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Bullet proofing Aboriginal and Torres Strait Islander communities from COVID-19

New rapid turnaround coronavirus (COVID-19) tests are being rolled out to 83 rural and remote Aboriginal and Torres Strait Islander communities, allowing people to get their test results in around 45 minutes, a significant reduction from current testing which can currently take up to 10 days.

Its one of a significant number of initiatives being welcomed and watched by the Aboriginal and Torres Strait Islander Advisory Group for the Communicable Disease Network of Australia, a key advisor to Australian governments on coronavirus responses.

James Ward, a Pitjantjatjara and Narungga man who is the Director of the Poche Centre for Indigenous Health and Professor within the School of Public Health at the University of Queensland, is a member of the Advisory Group and the only Indigenous member of the CDNA.

He outlines below the work being done by those groups and Indigenous communities and organisations to suppress the spread of the coronavirus.

According to the latest figures, just 44 cases (0.7%) had been reported in Aboriginal and Torres Strait Islander persons, and none in remote areas, since the start of the outbreak.


James Ward writes:

Much has been written about the impact the virus SARS COV-2 might have on Aboriginal and Torres Strait Islander communities.

It’s understandable. The omnipresent stream of media and online content, telling the story and in pictures that we face a higher risk from morbidity and mortality during a pandemic and more rapid spread of disease, particularly within discrete communities, has shaken us to our core.

We are not alone with risk. The stories, the numbers, the images from Europe, the USA and all around the globe will be etched in our memories forever.

The emerging stories from other Indigenous peoples internationally shake us further.

The Navajo Nation coronavirus death rate is eclipsing that of states with much larger populations, while the first death of a Yanomami person in the Amazon was a 15 year old, raising concerns for remote and isolated people residing on traditional lands in the Amazon, close to mining companies.

What does this mean for our own population of Indigenous peoples here in Australia?

These stories strengthen our resolve, forcing us to dig deep, enabling us to honour and serve our people, especially our Elders and those most vulnerable within our communities.

COVID-19 has forced us to drop almost everything else we do in our daily lives and focus on developing sensible responses to bullet proof our communities against this virus and, by doing so, protecting our people’s health and continuation of the world’s oldest culture.

The latest Communicable Diseases Intelligence report published (volume 44 for the week ended 12 April 2020) says that of 6,394  cases reported in Australia, only 44  had been reported among Aboriginal and Torres Strait Islander peoples. Of these just over half were acquired overseas. No cases have been reported in our population resident in a remote community. 

First, some COVID-19 and Indigenous health context

People should read this article with an open mind.

Recent stories about lack of equipment, resources and spaces to isolate in Aboriginal and Torres Strait Islander communities need to be told, however the reality is they are frightening many of our community members. You only have to read the online comments posted under such  stories to know the fear that people hold for our people, especially our Elders.

Unnecessary stress or pandemonium is not what we need to be creating for our population at this point in time. Instead we should be affirming what we have put in place by detailing the responses we are working at tirelessly to get us through this pandemic as best as we can. These messages should be firm, clear and consistent and optimistic.   

But first let’s put this into perspective.

The Australian health care system in ordinary circumstances is far from perfect, but there are constant shining lights from Aboriginal communities and their health services that guide us in how to prevent and manage disease, by delivering best care and treatment for our peoples.

Reforms are constant, evidence is always developing and technology changes the way we do things. Communities are always working to get the best outcomes in our stretched health care system, but also with such massive odds stacked up against us with social and cultural determinants of health at play here.

Nobody expected that Aboriginal primary health care services would be dealing with a pandemic of this magnitude and in such a short period of onset. Putting it bluntly and into perspective, our communities and our health care system were not prepared to deal with a global pandemic of this magnitude. For many we have started from scratch. 

Neither was the rest of the world prepared, as it turns out. Just a few months ago we were all cruising through life, dealing with what we do on a daily basis, fighting a good fight in striving for better health outcomes for our peoples. Today we are fighting an even bigger fight to combat this virus. 

Formulating the response

I am the only Aboriginal member of the Communicable Disease Network of Australia, the peak advisory group advising on communicable diseases that has been meeting regularly since January, racking up more than 70 meetings as of last week.

When it became very clear at an early stage that we needed to recruit extra help, the CDNA listened, followed up internally and recruited the very capable Dr Lucas De Toca, Assistant Secretary of the Department of Health, Indigenous Health Division, who progressed the development of an Aboriginal and Torres Strait Islander Advisory Group within the CDNA.

This advisory group has been meeting since the end of February, initially three times per week, now twice per week.  Convened and off and running within a week, its membership can be found  here. A special mention goes to both the National Aboriginal Community Controlled Health Organisation (NACCHO) for convening the group, and the Department of Health for providing secretarial support and other Government agency membership. 

During the past two months, the collective actions of this group have moved mountains that in normal times would not be even remotely imaginable nor possible.

In this article, I want to highlight some of the discussions and outcomes of this group so it is on the public record.

Contributing to the SoNG

The first thing we did was to contribute to the CDNA Series of National Guidelines for Public Health Units on COVID-19 (SoNG) highlighting why Aboriginal people needed to be accorded as a priority population.

A small group of us, were involved in drafting this SoNG: a few friends, Dr Dawn Casey representing NACCHO, Dr De Toca, and Ms Kristy Crooks, a PhD student who has been working with communities on pandemic preparedness.

The COVID-19 SoNG can be found here. It was developed using lessons from the last global pandemic among our peoples, 2009’s H1N1, as well as our collective insights. The first job of the Advisory Group was to refine and sign off on the input into the SoNG.

Developing a management plan

The second thing we completed was a National Management Plan for Aboriginal and Torres Strait Islander communities using the National Health Sector Emergency Response plan as a framework to highlight preparedness, actions required and a plan to scale back efforts when we can see light at the end of the tunnel.

With much robust discussion, input into the plan was extracted from committee members using an emerging issues agenda item at each meeting.  The plan can be found here.

Some have criticised the plan for its aspirational nature and the Government for not funding the plan. I want to put this straight.

This plan was developed for communities nationally to help guide the development of local and regional plans. Governments have funded parts of the plan, the rest has been reliant on goodwill of individuals and organisations, some of which are highlighted below.

Many of you will also know that the Aboriginal health sector doesn’t always have the necessary resources to do all the things that we know need to be done. They just get on and do it.

The sector is built on history and legacy. It demonstrates resilience, and in true fashion has been already conducting an enormous amount of work developing communications campaigns, innovative thinking around service delivery, leadership and advocacy, at the same time, demonstrating committed care to their patients.

What they are asking is for flexibility, leniency, understanding and compassion to enable them to do what they need to do to ride out this pandemic.

Planning into action

As a result of the Action Plan, the Advisory Group continues to meet twice weekly to discuss emerging issues that are reported from the ground up, for actioning within Government and for our collective benefit.

Below are major achievements that the Advisory Group has been involved in directly or indirectly.

Minimising remote community exposure

The Government has worked to minimise the exposure of remote and very remote communities to the coronavirus. Access to these communities has been restricted to protect community members from its spread. This has involved the deployment of the Commonwealth Biosecurity Act.

This action complements actions by many State and Territory Governments to close borders in order to control the virus spread. Biosecurity officers are now in place across Australia’s national and jurisdictional borders to protect our health.

Travel to remote communities is restricted to non-essential visitors and all essential service visitors will be required to quarantine for 14 days in line with health guidelines. Recent diagnoses recorded in the Kimberley region means that this will now be more stringently enforced.

Many members of the Advisory Group have in recent days argued for more stringent quarantine restrictions such as supervised quarantine as is occurring in many major cities for returning travellers.  

These actions are in line with recent actions taken by many Land Councils to restrict visitors to communities. See Northern and Central Land Councils as examples.

Advisory Group members are working with mining companies located in close proximity to communities to ensure there is minimal risk of transmission between employees of these sites and remote communities. The Minerals Council of Australia has collaborated with the Advisory Group to ensure protocols are consistent with our aspirations and has also worked with its members to provide assistance to communities, especially in providing emergency accommodation that may be needed for isolation and quarantine purposes.  

Special considerations for remote communities have been incorporated into the SoNG outlining what is required of communities and health services in the event of first, suspected and confirmed cases in remote communities and or in the event of an outbreak in these communities. Consideration for scaling up of testing among close contacts, medical evacuation isolation, and further restriction of movement will enable an effective response and limit exposure to other community members.

Respiratory clinics and telehealth

The Commonwealth Department of Health has worked on opening Aboriginal community controlled health services GP-led respiratory clinics to provide advice and health care to people with mild to moderate COVID-19 symptoms to reduce pressure on hospitals and the risk of transmission by visits to regular GP clinics.

Sites will include Aboriginal Community Controlled Health Services in several locations. Further sites will be progressively rolled out.

Many Aboriginal Community Controlled Health Services have made plans for increased testing capacity for SARS COV2 within their services, by reorienting clinics. Innovation has been paramount and has included creating separate entrances for people with symptoms like COVID-19, training specialist staff, minimising exposure to other patients and staff by ensuring people with COVID-19 like symptoms only see clinicians by appointment booking system only or via telehealth.

The Australian Government is working with Aboriginal and mainstream primary care services, to expand telehealth (phone and video calls with your health care provider) to allow eligible patients to access both coronavirus and ongoing care when they most need it and protect both patients and health care providers from the risk of infection.

Rapid testing

The Advisory Group is working with the Kirby Institute and others to rapidly establish and increase testing capacity in communities across Australia. The Australian Government is funding the rollout of this capability across the 33 existing platforms and an additional 54 rapid testing machines that can detect COVID -19 in a patient or not in a community setting and within 45 minutes.

These machines can detect COVID-19 from a simple nasopharyngeal swab. There are already 33 machines located in remote Australia previously used to test for other infectious diseases which will be converted to COVID 19 testing. This strategy will greatly enhance the ability to rapidly turn around test results enable contacts to be tested early and ensure swift strategies are put in place to minimise transmission within communities across Australia.

Other initiatives

From this week notifications of COVID-19 identified among Aboriginal and Torres Strait Islander people will be reported weekly and publicly, and more often to the Advisory Group for discussion to enable responses will be enacted when required. This was a request from the Advisory Group to CDNA.

Mathematical modelling has been commissioned to simulate the impact of particular interventions in communities, to ensure we are providing guidance and advice to Governments on the most impactful way forward, especially related to already introduced and future strategies.  

Several groups are banding together (NACCHO the Royal Australian College of GPs) the Lowitja Institute, Australian National University and University of Queensland) to ensure the Aboriginal health sector has access to the most recent evidence to help answer questions for health care workers working in Aboriginal community controlled health services and other primary care. This collaboration is developing a series of rapid evidence reviews to assist in the response.

Infection Control eLearning courses have been developed for workers in the health care sector and made freely available to all with caring responsibilities. Specific resources for Aboriginal Health Workers, Practitioners, and specific settings such as remote communities are being developed. Access the training here

All Aboriginal community controlled health services and other clinics have heightened awareness of coronavirus risk. The Australian Government, working with NACCHO, is providing funding to Aboriginal community controlled health services and local health clinics across 110 communities for preparedness activities.

The Advisory Group continues to monitor the ongoing need for personal protective equipment (PPE) for clinicians working in communities across Australia. Direct input from Advisory Group members ensures Government is aware of and can take action to prioritise supply to areas where it is required.

The Advisory Group meets with the Communicable Diseases Network regularly. Actions from the Advisory Group are taken directly to CDNA, NACCHO and the Department of Health and  Indigenous Australians Agency.

All of these together hopefully will reduce the burden of morbidity and mortality on our population. We have a good flattened curve. We need to maintain this into the longer term to ensure this occurs.

#InThisTogether

Of course all of this would not be possible if it weren’t for the commitment of Advisory Group members, their workplaces, the absolute commitment of our Co-Chairs Dr Dawn Casey and Dr Lucas De Toca, their respective teams and organisations. Many people have worked incredibly hard and will continue to do so until the end of this pandemic.

Putting this all into perspective, nobody in our collective has had to deal with something of this scale in our current lived history. We are all scrambling to plan, to scale up our health services responses, to bullet proof our communities, to think about the possibilities, to have a plan A and a Plan B.

The next steps will be to consider the road to recovery — hopefully coming out of this relatively unscathed but with considerable work to ensure we are protected at least until a vaccine is developed and we can reduce worldwide cases. The road ahead is long, but we are up for the challenge.

Having said that, we are confident we are in a strong place, we have the expertise required around the table. Of course it’s not perfect just yet but we have time on our side even if it is just a little.

You can be assured we have the backs of all of our peoples when we commit to this.    

We are all in this together.

Professor James Ward, a Pitjantjatjara and Narungga man, is the Director of the Poche Centre for Indigenous Health and Professor within the School of Public Health at the University of Queensland. He has a long history working in Aboriginal communities, and has various roles in Aboriginal public health policy for both government and non-government organisations.

In 2007 he was appointed as the Inaugural Program Head of the Aboriginal Program at the Kirby Institute, University of New South Wales. In 2012 he moved to Alice Springs to become Deputy Director of the Baker Institutes’ Aboriginal Health Program, after which he joined the South Australian Health and Medical Research Institute. In 2016 he completed his PhD focused on epidemiology of sexually transmissible infections in Aboriginal communities. His work has influenced policy and practice significantly over the last five years contributing to national guidelines, and policy and practice.

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