Experts warn that lower vaccination rates in some rural and regional areas leave residents vulnerable to COVID-19 outbreaks as travel restrictions ease and lockdown-weary city dwellers head out of town.
A new report from the OzSAGE multidisciplinary group of experts says rural and remote areas should be opened up only as high local vaccination rates are reached, “LGA by LGA”.
Nicole MacKee writes:
Rural and regional Australia should only be open to visits from city dwellers once local government areas (LGAs) reach high levels of COVID-19 vaccination, say experts who warn that these areas are particularly vulnerable to outbreaks that could overwhelm already strained local health care systems.
A new report from OzSAGE states: “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.”
The report calls for higher vaccination targets for rural and regional communities – more than 90 percent of 12-year-old and older population double-dose – before travel of city people to regional Australia is allowed.
They also called for restrictions to be eased “LGA by LGA” to account for the varying vaccination rates across rural and regional Australia, and for the adoption of a “vaccine-plus strategy”.
“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,” the report authors said.
Division and inequity
Speaking at a media conference to launch the report, Associate Professor Craig Underhill, medical oncologist in Albury Wodonga and co-chair of the OzSAGE working group, said the COVID-19 pandemic exploited “division and inequity”.
“We know that health outcomes in regional Australia are worse than affluent suburbs of the cities,” Underhill said.
“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.”
Heterogenous vaccine coverage
Underhill said some larger regional towns and cities had been able to achieve good double-dose vaccine coverage with recent improvements to vaccine supply in these areas.
But, he noted, there was a “heterogenous pattern” of vaccine coverage.
“Generally, the more remote, or the more under-privileged [an area], the lower the vaccination rates,” Underhill said.
“Pleasingly, the NSW Government has restricted the movement out of Sydney until the regions are at 80 percent double dose. But we will see that this Friday night in Victoria – the day on which it is suspected that the state as a whole will get to 80 percent double dose – people in Melbourne will be able to move out into the regional areas and coastal towns that may not have the same coverage as the metropolitan populations.
“These areas have a lower health capacity if there are outbreaks.”
The report authors identified several risk areas for rural and regional health, including:
- 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.
To mitigate some of these risks, the report authors made a series of recommendations to strengthen health systems and improve the resilience of regional communities to COVID outbreaks. Recommendations include:
- Provide adequate surge workforce to regional, rural, and remote health services.
- Provide better centralised co-ordination 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-COVID urgent care so 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, and antibiotics supplies.
Workforce under stress
Anna Davidson, Director of the Port Stephens GP Super Clinic and co-chair of the OzSAGE working group, said rural and regional general practices and health services had 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,” Davidson said.
“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-19 patients.”
Dr David Berger, a GP in remote Australia, added: “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 areas to ‘open up’.”
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