, have not had the same access to vaccinations through primary care or vaccination hubs and/or can face other barriers.
Risks for regional, rural and remote health include:
- Significant outbreaks could occur in regional Australia in the setting of reduced testing capacity, lower GP and hospital capacity, lack of safe indoor air, shortages of fitted N95 masks and other equipment.
- The capacity of ambulance transport services could be exceeded
- Collapse of community medical services due to service overload and health workers becoming sick or quarantined as close contacts.
- A collateral impact on non-COVID-19 medical services such as maternity services, paediatric services, cancer services, cardiovascular services and trauma.
- During holiday periods, especially December-January, non-metropolitan populations may swell to large numbers due to metropolitan holiday makers. During an epidemic, illness among holiday makers will place additional demand on health services.
In order to protect communities outside the cities from this airborne, highly contagious virus, OzSAGE is calling for higher vaccination targets, opening up LGA by LGA and more assistance for regional, rural and remote health services.
Vaccines Plus :
- Vaccination is essential to prevent infection, illness and hospitalisation, but a VaccinesPLUS strategy is required because vaccination alone will be insufficient to control COVID-19.
- Ensure safe indoor air by checking and adjusting ventilation of indoor spaces. Refer to OzSAGE advice on Safe Indoor Air (Ventilation).
- Ensure all regional populations achieve high levels of vaccine protection (more than 90% of 12 year old + population double-dose) before travel of city people to regional Australia is allowed. Similar policy is being used by Tasmania and New Zealand and been called for by the National Aboriginal Community Controlled Health Organisation, the Aboriginal Medical Services of the Northern Territory and the Central Australian Aboriginal Congress
- Regions should open up LGA by LGA when vaccination targets are met. The same call has been made by Rural Doctors Association of Australia in their media release “80 percent roadmap is 80 percent OK”.
Health systems and health capacity:
A series of recommendations are made to strengthen health systems and improve the resilience of regional communities to COVID-19 outbreaks. These are detailed in the full advice document but in summary:
- Work in partnership with communities keep regional, rural and remote Australia safe in locally appropriate and acceptable ways.
- Provide adequate surge workforce to regional, rural and remote health services.
- Provide better centralised coordination to enable rapid movement of severely ill patients (COVID-19 and non-COVID-19 diseases) to city hospitals as required
- Formal agreements for cross-state transfers for COVID and non-COVD urgent care for so that no patient is refused care.
- Assist local health services to develop separation pathways for COVID and non-COVID care, especially during holiday periods.
- Ensure supplies of Personal Protective Equipment (PPE) is readily available, including fitted N95 or elastomeric masks and equity of access for treatment including adequate oxygen, anti-virals, monoclonal antibody, antibiotics supplies.
“The COVID-19 pandemic exploits division and inequity. We know that health outcomes in regional Australia are worse than affluent suburbs of the cities. As we relax restrictions, the risk is that the pandemic will expose these differences and regional populations will suffer. We need to support regional health services and regional businesses to stop a health and economic crisis in the coming months. Border regions have extra pressures because our closest hospital may be interstate.”Assoc/Prof Craig Underhill, Medical Oncologist, Albury Wodonga
Our advice aligns to that of the Rural Doctors Association that recently called for “opening up LGA by LGA.’ Some regions and towns have not had the same access to vaccinations as the city. Our regions need urgent support to manage a surge after relaxation. The regions need time to get more people vaccinated and ensure adequate ventilation and other measures are in placeDr Karina Powers, Occupational and Environmental Physician
As a clinician I feel my duty of care is to be considerate of those who need us most and rural and regional communities are those at the greatest risk at the moment. I feel it is my job to ensure that no one is left behind.A/Prof Nada Hamad, Haematologist serving Sydney and Griffith
General Practices and health services have not stopped for 18 months. While we now have vaccine supply, we are still vaccinating patients for first and second doses and getting ready to roll out boosters, all while combatting misinformation and exhaustion. Many communities will also get an influx of visitors once restrictions are removed adding to already stretched local health services and that is without dealing with the health care needs of Covid patients.Ms Anna Davidson, Director, Port Stephens GP Super Clinic
Do not assume that when we hear the words ‘80% and 90% vaccinated’ that this means people in every street, in every suburb, in every community and every town are all similarly protected. This is not the case. Aggregated rates of cover do not offer protection to all. We can’t leave any one behind – least of all those in communities outside of the big cities. It just isn’t fair.Prof Lisa Jackson Pulver, Deputy Vice Chancellor, Professor of Public Health and Epidemiologist, University of Sydney
Opening up our at current vaccination targets won’t be safe for all. Whilst we celebrate population-based immunisation targets being reached we must pause and look at the geographic and Indigenous immunisation rates. The gaps are significant. As are the risks. More can be done and we hope that this document assistsDr Kat McLean, GP working in Aboriginal community controlled health organisation, South East Queensland
The people in regional, rural and remote areas of Australia are uniquely vulnerable to the ravages of COVID-19. Their welfare must not be put in danger as a result of the impatience of people in Metro area’s to “open up”.Dr David Berger GP in Remote Australia